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THERAPEUTIC AND
PROSTHETIC DEVICES
13.1 CARDIAC PACEMAKERS AND OTHER ELECTRIC STIMULATORS
13.2 DEFIBRILLATORS AND CARDIOVERTERS
13.3 MECHANICAL CARDIOVASCULAR ORTHOTIC AND PROSTHETIC DEVICES
13.4 HEMODIALYSIS
13.5 LITHOTRIPSY
13.6 VENTILATORS
13.7 INFANT INCUBATORS
13.8 DRUG DELIVERY DEVICES
13.9 SURGICAL INTRUMENTS
13.10 THERAPEUTIC APPLICATIONS OF THE LASER
Previous chapters
diagnostic instruments
This chapter
Targets of stimulation:
Epicardium
Myocardium
Endocardium
What to cure:
Pathalogical condition: heart block
Constant current
Constant voltage
Intramyocardial electrode
Package design:
(1) Compatible, tolerated by the body
(2) To protect the circuit
(3)Comfortability
Stainless steel,
Carbon,
titanium,
Alloys (Elgiloy, MP35N)
Figure 13.2
To place a pacemaker, a lead wire is inserted into the cephalic vein of the
shoulder and fed into the heart chambers (B). An electrode is implanted in the
heart muscle of the lower chamber, and the device is attached (C).
www.surgeryencyclopedia.com/La-Pa/Pacemakers.html
Synchronous pacemakers
SA node
(spontaneous)
Artificial pacemaker
ECG
Timing
(counter)
Out
Reset
Figure 13.3 A demand-type synchronous pacemaker Electrodes serve as a means of both
applying the stimulus pulse and detecting the electric signal from spontaneously occurring
ventricular contractions that are used to inhibit the pacemaker's timing circuit.
V 1g
V 1g
V1
V2
V3
V4
OUT
ECG
Figure 13.4 An atrial-synchronous cardiac pacemaker, which detects electric signals corresponding to the
contraction of the atria and uses appropriate delays to activate a stimulus pulse to the ventricles. Figure 13.5
shows the waveforms corresponding to the voltages noted.
Rate-responsive pacemaker
Physioogical variable
Sensor
Thermister
ECG electrodes
ECG electrodes
Electrochemical pH electrode
Semiconductor strain-gage pressure sensor
Optical oximeter
Electric-impedance plethysmography (intracardiac)
Electric-impedance plethysmography (thoracic)
Accelerometer
Figure 13.5
Figure 13.6
Example 13.1
Bladder
Detrusor (:).
Mucosal
Orifice
Prostatic
Seminal vesicle ;
Sphincter
Trigone
Ureter
Urethra
Urinary incontenence
Unable to pass the urine (empty the bladder)
Source: http://sci.rutgers.edu/forum/showthread.php?t=130246
(ages female)
(aged male)
Bladder stimulator
Cardiac fibrilation:
Individual myocardial cells contract asynchronously with only very local
patterns.
Cardiac output 0
What to use?
Defibrillators
http://www.britsattheirbest.com/ingenious/ii
_20th_century_1950_1970.htm
(cont.)
http://www.sciencemuseum.org.uk/images/I050/10319037.aspx?key
words=pack
Japanese
English
Simp. Chinese
Korean
2010.06.24
Hase-dera Temple, Kamakura City, Kanagawa, Japan
(cont.)
Capacitive-discharge dc dfibrillator
Figure 13.9 (a) Basic circuit diagram for a capacitivedischarge type of cardiac defibrillator. (b) A typical waveform of the
discharge pulse. The actual waveshape is strongly dependent on the values of L, C, and the torso resistance RL.
(cont.)
Primary
100 V
10 A
1000 W
10
turns
200
turns
Secondary
2000 V
0.5 A
1000 W
13.2
Defibrillation is a process in which an electronic device, called an
automated external defibrillator (AED), helps reestablish
normal contraction rhythms in a heart that's not beating properly.
It does this by delivering an electric shock to the heart.
All emergency personnel should be trained and allowed to use a
properly maintained defibrillator if their job requires them to
respond to people having cardiac arrest.
This includes all first-responding emergency personnel,
both hospital and non-hospital.
CAPACITIVE-DISCHARGE dc DEFIBRILLATORS
RECTANGULAR-WAVE DEFIBRILLATORS
DEFIBRILLATORS ELECTRODES
CARIOVERTERS
IMPLANTABLE AUTOMATIC DEFIBRILLATORS
QRS complex
R
0.1 mV
PR segment
ST segment
0.04 ms
T
P
U
ST interval
S
PR interval
QT interval
Fig. 13-11
Figure 13.12 A cardioverter The defibrillation pulse in this case must be synchronized
with the R wave of the ECG so that it is applied to a patient shortly after the occurrence
of the R wave.
Implantable
defibrillator
Artificial
pacemaker
Tachyarrhythmia (fibrillation)
Bradyarrhythmia
cardiovascular
orthotics
prosthetic
.
Cardiac-assist devices
To aid the failing heart after acute traumatic insults such as
myocardial infarction or cardiac surgery
embolism
trauma
traumatic
myocardial infarction
Example 13.3
An intra-aortic balloon pump device is being applied to a patient in cardiovascular shock. The patient's blood
pressure is 80/60, and his heart rate is 85 beats per min. The patient's cardiac output has been determined
to be 2.5 liters/min. Once the balloon cardiac-assist device has been started, the patient's systolic blood
pressure at the heart drops to 65 mm Hg; the heart rate and cardiac output remain the same. After several
hours on the balloon, the systolic pressure is back to 80 mm Hg, the heart rate has dropped to 78
beats/min, and the cardiac output has risen to 3.4 liters/min. Estimate the work done by the heart per beat
and per minute before and after the balloon pump was started, as well as several hours later. If the balloon
pumps against an average diastolic pressure of 60 mm Hg, how much work is it doing?
-1- (Before a balloon is used)
BP = 80/60 mmHg, HR = 85 bpm, CO = 2.5 L/min
-2- (Once the balloon cardiac-assist device has been started)
BP = 65/-- mmHg, HR = 85 bpm, CO = 2.5 L/min
-3- (After several hours on the balloon)
BP = 80/-- mmHg, HR = 78 bpm, CO = 3.4 L/min
Q: The work done by the heart = ? in -1-, -2-, and -3-.
Q: The work done by the balloon to pump against 60 mmHg = ?
Pump Oxygenator
Blood and oxygen are in direct
contact. This can denature some
of the protein components of the
blood, which can lead to formation
of clots and emboli.
1.
2.
pump-oxygenator:
,(,).
Figure 13.13 Connection of a pump oxygenator to bypass the heart
A disk-type oxygenator is used with a roller pump. Venous blood is taken
from a cannula in the right atrium, and oxygenated blood is returned
through a cannula in the femoral artery.
cannula
venous
femoral
AbioCor
Jaarvic 7
13.4 Hemodialysis ()
renal
peritoneal
dialysis
13.4 Hemodialysis ()
Dialysate = water + various solutions
Types of exchangers:
(1) The coil-dialyzer
(2) The parallel-plate dialyzer
(3) The hollow-fiber kidney
10,000-15,000 parallel hollow fibers with 0.2-mm in diameter
and 150 mm in length
dialysate
Example 13.4
The electric conductivity (S/cm) of an electrolytic solution such as a dialysate can be
approximated by
N i qi i
(E13 .19 )
http://www.allproducts.com/manufacture97/sunglowltd/product5.html
infant incubator
Technical specification:
Power supply : AC220V50HZ
Power input: 600VA
Air Temperature control range25~37
Skin Temperature control range34~37
Sensor precision: 0.3
Changing of temperature: 0.5
Uniformity of temperature: 0.8
Temperature rising time: 30min
Noise level: 55dBA
Inclination of bassinet: 0~5
Alarming:
audible and visible alarm indication, and it can indicate the real temperature and cut off the power supply of heater
(except for the low deviation alarm), meanwhile, the skin temperature indication window can indicate the alarm code. For
the alarm 1-6, the relevant light is on, and for the alarm 7, all alarming lights are on; all alarm sound can be cancelled
except for the power failure alarm and the system alarm.
Over-temp alarm: when the air temperature control 38, skin temperature control40
Upper Deviation alarm: air temperature control +3.0, skin temperature control +1.0
Lower Deviation alarm: air temperature control -3.0, skin temperature control -1.0
Sensor alarm: when the sensor is disconnected, open circuit, short circuit or put on the wrong place;
Fan alarm: when the fan is blocked, speed 1000rpm or stop working;
Power failure alarm: when there is no power or the power cord is disconnected.
System alarm: when there is E2ROM malfunction inside of temperature controller.
Package
Gross Weight66Kg
Net Weight 55Kg
Measurement1085mm640mm915mm
Notice
Some technical data of this model can be changed properly in standard permission range according to the standard and
users requirement like infant scale, tray. If the technical specification of above product changes, please refer to the
standard at selling time.
http://www.allproducts.com/manufacture97/sunglowltd/product5.html
http://www.freepatentsonline.com/6679830.html
Figure 13.16 Block diagram of a proportional temperature controller used to maintain the
temperature of air inside an infant incubator.
Thermistor
Bridge
Power
line
Amplifier
Comparator
Set-point
resistor
1-Hz
sawtooth
generator
Gate
4
pulse
generator
Siliconcontrolled
switch
5
Heater
Electrosurgical unit
http://www.ihe-online.com/products/surgicalor/electrosurgery-accessories/hospitalequipment/electrosurgical-units1/index.html?tx_ttproducts_pi1%5BbackPID%5D=
1334&cHash=2e28600aef
http://yesng.english.eyp.com.tw/eyp/front/bin/
ptdetail.phtml?Category=4206&Part=Access
ories-3
coagulate
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