MODULE 3

ELECTROENCEPHALOGRAM
•The recorded representation of bioelectric potential by the neuronal
activity of the brain is called the electroencephalogram.
•The first recordings were made by Hans Berger, a German psychiatrist in
1924
•EEG measures voltage fluctuations resulting from ionic current within
the neurons of the brain. In clinical contexts, EEG refers to the recording
of the brain's spontaneous electrical activity over a period of time, as
recorded from multiple electrodes placed on the scalp.
•EEG is most often used to diagnose epilepsy, sleep disorders, depth of
anesthesia, coma, encephalopathies, and brain death.
•EEG potentials measured at the surface of the scalp, actually represent
the combined effect of potentials from a fairly wide region of the
cerebral cortex and from various points beneath.

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 ELECTROENCEPHALOGRAM
Principle:
•Brain’s electrical charge is maintained by billions of neurons.
•Neurons pass signals via action potential created by ionic exchange
between sodium and potassium ions in and out of the cell volume
conduction.
•When the wave of ions reaches the electrode on the scalp, they can push or
pull electrons on the metal in the electrodes. The difference in push or pull
voltage between any two electrodes can be measured by a voltmeter.
Recording these voltages over a time gives us the EEG.
•The electric potential generated by an individual neuron is far too small to
be picked up by EEG. EEG activity therefore always reflects the summation
of the synchronous activity of thousands or millions of neurons that have
similar spatial orientation. If the cells do not have similar spatial orientation,
their ions do not line up and create waves.

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ELECTROENCEPHALOGRAM

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ELECTROENCEPHALOGRAM

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ELECTROENCEPHALOGRAM
•The pattern of electrodes to be used on the head and the channel
where they are connected is termed to be montage. The montage
selector is used to select the pattern.
•The jack box is a junction box in which the wires of the electrodes are
connected using jack pins.
•The electrode test/calibrate circuit is used to calibrate the electrodes.
•The output from the montage selector is given to the amplifier having
high gain and low noise characteristics. It contains a high pass, low pass
and notch filters. The filters are used select the waveform to be
recorded. It also controls the sensitivity of the writing unit.
•The output from the amplifier is given to an ADC and the writing unit.
•The ADC converts the analog signal into digital for storage and display
purpose. The writing unit gives the output in a paper as graph.

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ELECTROENCEPHALOGRAM
The 10-20 Electrode system:
•The system most often used to place electrodes for monitoring the
clinical EEG is the International Federation 10-20 System. So named
because electrode spacing is based on intervals of 10-20 percent of the
distance between specified points on the scalp. It uses 21 electrodes.
•This system uses certain anatomical landmarks to standardize
placement of EEG electrodes. It has three types of electrode
connections.
• Between each member of a pair (bipolar)
• Between one unipolar lead and a distant reference electrode
(usually attached one or both ear lobes)
• Between one unipolar lead and the average of all

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 ELECTROENCEPHALOGRAM

Position of electrode:
Fp – frontal polar
F – Frontal
C- Central
P- Parietal
T – temporal
O- occipital
Pg- Naso Pharyngeal
A- ear Lobe

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ELECTROENCEPHALOGRAM
Waveforms of brain:
•Brain patterns form wave shapes that are commonly sinusoidal
•Measured from peak to peak and normally range from 0.5 to 200 μV in
amplitude
•Brain waves have been categorized into five basic groups:
Alpha (8-13 hz)
Beta (14-30 hz)
Gamma (>30 Hz)
theta (4-8 hz)
Delta (0.5-3.5 Hz)

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ELECTROENCEPHALOGRAM

GAMMA:
Thinking

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ELECTROENCEPHALOGRAM
Alpha:
•Frequency : 8 to 13 hz
•Recorded site: Most intensely in Occipital region.
•Can be recorded in frontal and parietal region of the scalp
•Slower, and higher in amplitude
•Prominent with closed eyes and with relaxation
•Seen in all age groups but are most common in adults.
•Common state for the brain and occurs whenever a person is alert but
not actively processing information.

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ELECTROENCEPHALOGRAM
Beta:
•Freq: Above 13 hz
•Recorded site: Parietal and frontal region of the scalp
•It is the state that most of brain is in when we have our eyes open,
listening and thinking during analytical problem solving, judgment,
decision making, processing information about the world around us.

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ELECTROENCEPHALOGRAM
Gamma:
•Gamma is measured between 36 – 44 (Hz) and is the only frequency
group found in every part of the brain.
•When the brain needs to simultaneously process information from
different areas, its hypothesized that the 40Hz activity consolidates the
required areas for simultaneous processing.
•A good memory is associated with well-regulated and efficient 40Hz
activity, whereas a 40Hz deficiency creates learning disabilities.
•It is the state that most of brain is in thinking (integrated thoughts) and
associated with information-rich task processing

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ELECTROENCEPHALOGRAM
Theta:
•Freq : 4 to 8 hz
•Recorded site : parietal and temporal region in children.
•But they also occur during emotional stress in some adults, particularly
during the period of disappointment and frustration.
•It is seen in connection with creativity, intuition, daydreaming, and
fantasizing and is a repository for memories, emotions, sensations.
•Theta waves are strong during internal focus, meditation, prayer, and
spiritual awareness.
•It reflects the state between wakefulness and sleep. Relates to
subconscious.

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ELECTROENCEPHALOGRAM
Delta:
•Freq: below 3.5 Hz.
•Sometimes these waves occur only once every 2 or 3 s.
•They occur in deep sleep and in serious organic brain disease.
•They occur solely within cortex.
•It is the dominant rhythm in infants up to one year of age and it is
present in stages 3 and 4 of sleep.
•It tends to be the highest in amplitude and the lowest in frequency.
•It reflects the state deep dreamless sleep, dreaming sleep.

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ELECTROENCEPHALOGRAM

Abnormal EEG for various brain disease

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NEURONAL COMMUNICATION
•When neurons are excited, they generate action potentials and are
transmitted in the form of spike discharge patterns.
•It is propagated down the axon to the axiom terminals where it can be
transmitted to other neurons.
•The neurons can be triggered at any point along the dendrites, cell body
or axon. The communication is only one way.
•There are two types of communication across a synapse – excitatory
and inhibitory. When an action potential arrives at axon, it releases a
chemical called acetylcholine which excites the adjacent membrane of
the receiving neuron.
•Potentials of the receiving neurons are graded when it reaches a certain
threshold.

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NEURONAL COMMUNICATION
•An excitory grade potential is known as excitatory post synaptic
potential (EPSP) and an inhibitory graded potential is known as
inhibitory post synaptic potential (IPSP).
•Inhibitory axon causes a graded potential in the receiving neuron which
is more negative than the normal resting potential. So it requires
greater amount of excitation.

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EEG MEASUREMENT
•The measurement of the electrical activity of the nervous system is
through the effects of nervous system on other systems of the body.
•The individual neurons can be stimulated electrically. Care must be
taken to ensure that neurons are stimulated similar to natural
stimulation.
•Single neuron’s action potential can be seen either extracellularly using
a microelectrode located just outside the cell membrane or
intracellularly by penetrating the microelectrode in the cell.
•Evoked potentials are the potentials developed in the brain as the
responses to external stimuli like sound , light etc.
•The external stimuli are detected by the sense organs which cause
changes in the electrical activity of the brain. This is also called as Event
Related Potential (ERP).

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EEG MEASUREMENT
•Evoked Potential (EP) tests are used to check the condition of the nerve
pathways. They measure the brain's electrical response to the signals
sent by the nerves.
• EP tests help diagnose nervous system abnormalities, hearing loss, and
assess neurological functions.
Major Types of Evoked Potentials:
•Brainstem Auditory Evoked Potential - Checks the pathway from the ear
to the brain. The BAEP test may help uncover the cause of hearing and
balance problems, and other symptoms.
•Visual Evoked Potential - Checks the pathway from the eyes to the
brain. May help find the cause of certain vision problems and other
conditions.

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EEG MEASUREMENT
•Somatosensory Evoked Potential - Checks the pathway from the nerves in
the limbs to the brain. It is a way to study the function of the nerves, the
spinal cord and brain.
•If light is flashed in the eye or a small electrical pulse given to the skin over
a nerve in an arm or leg, a characteristic the evoked potential can be
recorded from the brain using electrodes placed on the scalp.
•There will be a very short delay - measured in fractions of a second
between the delivery of the stimulus and the appearance of the electrical
response in the brain.
•This delay corresponds to the time that it takes for the signal to pass from
the eye or skin to the brain, along the nerve pathways.
• If there is more delay in the appearance of the evoked potential in the
brain, this may mean that something is wrong somewhere in the nerve
pathways.

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MUSCLE RESPONSE
•Muscle is a bundle of fibrous tissue in a human or animal body that has
the ability to contract, producing movement or maintaining the position
of parts of the body.
•Characteristics of muscle:
excitability - responds to stimuli
contractility - able to shorten in length
extensibility - stretches when pulled
elasticity - tends to return to original shape & length after
contraction or extension

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MUSCLE RESPONSE
•Functions of muscle:
motion
maintenance of posture
heat production
•Types of muscle:
skeletal (attached to bones & moves skeleton)
smooth (muscle of the viscera)
cardiac (muscle of the heart)

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MUSCLE RESPONSE
•Skeletal muscles are usually attached to bone by tendons composed of
connective tissue.
•Skeletal muscles vary considerably in size, shape, and arrangement of
fibers. They range from extremely tiny strands such as the stapedium
muscle of the middle ear to large masses such as the muscles of the
thigh.
•Skeletal muscles may be made up of hundreds, or even thousands, of
muscle fibers bundled together and wrapped in a connective tissue
covering.
•Before a skeletal muscle fiber can contract, it has to receive an impulse.
•The cell membrane of a muscle cell is called the sarcolemma, and this
membrane, like that of neurons, maintains a membrane potential.

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MUSCLE RESPONSE
•So, impulses travel along muscle cell membranes just as they do along
nerve cell membranes. However, the 'function' of impulses in muscle
cells is to bring about contraction.
•The sarcoplasm is the specialized cytoplasm of a muscle cell that
contains the usual subcellular elements along with the Golgi apparatus,
abundant myofibrils, a modified endoplasmic reticulum known as the
sarcoplasmic reticulum (SR), myoglobin and mitochondria.
•Transverse (T)-tubules invaginate the sarcolemma, allowing impulses to
penetrate the cell and activate the SR. The SR forms a network around
the myofibrils, storing and providing the Ca2+ that is required for muscle
contraction.

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MUSCLE RESPONSE
•A muscle fiber is excited via a motor nerve that generates an action
potential that spreads along the surface membrane (sarcolemma) and
the transverse tubular system into the deeper parts of the muscle fiber.
•A receptor protein senses the membrane depolarization, alters its
conformation, and activates the ryanodine receptor (RyR) that releases
Ca2+ from the SR. Ca2+ then bind to troponin and activates the
contraction process.
•Skeletal muscle relaxes when the nervous impulse stops. So, calcium no
longer diffuses out. The CALCIUM PUMP in the membrane will now
transport the calcium back into the SR.

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MUSCLE RESPONSE
•A muscle twitch is the response of a muscle to a single, brief threshold
stimulus
•The three phases of a muscle twitch are:
• Latent period – first few milliseconds after stimulation when excitation-
contraction coupling is taking place
• Period of contraction – cross bridges actively form and the muscle shortens
• Period of relaxation – Ca2+ is reabsorbed into the SR, and muscle tension
goes to zero
•Muscle responses are graded by:
• Changing the frequency of stimulation
• Changing the strength of the stimulus

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MUSCLE RESPONSE
Muscle response grade due to changing the frequency of stimulation:
•A single stimulus results in a single contractile response – a muscle
twitch
•Frequently delivered stimuli (muscle does not have time to completely
relax) increases contractile force – wave summation
•More rapidly delivered stimuli result in incomplete tetanus
•If stimuli are given quickly enough, complete tetanus results

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MUSCLE RESPONSE
Muscle response grade due to changing the strength of the stimulus:
•Threshold stimulus – the stimulus strength at which the first observable
muscle contraction occurs. Beyond threshold, muscle contracts more
vigorously as stimulus strength is increased.
•Force of contraction is precisely controlled by multiple motor unit
summation. This phenomenon, called recruitment, brings more and
more muscle fibers into play.
•Staircase – increased contraction in response to multiple stimuli of the
same strength. Contractions increase because:
• There is increasing availability of Ca2+ in the sarcoplasm
• Muscle enzyme systems become more efficient because heat is increased
as muscle contracts.

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ELECTROMYOGRAM
•Electromyography (EMG) is an electrodiagnostic technique for
evaluating and recording the electrical activity produced by skeletal
muscles.
•EMG is performed using an instrument called an electromyograph to
produce a record called an electromyogram
•An electromyograph detects the electric potential generated by muscle
cells when these cells when these cells contract and relax.
•Measured EMG potentials range between 50 μV and up to 30 mV,
depending on the muscle under observation.
•EMG is used as a diagnostics tool for identifying neuromuscular
diseases. An electromyogram (EMG) measures the electrical activity of
muscles at rest and during contraction.

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ELECTROMYOGRAM

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ELECTROMYOGRAM
•The signals captures by the electrodes are given to the amplifier device
which contains a preamplifier, RC filter and a differential amplifier.
•The signal gets amplified and then given to the ADC to convert the
signal to digital form.
•It is then processed by the signal processing unit as per the required
mode of displaying the output.

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NERVE CONDUCTION
VELOCITY MEASUREMENT
•In nerve fibers, the action potential moves down the fiber with a
propagation rate called nerve conduction rate or nerve conduction
velocity.
•It varies widely depending on the type and diameter of the nerve fiber.
The usual velocity ranges from 20 to 140 metres per second.
•Nerve conduction velocity measurement are performed as follows:
• Two electrodes are attached to the subject's skin over the nerve being tested.
• Electrical impulses are sent through one electrode to stimulate the nerve.
• The second electrode records the impulse sent through the nerve as a result of
stimulation.
• The time difference between stimulation from the first electrode and pick-up by the
downstream electrode is known as the latency. Nerve conduction latencies are
typically on the order of milliseconds.
• The speed is then calculated by measuring the distance between electrodes and the
time it takes for electrical impulses to travel between electrodes.

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ELECTROMYOGRAM
MEASUREMENT
•A needle electrode that is attached by wires to a recording machine is
inserted into a muscle.
•When the electrodes are in place, the electrical activity in that muscle is
recorded while the muscle is at rest. Then the muscle is tightened
slowly and steadily. This electrical activity is recorded.
•The electrode may be moved a number of times to record the activity in
different areas of the muscle or in different muscles.
•The electrical activity in the muscle is shown as wavy and spiky lines on
a video monitor and may also be heard on a loudspeaker as machine
gun-like popping sounds when you contract the muscle. The activity
may also be recorded on video.

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ELECTROMYOGRAM
MEASUREMENT

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RESPIRATORY PARAMETERS
•The exchange of gases in the living being is termed as respiration. It is
the entire process of taking in oxygen from the environment,
transporting the oxygen to the cells, removing the carbon dioxide from
the cells and exhausting this waste product into the atmosphere.
•The important parameters to be considered for respiratory
measurement are:
• Ventilation rate
• Tidal volume
• Minute ventilation
• Peak inflation pressure
• Peak inspiratory flow rate
• Peak expiratory flow rate
• End tidal CO2

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RESPIRATORY PARAMETERS
• Inspiratory reserve volume
• Expiratory reserve volume
• Residual volume
• Vital capacity
• Total lung capacity
• Inspiratory capacity
• Functional residual capacity
• Forced vital capacity

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RESPIRATORY PARAMETERS
Ventilation rate:
Ventilation rate is the amount of air inhaled in a specified time period
(e.g., per minute, per hour, per day, etc.); also called breathing rate and
inhalation rate.
Tidal volume:
Tidal volume (symbol VT or TV) is the lung volume representing the
normal volume of air displaced between normal inhalation and
exhalation when extra effort is not applied.
Minute ventilation:
Minute ventilation (or respiratory minute volume or minute volume) is
the volume of gas inhaled (inhaled minute volume) or exhaled (exhaled
minute volume) from a person's lungs per minute.

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RESPIRATORY PARAMETERS
Peak inflation pressure:
Peak inflation pressure or peak inspiratory pressure (PIP) is the highest level
of pressure applied to the lungs during inhalation.
Peak inspiratory flow rate:
Peak inspiratory flow (PIF), also called Peak Inspiratory Flow Rate (PIFR) is
defined by the fastest flow rate noted during the inspiratory cycle.
Peak expiratory flow rate:
The peak expiratory flow (PEF), also called peak expiratory flow rate (PEFR)
is defined by the fastest flow rate noted during the expiratory cycle.
End tidal CO2:
End-tidal CO2 (ETCO2) is the partial pressure of CO2 detected at the end of
exhalation.

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RESPIRATORY PARAMETERS
Inspiratory reserve volume:
It is the extra volume of gas that a person can inspire with maximal effort
after reaching the normal end inspiratory level.
Expiratory reserve volume:
It is the extra volume of gas that a person can expire with maximal effort
beyond the end expiratory level.
Residual volume:
It is the volume of gas remaining in the lungs at the end of maximal
expiration.
Vital capacity:
It is the maximum volume of gas that can be expelled from the lungs by
forceful effort after a maximal inspiration.

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RESPIRATORY PARAMETERS
Total lung capacity:
It is the amount of gas contained in the lungs at the end of a maximal
inspiration.
Inspiratory capacity:
It is the maximum amount of gas that can be inspired after reaching the end
expiratory level.
Functional residual capacity:
It is the volume of gas remaining in the lungs at the end of expiratory level.
Forced vital capacity:
It is the total amount of air that can forcibly be expired as quickly as
possible after taking the deepest possible breath.

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SPIRO METER
•A spirometer is an apparatus for measuring the volume of air inspired
and expired by the lungs.
•The spirogram will identify two different types of abnormal ventilation
patterns - obstructive and restrictive.
•All lung volumes and capacities that can be obtained by measuring the
amount of gas inspired or expired under a given set of conditions can be
obtained.
•The only volume and capacity measurement that cannot be obtained
with spirometer are those requiring measurement of gas that cannot be
expelled from the lungs under any condition.

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SPIRO METER

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SPIRO METER
•Spirometer contains a movable bell inverted over a chamber of water.
Inside the bell, above the water line, is the gas that is to be breathed.
•The bell is counter balanced by a weight to maintain the gas inside at
atmospheric pressure so that its height above the water is proportional
to the amount of gas in the bell.
•A breathing tube connects the mouth of the patient with the gas under
the bell. In this condition the nose of the patient is blocked.
•As the patient breathes into the tube, the bell moves up and down with
each inspiration and expiration in proportion to the amount of air
breathed in or out.
•A pen attached to the balancing weight mechanism writes on the paper
attached to the drum recorder called kymograph.

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SPIRO METER
•As the kymograph rotates, the pen traces the breathing pattern of the
patient. A rotational displacement sensor is attached to the drum
mechanism.
•The output of the rotational displacement sensor is fed to an
operational amplifier which is connected to an electronic strip chart
recorder.
•Generally respirometry tests are repeated two to three times to get
better results. Although the spirometers are calibrated for direct read
out, the height of the tracing have to be converted to litres by using a
calibration factor called spirometer factor.
•The various types of clinically used spirometer are listed in the next
slide.

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SPIRO METER
Whole body plethysmograph:
This type of spirometer gives a more accurate measurement for the
components of lung volumes as compared to other conventional
spirometers. A person is enclosed in a small space when the
measurement is taken.
Pneumotachometer (Pneumograph):
This spirometer measures the flow rate of gases by detecting pressure
differences across fine mesh. One advantage of this spirometer is that
the subject can breathe fresh air during the experiment.
Incentive spirometer:
This spirometer is specially designed to improve one's lung function.

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SPIRO METER
Fully electronic spirometer:
Electronic spirometers have been developed that compute airflow rates
in a channel without the need for fine meshes or moving parts. They
operate by measuring the speed of the airflow with techniques such as
ultrasonic transducers, or by measuring pressure difference in the
channel. These spirometers have greater accuracy by eliminating the
momentum and resistance errors associated with moving parts such as
windmills or flow valves for flow measurement. They also allow
improved hygiene by allowing fully disposable air flow channels.
Peak flow meter:
This device is useful for measuring how well a person's lungs expel air.

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SPIRO METER
Windmill-type spirometer:
This type of spirometer is used especially for measuring forced vital
capacity without using water; it has broad measurements ranging from
1000 ml to 7000 ml. It is more portable and lighter than traditional
water-tank type spirometers. This spirometer should be held
horizontally while taking measurements because of the presence of a
rotating disc.
Tilt-compensated spirometer:
Tilt-compensated type spirometer also known as the AME Spirometer
EVOLVE. This new spirometer can be held horizontally while taking
measurements. If the patient leans too far forward or backward, the
spirometer's 3D-tilt sensing compensates and indicates the patient
position.

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SPIRO METER

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PNEUMOGRAPH
•A pneumograph, also known as a pneumatograph or spirograph, is a
device for recording airway resistance and force of chest movements
during respiration by measuring the airflow.
•It uses the principle that air flowing through an orifice produces a
pressure difference across the orifice that is a function of the velocity of
the air.
•The orifice consists of a set of capillaries or a metal screen. Two
pressure transducers are used to measure the pressure difference.
•Another method of measuring airflow is by a transducer in which a
heated wire is cooled by the flow of air and the resistance change due
to the cooling is measured as representative of airflow.

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GAS EXCHANGE AND
DISTRIBUTION
•Once air is in the lungs, oxygen and carbon dioxide must be exchanged
between the air and the blood in the lungs and between the blood and the
cells in the body tissues.
•The mixing of gases within the lungs, the ventilation of the alveoli and the
exchange of oxygen and carbon dioxide between the air and blood in the
lungs takes place through a process called diffusion.
•It is the movement of gas molecules from a point of higher pressure to a
point of lower pressure to equalize the pressure difference.
•There are many methods to determine the amount of diffusion. Some of
the methods are:
1. Chemical analysis methods:
•A gas sample is introduced into a reaction chamber using a pipet at the
upper end of the reaction chamber capillary.

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GAS EXCHANGE AND
DISTRIBUTION
•An indicator droplet allows the sample to be balanced against a trapped
volume of air in the thermobarometer.
•Absorbing fluids for CO2 and O2 are transferred in from side arms
without affecting the total volume of the system.
•The volume of the absorbed gases is read from the micrometer barrel
calibration.
2. Diffusing capacity using CO infrared analyser:
•This is used to find the transfer of oxygen from the alveoli into the
pulmonary capillary blood.
•For this measurement, a carbon monoxide analyser or a gas
chromatograph is used.

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GAS EXCHANGE AND
DISTRIBUTION
•It uses an infrared energy source, a beam chopper, sample and
reference cells, a detector and amplifier. A milliammeter or a digital
meter is used for display.
•Two infrared beams are generated, one is directed through the sample
and other through the reference. The CO gas mixture flowing through
the sample cell absorbs more infrared energy than the reference.
•The two infrared beams are measured separately by a differential
infrared detector.
•The output is proportional to the amount of monitored gas in the
sample cell. The signal is amplified and given to the display.

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GAS EXCHANGE AND
DISTRIBUTION
3. Gas chromatograph:
•The quantities of various gases in the expired air is determined by the
gas chromatograph.
•Here the gases are separated when the air passes through a column
containing various substances that interact with the gases.
•The reaction cause different gases to pass at different rates through the
column.
Measurement of gas distribution:
•The distribution of oxygen from the lungs to the tissues and carbon
dioxide from the tissues to the lungs are measured using blood gas
electrodes and pH electrodes. These electrodes along with amplification
and readout systems provide the analysis.

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RESPIRATORY THERAPY
EQUIPEMENT
•When a patient is incapable of adequate natural ventilation process
mechanical assistance should be provided. The equipment which
provide this mechanical assistance are known as respiratory therapy
equipment.
•The instruments for respiratory therapy are:
• Inhalators
• Ventilators
• Humidifiers or Nebulizer

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INHALATORS
•It is a device used to supply oxygen or some other therapeutic gas to a
patient who is able to breathe spontaneously without assistance.
•Inhalators are used when a concentration of oxygen higher than that of
air is required.
•It consists of a source of therapeutic gas, equipment for reducing
pressure and controlling the flow of gas and a device for administering
the gas.
•Devices for administering oxygen to patient include nasal cannulae and
cathers, face masks that covers the nose and mouth.
•By adjusting the flow of gas into the mask, the oxygen concentration
given to the patient is controlled.

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INHALATORS

57
VENTILATORS
•Ventilators or respirators are equipment which is used to improve
ventilation of the lungs and to supply humidity or aerosol medications
to the pulmonary tree.
•Most of the ventilators use positive pressure during inhalation to inflate
the lungs with various gases.
•Generally they are classified as assistor – controllers and can be
operated in three different modes such as assist mode, control mode
and assist-control mode.
•In assist mode inspiration is triggered by the patient. A pressure sensor
responds to the slight negative pressure that occurs each time the
patient attempts to inhale and triggers the apparatus to begin inflating
the lungs.

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VENTILATORS
•In the control mode breathing is controlled by a timer set to provide the
desired respiration rate. In this mode, the respirator has complete
control over the patient’s respiration.
•In the assist-control mode the apparatus is normally triggered by the
patient. However if the patient fails to breathe within a predetermined
time, a timer automatically triggers the device to inflate the lungs.
•In addition to the three modes, many respirators can be triggered
manually by means of a control on the panel.
•Once the inspiration is triggered, inflation of the lungs continues until
one of the following condition occurs:
1. The delivered gas reaches a predetermined pressure in the proximal or
upper airways. A ventilator that operates primarily in this manner is called
as pressure-cycled ventilators.

59
VENTILATORS
2. A predetermined volume of gas has been delivered to the patient. This is
the primary mode of operation of volume-cycled ventilators.
3. The air or oxygen has been applied for a predetermined period of time.
This is the primary mode of operation of time-cycled ventilators.
•The various types of ventilators are categorized under two basic types –
pressure cycled ventilator or positive pressure assistor-controller and
volume-cycled ventilator or volume respirator.
•In pressure cycled ventilator, the device is powered pneumatically from
a source of gas.
•The volume cycled ventilator uses either a piston or bellows to dispense
a precisely controlled volume for each breath.

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VENTILATORS

61
HUMIDIFIERS OR NEBULIZER
•The air or oxygen given to the patient during respiratory therapy should
be humidified to prevent lung damages. Thus all ventilators and
inhalators include an equipment to humidify the air either by heat
vaporization or by bubbling an air stream through a jet of water.
•If the therapy requires some type of medication to be suspended in the
inspired air as aerosol, a device called nebulizer is used.
•In this the water or medication is picked up by a high velocity jet of
oxygen and thrown against one or more baffles to break the substance
into controllable-sized droplets, which are then applied to the patient
via respirator.

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HUMIDIFIERS OR NEBULIZER

63
 ARTIFICIAL HEART VALVES
•An artificial heart valve is a device implanted in the heart of a patient with valvular
heart disease. When one of the four heart valves malfunctions, the medical choice
may be to replace the natural valve with an artificial valve. This requires open-heart
surgery.
•There are three main types of artificial heart valves: mechanical, biological, and
tissue engineered valves.
•Mechanical heart valves (MHV) are prosthetics designed to replicate the function of
the natural valves of the human heart.
•Biological valves are valves of animals, like pigs, which undergo several chemical
procedures in order to make them suitable for implantation in the human heart. The
pig heart is most similar to the human heart, and therefore represents the best
anatomical fit for replacement.
•Rather than replacing a diseased or defective native valve with a mechanical or
animal tissue–derived artificial valve, a tissue-engineered valve would be a living
organ, able to respond to growth and physiological forces in the same way that the
native aortic valve does.

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ARTIFICIAL HEART VALVES

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HEART LUNG MACHINE
•Heart lung machine is a machine that temporarily takes over the
functions of the heart and lungs, especially during heart surgery. It is
also known as Cardiopulmonary bypass (CPB) pump.
•The machine pumps the blood and using an oxygenator, allows red
blood cells to pick up oxygen, as well as allowing carbon dioxide levels
to decrease. This mimics the function of the heart and the lungs
respectively.
•CPB can be used for the induction of total body hypothermia, a state in
which the body can be maintained for up to 45 minutes without blood
flow. Similarly, CPB can be used to rewarm individuals suffering from
hypothermia.

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HEART LUNG MACHINE

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HEMODIALYSIS
•Hemodialysis commonly called kidney dialysis or simply dialysis, is a
process of purifying the blood of a person whose kidneys are not
working normally.
•This type of dialysis achieves the extracorporeal removal of waste
products such as creatinine and urea and free water from the blood
when the kidneys are in a state of kidney failure.
•The principle of hemodialysis involves diffusion of solutes across a
semipermeable membrane. Hemodialysis utilizes counter current flow,
where the dialysate is flowing in the opposite direction to blood flow in
the extracorporeal circuit.
•Counter-current flow maintains the concentration gradient across the
membrane at a maximum and increases the efficiency of the dialysis.

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HEMODIALYSIS
•Fluid removal (ultrafiltration) is achieved by altering the hydrostatic
pressure of the dialysate compartment, causing free water and some
dissolved solutes to move across the membrane along a created
pressure gradient.
•The dialysis solution that is used may be a sterilized solution of mineral
ions. Urea and other waste products, potassium, and phosphate diffuse
into the dialysis solution.
•Sodium bicarbonate is added in a higher concentration than plasma to
correct blood acidity. A small amount of glucose is also commonly used.
•There are three types of hemodialysis: conventional hemodialysis, daily
hemodialysis, and nocturnal hemodialysis.

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HEMODIALYSIS

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LITHOTRIPSY
•Lithotripsy is a treatment, typically using ultrasound shock waves, by
which a kidney stone or other calculus is broken into small particles that
can be passed out by the body.
•Kidney stones occur when minerals and other substances in your urine
crystallize in your kidneys, forming solid masses, or stones. This can lead
to kidney damage.
•Lithotripsy uses sound waves to break up large kidney stones into
smaller pieces. These sound waves are also called high-energy shock
waves. The most common form of lithotripsy is extracorporeal shock
wave lithotripsy (ESWL).
•During ESWL, a special machine called a lithotripter generates the shock
waves. The waves travel into your body and break apart the stones.

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LITHOTRIPSY

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INFANT INCUBATORS
•An incubator is an apparatus used to maintain environmental conditions
suitable for a neonate (newborn baby). It is used in preterm births or for
some ill full-term babies.
•Possible functions of a neonatal incubator are:
• Oxygenation: through oxygen supplementation by head hood or nasal
cannula, or even continuous positive airway pressure (CPAP) or mechanical
ventilation.
• Observation: Modern neonatal intensive care involves sophisticated
measurement of temperature, respiration, cardiac function, oxygenation,
and brain activity.
• Protection from cold temperature, infection, noise, drafts and excess
handling
• Maintaining fluid balance by providing fluid and keeping a high air humidity
to prevent too great a loss from skin and respiratory evaporation

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INFANT INCUBATORS

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