Patients are monitored because they have an unbalance in their body systems.

This can be
caused by a heart attack or stroke, for example, or it may be the result of a surgical operation,
which can drastically disturb these systems. By continual monitoring, the patient problems can
be detected as they occur and remedies taken before these problems get out of hand.

The Elements of Intensive-Care Monitoring

The basic block diagram which shows the elements of patient monitoring system is indicated
below.

Although patient-monitoring systems vary greatly in size and configuration, certain basic
elements are common to nearly all of them. A cardiac-care unit, for example, generally includes
the following components:

 Skin electrodes to pick up the ECG potentials

 Amplification equipment
 A cathode-ray-tube (CRT) display
 Rate meter
 Alarming Systems
 Recording Equipment
  CCTV Camera’s

The purpose of body electrodes is to extract the biopotentials from the body with the help of
help of sensing element and transduction element.

The potential we pick up from the human being is not in a suitable form so it has to be amplified
and processed to a suitable format to see on a display. This can be done with the help of
amplification equipment.
For visual representation of the biopotentials we generally use CRT displays. Some times we
also prefer non fade displays and bouncing ball displays depend on the application (ECG,
EMG, and EEG).

Rate meters are used to obtain the pulse rate, heart beat rate, respiration rate with the help of
Electrocardiograph, Electroencephalograph etc….

Alarming systems plays a major role in ICU’s to monitor and alert the physician or nurse
whenever there is an abnormality found with the patient. These systems may use some sort of
beeping sounds or flash light mechanisms to alert the authorized person.
Recording equipment are used to store the data either on a physical media like strip chart
recorders, cylindrical drum recorder or on a virtual media like CD, DVD’s for future purpose.
To monitor the patient 24/7 in an ICU we use closed circuit TV cameras which are available at
a bearable cost. Usually in every hospital there is central nurses monitoring station which
contains 8 to 10 computers to maintain a continuous coverage of the ICU.
Patient Monitoring Displays
An important feature of any patient-monitoring system is its ability to display the physiological
waveforms being monitored. Clear, faithful reproductions of the ECG, blood pressure, and
other variables enable the medical staff to periodically check a patient's progress and make
vital decisions at times of crisis. Although paper-chart recordings areoften used to provide
a permanent record of the data, the principal display device for patient monitoring is the
cathode-ray tube (CRT).
There are three types of patient monitoring displays used in the bed side of the patient for
parameter observations. They are

a) CRT displays
b) Bouncing ball displays
c) Non fade displays
CRT displays:
Most monitors (computer screens) use cathode ray tubetis (or CRT for short), which are glass
vacuum tubes into which an electron gun emits a flow of electrons guided by an electrical field
towards a screen covered in small phosphorescent elements.
The electron gun is made up of a cathode, a negatively charged metallic electrode, and one or
more anodes (positively charged electrodes). The cathode emits the electrons attracted by the
anode. The anode acts as an accelerator and concentrator for the electrons, forming a flow of
electrons aimed at the screen. A magnetic field guides the electrons from left to right and from
top to bottom. It is created with two electrified X and Y plates (called deflectors) which send
the flow horizontally and vertically, respectively.

Bouncing ball displays:

The bouncing ball displays are similar to the conventional CRT displays but difference is in
terms of sweep rate. The sweep rates of ordinary CRT display vary from 20 to 25 mm/sec.
whereas the sweep rates of bouncing ball display vary from 35 to 40 mm/sec.Due to high sweep
rates they appeared to be continuous but usually not.

Non - fade displays:

Nonfade displays also use the cathode-ray tube, but in an entirely different way. In the Nonfade
method, the electron beam rapidly scans the entire surface of the CRT screen in a television-
like raster pattern, but with the brightness level so low that the background raster is not visible.
The beam is brightened only when a brightening signal is applied to the CRT by a method
called Z-axis modulation. This brightening signal is applied only when the electron beam
passes a location that is to contain a part of the displayed waveform, at which time it produces
a dot on the screen. Each time the entire screen is scanned, each of the traces appears as a series
of dots similar to the ECG pattern shown in Figure.
Equipments required for the patient monitoring

Surgical Equipment:
The equipment like scissors, knives and other equipment required for the surgery or any
operation in an ICU is called Surgical Equipment.

Non-surgical Equipment:

The equipment like Rate meters, ECG, EEG machines and respiratory therapy equipment like
inhalators, aspirators, and emergency equipment like pacemakers and defibrillators are called
as Non-surgical Equipment.

PACEMAKERS

The rhythmic action of the heart is initiated by regularly recurring action potentials
(electrochemical impulses) originating at the natural cardiac pacemaker, located at the
sinoatrial (SA) node.

A natural pacemaker is an organ which maintains heart rhythm to beat at regular intervals.
Failure of this pacemaker in the body leads to uneven rhythm of the heart beat which further
leads to failure of the heart functioning.

(Or)

A device capable of generating artificial pacing impulses and delivering them to the heart is
known as a pacemaker system (commonly called a pacemaker) and consists of a pulse
generator and appropriate electrodes.

Heart block occurs whenever the conduction system fails to transmit the pacing impulses
from the atria to the ventricles properly.

If the speed of the heart rate is increased beyond the natural pace, then that condition is called
as “TACHYCARDIA”. Similarly, if the speed of the heart rate is below the natural pace, the
situation is called as “BRADYCARDIA”. Below diagram shows the difference between the
natural rhythm and deviated rhythm.
Heart block occurs whenever the conduction system fails to transmit the pacing impulses from the
atria to the ventricles properly. In first degree block an excessive impulse delay at the AV junction
occurs that causes the P-R interval to exceed 0.2 second for normal adults.
In Second degree block electrical signal is partially blocked, causing occasional missed beats.
In third degree block electrical signal is completely blocked and the atria and ventricles beat
independently each other.

Types of Pacemakers:

a) Internal pacemakers
b) External pacemakers

Internal pacemakers:

 Pacemakers are available in a variety of forms. Internal pacemakers may be

permanently implanted in patients whose SA nodes have failed to function properly or
who suffer from permanent heart block because of a heart attack.
 An internal pacemaker is defined as one in which the entire system is inside the body.
It can be seen from the figure below.
 Internal pacemaker systems are implanted with the pulse generator placed in a
surgically formed pocket below the right or left clavicle, in the left sub costal area.
 Internal leads connect to electrodes that directly contact the inside of the right ventricle
or the surface of the myocardium.
 The exact location of the pulse generator depends primarily on the type of electrode
used, the nature of the cardiac dysfunction, and the method of pacing that may be
prescribed.
 Since there are no external connections for applying power, the pulse generator must
be completely self-contained, with a power source capable of continuously operating
the unit for a period of years.
 The battery life is up to 5 years and it is usually made up of lithium iodide.
 The persons who are implanted with internal pacemakers should be stay away from
the microwave ovens and devices which emit high electromagnetic field radiation.
External pacemakers:

 An external pacemaker usually consists of an externally worn pulse generator

connected to electrodes located on or within the myocardium. We can see the external
pacemaker from the below figure.

 External pacemakers are used on patients with temporary heart irregularities, such as
those encountered in the coronary patient, including heart blocks.
 They are also used for temporary management of certain arrhythmias that may occur in
patients during cardiac surgery, especially if the surgery involves the valves or septum.
 External pacemakers, which include all types of pulse generators located outside the
body, are normally connected through wires introduced into the right ventricle via a
cardiac catheter, as shown in Figure.
 The pulse generator may be strapped to the lower arm of a patient who is confined to
bed, or worn at the midsection of an ambulatory patient.
Pacing Modes in pacemakers

 Several pacing techniques are possible with both internal and external pacemakers.
They can be classed as either competitive or noncompetitive pacing modes as shown in
Figure.

 The noncompetitive method, which uses pulse generators that are either ventricular
programmed or programmed by the atria, is more popular.
 Ventricular-programmed pacemakers are designed to operate either in a demand (R-
wave-inhibited) or standby (R-wave-triggered) mode, whereas atrial-programmed
pacers are always synchronized with the P wave of the ECG.
 The first (and simplest) pulse generators were fixed-rate or asynchronous (not
synchronized) devices that produced pulses at a fixed rate (set by the physician or nurse)
and were independent of any natural cardiac activity.
 Asynchronous pacing is called competitive pacing because the fixed-rate impulses may
occur along with natural pacing impulses generated by the heart and would therefore
be in competition with them in controlling the heartbeat.
 Fixed-rate pacers are sometimes installed in elderly patients whose SA nodes cannot
provide proper stimuli.
 DEFIBRILLATORS

 The heart is able to perform its important pumping function only through precisely
synchronized action of the heart muscle fibers. The rapid spread of action potentials
over the surface of the atria causes these two chambers of the heart to contract together
and pump blood through the two ventricles. After a critical time delay, the powerful
ventricular muscles are synchronously activated to pump blood through the pulmonary
and systemic circulatory systems. A condition in which this necessary synchronism
is lost is known as fibrillation.
 During fibrillation the normal rhythmic contractions of either the atria or the ventricles
are replaced by rapid irregular twitching of the muscular wall. Fibrillationof atrial
muscles is called atrial fibrillation; fibrillation of the ventricles is known as ventricular
fibrillation.
 Ventricular fibrillation is far more dangerous, for under this condition the ventricles are
unable to pump blood; and if the fibrillation is not corrected, death will usually occur
within a few minutes.
 Unfortunately, fibrillation, once begun, is not self-correcting. Hence, a patient
susceptible to ventricular fibrillation must be watched continuously so that the medical
staff can respond immediately if an emergency occurs.
 Although mechanical methods (heart massage) for defibrillating patients have been
tried over the years, the most successful method of defibrillation is the application of
an electric shock to the area of the heart.
 If sufficient current to stimulate all musculature of the heart simultaneously is applied
for a brief period and then released, all the heart muscle fibers enter their refractory
periods together, after which normal heart action may resume.
 This application of an electrical shock to resynchronize the heart is sometimes called
counter shock. If the patient does not respond, the burst is repeated until defibrillation
occurs. This method of counter shock was known as ac defibrillation.
 There are a number of disadvantages in using ac defibrillation, however. Successive
attempts to correct ventricular fibrillation are often required. Moreover, ac defibrillation
cannot be successfully used to correct atrial defibrillation.
 In fact, attempts to correct atrial fibrillation by this method often result in the more
serious ventricular fibrillation. Thus, ac defibrillation is no longer used.
DC Defibrillator

A new method of dc defibrillation that has found common use today. In this method, a capacitor
is charged to a high dc voltage and then rapidly discharged through electrodesacross the chest
of the patient. A dc defibrillator is shown in Figure with a typical dc defibrillator circuit shown
in Figure.

It was found that dc defibrillation is not only more successful than the ac method in correcting
ventricular fibrillation, but it can also be used successfully for correcting atrial fibrillation and
other types of arrhythmias.

Depending on the defibrillator energy setting, the amount of electrical energy discharged by
the capacitor may range between 100 and 400 W-sec, or joules.

The duration of the effective portion of the discharge is approximately 5 msec. The energy
delivered is represented by the typical waveform shown in Figure as a time plot of the current
forced to flow through the thoracic cavity.
The area under the curve is proportional to the energy delivered. It can be seen that the peak
value of current is nearly 20 A and that the wave is essentially monophasic, since most of its
excursion is above the baseline.

An inductor in the defibrillator is used to shape the wave in order to eliminate a sharp,
undesirable current spike that would otherwise occur at the beginning of the discharge.

Even with dc defibrillation, there is danger of damage to the myocardium and the chest walls
because peak voltages as high as 6000 V may be used.

To reduce this risk, some defibrillators produce dual-peak waveforms of longer duration
(approximately 10 msec) at a much lower voltage. When this type of waveform is used,
effective defibrillation can be achieved with lower levels of delivered energy (between 50
and 200 W-sec). A typical dual-peak waveform is shown in Figure.
To protect the person applying the electrodes from accidental electric shock, special insulated
handles are provided. A thumb switch, located in one (or both) of the handles, is generally used
to discharge the defibrillator when the paddles are properly positioned.

The two defibrillator electrodes applied to the thoracic walls are called either anterior-anterior
or anterior-posterior paddles.

With anterior-anterior paddles, both paddles are applied to the chest. Anterior-posterior paddles
are applied to both the patient's chest wall and back so that the energy is delivered through the
heart. This method of paddle application offers better control over arrhythmias that occur as a
result of atrial activity.
ISOLATED POWER DISTRIBUTION SYSTEM
The ground return resistance of a normal power distribution system is very low. If this
resistance could be made large by operating the substation transformer without grounding its
center tap, all electrical accidents involving ground contact of the victim could be avoided. But
it is not possible to operate general purpose electrical distribution systems in this way.
In an isolated distribution system, the power is not supplied from the transformer substation
directly, but is obtained from a separate isolation transformer for each operating room. This
transformer together with the associated circuit breaker prevent shock hazards.

If a short between the case and one of the two wires occurs in a piece of equipment powered
from an isolated system, the result will be quite different from that of the grounded system.
Even if the case of the equipment is not grounded properly, someone touching the equipment
and grounded object simultaneously will not receive a shock. A small current (1 or 2Ma) can
flow through the body of such person because of the capacity between conductors of the system
and ground.
Isolated power systems employ line isolation monitors (LIM). This device alternatively checks
the two wires of distribution system for isolation from ground. The degree of isolation
expressed as risk current or fault hazard current is indicated in electric meter. In addition to
meter two warning lamps are provided. EX. Green lamp labelled as SAFE. If a short occurs
between one of the wires and ground anywhere in the system red lamp will light up. At the
same time acoustic alarm will begin to sound. The line isolation monitor also has a button that
allows it to be tested for proper functioning. Pressing this button simulates a short.
In addition to the Isolated distribution system a special high quality grounding system is also
required for all anesthetizing locations. This system not only protects the patient and staff by
shunting all leakage currents to the ground but is also for proper functioning of the line isolation
monitor. The special grounding system is called equipotential grounding system.
Radio Frequency Applications in Therapeutic Use
Radio Frequency (RF) technology has become an essential tool in modern therapeutic
applications due to its ability to generate heat and electromagnetic fields that can interact with
biological tissues. These properties make RF suitable for a range of medical treatments,
primarily for its precision in targeting specific tissues without affecting surrounding areas. Here
are the key therapeutic applications of RF:
1. RF Ablation (RFA)
RF ablation is a widely used technique that applies RF energy to destroy abnormal tissues,
typically in the treatment of tumors, cardiac arrhythmias, and chronic pain.
• Tumor Ablation: RF energy is used to heat and destroy cancerous tumors, particularly
in the liver, lungs, kidneys, and bones. The precision of the RF waves allows targeted
destruction of the tumor while minimizing damage to nearby healthy tissue.
• Cardiac Ablation: RF ablation is used to treat irregular heartbeats, such as atrial
fibrillation. The RF energy destroys small areas of heart tissue that are causing
abnormal electrical signals, helping to restore a normal heart rhythm.
• Pain Management: RF ablation is also employed in pain management, particularly for
patients with chronic back or joint pain. By targeting nerves transmitting pain signals,
RF can reduce or eliminate pain without invasive surgery.
2. RF Therapy for Hyperthermia
RF energy is used in hyperthermia therapy to heat tissues and increase blood flow, which can
help in various therapeutic applications.
• Cancer Treatment: RF-induced hyperthermia is used in conjunction with
chemotherapy or radiotherapy to enhance the effectiveness of cancer treatments. The
heat generated by RF energy makes cancer cells more susceptible to damage by other
treatments.
• Physical Therapy and Rehabilitation: RF therapy is used to reduce inflammation,
improve circulation, and accelerate the healing of soft tissues in patients recovering
from injuries or surgeries.
3. Cosmetic and Dermatological Applications
RF technology is frequently used in non-invasive cosmetic treatments due to its ability to heat
the deeper layers of the skin, stimulating collagen production and tightening skin.
• Skin Tightening: RF devices are used to reduce sagging skin and wrinkles by
stimulating collagen remodelling. This application is common in facial rejuvenation
treatments and body contouring.
• Cellulite Reduction: RF therapy is also employed in the reduction of cellulite, as the
heat can break down fat cells and tighten the skin.
• Acne Treatment: In some cases, RF technology is used to treat acne by targeting and
shrinking sebaceous glands, reducing oil production and preventing breakouts.
4. RF for Chronic Pain and Neuromodulation
RF therapy is increasingly used for neuromodulation, where RF energy is applied to modify
nerve function and treat various types of chronic pain.
• Nerve Blocks: RF energy can be used to create nerve blocks, temporarily or
permanently disabling nerves transmitting chronic pain signals, such as in cases of
trigeminal neuralgia or chronic migraines.
• Spinal Cord Stimulation: RF energy can be delivered to spinal nerves to alter pain
signal transmission and provide relief for patients with neuropathic pain or failed back
surgery syndrome.
5. RF in Wound Healing
RF therapy has shown promising results in improving wound healing by increasing blood flow
and stimulating tissue repair.
• Diabetic Ulcers: RF treatment has been used to enhance the healing process of diabetic
foot ulcers by promoting angiogenesis and reducing inflammation.
• Post-Surgical Wounds: In post-operative care, RF therapy may be applied to reduce
the risk of infection and promote faster tissue regeneration.
6. RF for Varicose Vein Treatment (Endo venous RF Ablation)
Endo venous RF ablation is a minimally invasive procedure used to treat varicose veins. RF
energy is applied inside the affected vein, causing the vein walls to collapse and close off,
rerouting blood flow to healthier veins.
7. RF-Assisted Liposuction
RF energy is employed during liposuction procedures to liquefy fat cells before removal,
making the procedure less invasive and improving post-surgical skin tightening and
contouring.
Advantages of RF in Therapeutic Applications:
• Minimally Invasive: RF treatments are often less invasive than traditional surgical
procedures, leading to faster recovery times and reduced risk of complications.
• Precision: RF technology allows for highly targeted treatments, reducing damage to
surrounding healthy tissues.
• Versatility: RF can be used for a wide range of applications, from treating cancer and
pain to cosmetic enhancements and wound healing.
• Non-Surgical Alternatives: RF offers non-surgical alternatives to many common
medical and cosmetic treatments, appealing to patients seeking less invasive options.