Present vs+cns9701
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Transcript of Present vs+cns9701
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CNS-9701K with QP-974P (64/p) CNS-9701
นาย วส ุวิชาธรรม (B.Sc.,(Medical Instrument))
ต าแหน่ง Respiratory Products Manager
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’78 OEC-3000 ’81 OMP-7000
’82 OEC-5000
’87 BSM-8500
’84 OEC-6000
’70 ICU-2000
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’90 8000 series
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This monitor system (ICU-80) by Nihon Kohden was first used
in the ICU in Japan in 1967.
Tohoku Univ.
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Central Monitor & ECG data Management System
LS-NET (Ethernet LAN)
Laser Printer
Central monitor
Hub
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Easy to See: Large Display
There are no keys or buttons on the bottom.
You can enjoy the full display size.
- Display 12” - max. 14 waveforms -ECG (3/6/10 lead), Resp, SpO2, NIBP, Temp, CO2, IBP, CO, EEG, BIS, Gas, FLOW/Paw - Data storage 24 hr. - Battery 1.5 hr.
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Easy to See: Large Numeric
In a large ICU, you can see numeric values from a distance.
This makes it easier for caregivers to check the patients’ conditions.
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Easy Operation: Less Hard Keys, Touch Screen
Less Hard Keys Touch Screen
You can operate Venus intuitively by touching the spot you want to see in detail. Saves time and allows accurate operation.
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Powerful Review: Time Linked Data
You can easily review patient at the bedside without a central monitor. Up to 24 hours of 5 selected full disclosure waveforms
Saves time for patient care.
Full disclosure
Arrhythmia Recall
Trend Graph
Trend List
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Powerful Review: Short Trend
Short trend enables you to check the trend on the main screen on top of the current waveforms.
You can easily tell whether the value is stable, fluctuating or increasing.
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Network Capability: Interbed ICU 1 ICU 2
Multiple Beds Window Individual Beds Window
You can check other patients’ conditions without going back to the central monitor. You can check them at the nearest bedside.
Improve quality of care.
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Easy Operation: Smart Cable
IBP
CO
CO2
BIS
You don’t need any modules for each parameter.
Flexible monitoring depending on patients’ conditions.
Cables don’t break even you drop it on the floor.
Reduces cost.
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Basic Cardiology Product
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Electrical System of Heart
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Heart Function
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Normal Components of the EKG Waveform
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4. Normal Intervals for the Human, Dog and Cat
• Human- HR- 60-100 bpm
» PR interval- 0.12-0.20 sec
» QRS width max= 0.11 sec
» QT interval= 0.36-0.44 sec
• Dog- HR- 60-220 bpm
» PR interval= 0.06-0.13 sec
» QRS width max= 0.06 sec for large 0.05 sec for small
» QT interval= 0.15-0.25 sec
• Cat- HR = 120-240 bpm
» PR interval= 0.05-0.09 sec
» QRS width max= 0.04 sec
» QT interval= 0.12-0.18 sec
» -Tilley L.P. et al 1995
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IEC : R,L,F AHA : RA,LA,LL
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สาเหตุที่ท าเกิดสัญญาณรบกวนในการวัด ECG
ไมไ่ด้ clean หรือ shave ต ำแหน่งที่ติด electrode
ต ำแหน่งท่ีติด Electrode มีเหง่ือออก Electrode เสื่อมประสิทธิภำพ หรือ แห้งหมดอำย ุตวัรับสญัญำณไมไ่ด้ท ำควำมสะอำด มีออกไซด์ติดขดัขวำงกำรรับสญัญำณ ปลำยสำย ECG connector มีฝุ่ นจบั
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About NIBP Oscillometric Method
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ค่าความดนัโลหิตที่ผดิปกตจิากการวดัในท่าทีไ่ม่เหมาะสม
Problem Result
แขนท่ีวดัอยูต่ ่ำกวำ่ระดบัหวัใจ
BP สูง
แขนท่ีวดัอยูสู่งกวำ่ระดบัหวัใจ BP ต ่ำ
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Blood Pressures ในทำ่ยืน
Rushmer RF (ed): Cardiovascular Dynamics, 3rd Ed. p.196. W.B. Saunders Co., Philadelphia, 1976
ควำมดนัโลหิตท่ีขำจะเพิ่มสงูขึน้ทัง้ควำมดนัในหลอดเลือดแดง และควำมดนัของหลอดเลือดด ำ ทัง้สองอยำ่งจะเพิ่มสงูขึน้ประมำณ 85mmHg.
ถ้ำยกแขนให้สงูเหนือศีรษะขึน้ไป ค่ำของ mean arterial pressure (MAP) ท่ีวดัได้จำกแขนจะลดลงประมำณ 50 mmHg.
Pressure difference ≒ 0.7 mmHg/cm
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ต ำแหน่งท่ีพนั Cuff ใหต้รงกบัหลอดเลือดแดง
ต ำแหน่งที่ต้องวำง Cuff ก่อนพนั
Whether the cuff size and its placement are appropriate can be confirmed in a glance.
About Cuffs
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การพนั cuff pressure ในลกัษณะต่างๆ
A. Cuff ที่เหมาะสม B. ใช้ cuff ขนาดเล็ก
ต้องใช้ pressure สงูในกำรบีบรัดเส้นเลือด
C. พัน cuff หลวม ต้องใช้ pressure สงูเหมือนกำรใช้ cuff ท่ีมี
ขนำดเล็ก
Blue-colored area: transmitted cuff pressure through tissue
Rushmer RF (ed): Cardiovascular Dynamics, 3rd Ed. p.157. W.B. Saunders Co., Philadelphia, 1976
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ความดันโลหิตที่ผดิปกตจิากการพนัและเลอืกขนาด Cuff ที่ไม่เหมาะสม
Cuff Problem Result Cuff ขนำดเลก็ พนั Cuff หลวม
BP สูง ↑
Cuff ขนำดใหญ่ พนั Cuff แน่น
BP ต ่ำ ↓
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วธีิการหาขนาดของ cuff ที่เหมาะสม
W
C: arm circumference W: Width of the bladder
W= 0.4 × C L ≧ 0.8 ×C ( in adults) ≧ 1.0 ×C ( in children)
Dimensions of the bladder
W
L
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วธีิการพนั Cuff ทีถู่กต้อง
1. ประเมินขนำดรอบแขน และเลือกขนำด Cuff ท่ีเหมำะสม
2. พนั Cuff ให้ต ำแหน่งตรงกึ่งกลำงของ bladder อยู่ตรงกบั arterial pulsation
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Proper Placement and Fitting
3. หลงัจำกพนั cuff เรียบร้อยให้ทดสอบวำ่พนัแน่นเกินไปหรือไม่ โดยกำรสอดนิว้ชีเ้ข้ำไปแล้วหมนุวนรอบแขน
4. พนั cuff ให้เหนือจำกข้อพบัประมำณ 2 cm.
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High Blood Pressure Low Blood Pressure
Innovative Technology, PWTT
PWTT Triggered NIBP Measurement
PEP: Pre-ejection period
a-PWTT: Pulse wave transition time in the artery
PWTT: Pulse wave transition time
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SPO2
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OLV-5100 (1975) World’s first ear oximeter developed by NIHON KOHDEN
World’s first ear oximeter
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ASA NEWSLETTER
Dr. Takuo Aoyagi of NIHON KOHDEN is introduced on ASA NEWSLETTER as the originator of the pulse oximeter.
http://www.asahq.org/Newsletters/2002/9_02/feature4c.htm
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ประเมินการแลกเปล่ียนก๊าชที่ปอด
ท าไมต้องวดัค่า Oxygen saturation
ประเมินระบบไหลเวียนของเลือดในร่างกาย
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Lungs
Body
O2
Oxygen delivering
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Hb is a ‘ship’ delivering oxygen in the blood
What is Hemoglobin (Hb) ?
Dissolved O2
O2 joined to Hb
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SaO2 is a boarding rate of ship ‘Hemoglobin’
What is SaO2?
All the ship ‘Hemoglobin’ is filled with oxygen = SaO2 100%
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What is SaO2?
Amounts of Hemoglobin joined to oxygen (O2Hb)
Total amounts of Hemoglobin in the blood SaO2 (%) =
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SaO2 vs SpO2
SpO2 SaO2
Definition Saturation of arterial blood oxygen by pulse oximetry
Saturation of arterial blood oxygen
Measurement Pulse oximeter Arterial Blood Gas Sample (ABG)
Non-invasive, continuous Invasive, peropdocally
… … … … … … SpO2 … … … …
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หลกัการท างานของเคร่ืองวดั Pulse Oximetry
Infra red light 940nm
Red light 660nm
LED
Detector
SpO2 วดัได้จำกกำรใช้คลื่นแสง 2 ชนิด คือแสงที่มีควำมยำวคลื่น 660 nmและ แสงที่มีควำมยำวคลื่น 940 nm
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Pulse Oximetry
Red Infra red
ΔR ΔIR
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ท ำควำมสะอำดเลบ็ ถ้ำทำสีเลบ็ให้ลบสีออกให้หมดก่อน
ควรติด probe กบันิว้มือของแขนข้ำงท่ีไมไ่ด้วดัควำมดนัโลหิต หรือให้สำรละลำยทำงหลอดเลือด
ในพืน้ท่ีท่ีมีแสงสว่ำงจ้ำมำก ควรใช้ผ้ำหรือผ้ำหม่คลมุนิว้ข้ำงท่ีติด probe ด้วย
Attachment
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Reusable probe: 4 hrs Disposable probe: 8 hrs
ควรมีกำรเปลี่ยนต ำแหน่งกำรติด probe
ห้ำมใช้ในห้องตรวจสนำมแมเ่หลก็ (MRI)
การป้องกันให้ไม่มีการท าลายผิวหนัง หรือ Burn
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ควำมดนัโลหิตต ่ำ มีควำมผิดปกติของระบบ Hemodynamic วดัค่ำตรงต ำแหน่งที่เป็นหลอดเลือดด ำ
มีกำรเคล่ือนไหวต ำแหน่งนิว้ท่ีวดั
ผิวหนงั Burn injury/ ผิวด ำมำกๆ
สาเหตุทีท่ าให้การอ่านค่า Oxygen ผดิปกต ิ
มี Carbon monoxide ในเลือดสงู/ hemoglobin ในเลือดมีควำมผิดปกติไมส่ำมำรถจบักบั Oxygen ได้
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Non-Adhesive • For protecting extremely
feeble skin of neonate
• Soft and breathable sponge for attachment tape
• Can always keep clean, just by changing the tape
Probe sensor ทีใ่ช้วดักบัเดก็แรกเกดิ
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ติดให้ตวัก ำเนิดแสงอยูใ่นต ำแหน่งท่ีตรงกบัตวัรับแสง
หลีกเลี่ยงบริเวณท่ีมีแสงสว่ำงจ้ำ หรือใช้ผ้ำหรือผ้ำห่มคลมุต ำแหน่งท่ีวดั
วธีิการตดิ Probe ในเด็กแรกเกดิ
ห้ำมพนั probe แน่นเกินไป
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SpO2 Sensors
Comfortable fit probe Washable probe
Variety of probes from neonate to adult
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ETCO2 The Best Choice for the Respiratory Care
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ETCO2 vs. SpO2
CO2
Detector of
Ventilation
SpO2
Detector of
Oxygenation
SpO2 monitoring, in some cases, can’t detect the critical moment
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Normal Capnogram
Flo
w
Expiration
Inspiration
0 時間
CO2
(mmHg)
40
Expiration phase
Innspiration phase
ETCO2
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Capnography and Capnometry
• Measurement and display of ETCO2 value and capnogram
• Measured by a capnograph
• Measurement and display of ETCO2 value (no waveform)
• Measured by a capnometer
Capnography Capnometry
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Normal Value
ETCO2
PETCO2 (ETCO2) PaCO2
Definition Partial pressure of CO2 at the end of expiration
(End Tidal CO2)
Partial pressure of CO2 in arterial blood
Measurement Capnograph or Capnometer Arterial Blood Gas Sample (ABG)
Normal value 37- 43 mmHg 35- 45 mmHg
… … … … … … PaCO2 … … … …
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Infra-red Spectrography
• CO2 absorbs infrared light of 4.3μm wavelength.
• Expired CO2 passing through the airway is measured using this characteristic of CO2.
Transmission
100%
50%
Wavelength (μm)
3 4 5 4.3μm
Infrared light is absorbed by CO2.
No absorption of infrared light
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Infra-red Spectrography
Basic structure of infrared CO2 sensor
IR Detector Infrared light source
Filter Expired CO2
Absorbs and diminishes infrared light.
Transmits infrared light of 4.3μm.
Detects changes of infrared light transmitting the airway adapter
CO2
Airway adapter Window
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Infra-red Spectrography
Few CO2 Large amount of IR light
CO2
Large output
IR light
Much CO2 Small amount of IR light
CO2
Small output
IR light
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Mainstream and Sidestream
Mainstream Method Sidestream Method
Sensor Sensor
Sampling tube
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For intubated patients
Easy handling
No warm-up time
No calibration requires
TG-101T Semi-quantitative sensor
YG-101T (for adult, pediatric) Disposable airway adapter
TG-900P (Semi-quantitative)
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World’s first mainstream sensor for non-intubated patient
Smallest mainstream sensor in the world.
Reliably detect both oral and nasal breathing.
TG-920P (Semi-quantitative)
Nasal adapter
TG-121T Semi-quantitative sensor
YG-120T (for nasal)
YG-121T (for naso-oral)
YG-122T (for nasal oxygen cannula)
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High Flexibility
Just pulg into a MULTI Connector
TG-900P
TG-950P
TG-920P (cap-
ONE)
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Conventional Sapphire Window
• Uneven reflection and refraction of light cause inaccurate measurement.
• Needs heater to prevent water droplets.
Water droplets
Infrared light
Sapphire window
Sapphire window
Heater
Airway adapter
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• Anti-fogging membrane makes a water layer, then produces an even light transmission
• Accurate and stable measurement without the heater
Water Layer
Infrared light
Smart Anti-Fogging Membrane
Anti-Fogging membrane
Airway adapter
Anti-Fogging membrane
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Advantage of Anti-Fogging Membrane
• Smaller and lighter sensor
- Hardly kinks the circuit
• No warm-up time
- Quickly start the measurement
• Low power consumption
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Unique Airway Structures of TG-950P
Window placed outside the airway
For adult For pediatric
Anti-fogging membrane
placed inside the airway
No water dripping
Deeply indented to reduce dead space
Reduced dead space keeping the flat inside
Water dripping
No water dripping
Co
mp
etit
ors
Water dripping
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Invasive blood pressure
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Cardiac out put
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Cardiac out put
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Hemodymics Formula
• MAP mean Arterial Pressure
• RAP Right Arterial Pressure 0-8 mmhg,3-11 cmh2o
• C.O. Cardiac output 4-8 l/min
• PCWP Pulmonary Capillary Wedge Pressure 6-12 mmhg
• C.I. Cardiac index C.O./BSA 2,5-4 l/m/m2
• Mean= systolic pressure+(diastolicx2)/3
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Central Monitor
CNS-9701K with QP-974P (64/p)
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•Windows XP Pro •Thai /ENG Version. •16 Beds Data Save • 300 Beds Networking • Alarm Control set • NIBP Start and Control • Nurse Note Report • Hard Wire or Wireless LAN • Telemetry system ( Option ) • HL-7 ( Option )
CNS-9701
Main Feature User-friendly
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CNS-9701K
<8 patients with 3 waveforms> <6 patients with 4 waveforms>
More flexible display pattern of All-Bed screen
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CNS-9701K Ver.01-60
<4 patients with 6 waveforms>
More flexible display pattern of All-Bed screen
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CNS-9701K
1) Alarm Icon indication
Via only 1-step
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CNS-9701K
2) Arrhythmia Icon indication
Via only 1-step
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Trend list
72 hour
Large capacity data storage
Trendgraph
72 hour
CNS-9701
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768 arrhythmia episodes per 1 bed
Arrhythmia recall
Stored waveform length: 8 sec
Large capacity data storage
CNS-9701
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6 waveform display (ECG and 5 other waveform for
each patient)
72 hour
Large capacity data storage
CNS-9701
Main Feature
Full disclosure
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Expand compressed
waveform
Large capacity data storage
CNS-9701
Main Feature
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Caliper function
Large capacity data storage
CNS-9701
Main Feature
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64 Save interpreted
waveforms with
analysis report and
average waveform
Filing function for 12 lead ECG analysis
Compare interpreted
waveforms
Large capacity data storage
CNS-9701
Main Feature
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Nihon Kohden Monitoring System
Print Settings
1) ECG 12 lead printing format
<3 rows X 4 columns> <6 rows X 2 columns>
2) Arrhythmia alarm recording settings can be set for every event independent from the bedside monitor
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Thank you