F O R M 2

THE PATENTS ACT, 1970
(39 of 1970)
&
The Patents Rules, 2003
COMPLETE SPECIFICATION
(See section 10; rule 13)

1. Title of the invention: A PATIENT MONITORING APPARATUS WITH GRAPHICAL AND TABULAR TREND REPRESENTATION

2. Applicant(s):

(a) NAME : LARSEN & TOUBRO LIMITED

(b) NATIONALITY : An Indian Company

(c) ADDRESS : L & T House, Ballard Estate, Mumbai 400 001,
State of Maharashtra, India and also having a place of business named as "Medical Equipments & Systems" at Gate No. 5, Mysore Campus, KIADB Industrial Area, Hebbal, Mysore- 570018 Karnataka, India

3. PREAMBLE TO THE DESCRIPTION

The following specification particularly describes the invention and the manner in which it is to be performed:

FIELD OF THE INVENTION

The present invention relates to a patient monitor with graphical and tabular trend representation. More particularly, the invention relates to a patient monitor with graphical and tabular trend representation where a single TFT display window itself is provided to view trend and a digital data simultaneously.

BACKGROUND OF THE INVENTION AND PRIOR ART

US 3707147 has been incorporated herein by way of reference which discloses a method and apparatus for recording and displaying in a single picture the value of a signal, such as an electro cardial voltage, which varies as a function of time and position on a body. The display may be formed on an oscilloscope and is like a television picture in that an entire area is filled with information and each point in the area and the overall pattern are meaningful. The display shows signal value as a function of time along one axis and shows signal value as a function of position along another axis. The beam of the cathode ray tube is deflected through multiple sweeps along one axis while deflecting it through a single sweep along the other axis with traces which effectively fill the area bounded by the axes. The deflection along the respective axes are correlated with time and position on the body and the beam is continuously modulated in accordance with the amplitude of the signal.
US 3894533 has been incorporated herein by way of reference which discloses the recorder displays these vital sign trends in a manner which is intuitively representative of the measurement process for each vital sign. Vital sign trends are recorded on cross-hatched chart paper which is advanced by the recorder in a stepped manner that is synchronized with application of recorder pens to chart paper to achieve the desired display.
US 4513294 has been incorporated herein by way of reference which discloses a strip chart recorder and method for recording trend signals representative of a physiological condition on a strip chart responsive to the occurrence of an alarm condition. Trend signals representative of said physiological condition in the past are stored. Upon the occurrence of the alarm condition, the stored trend signals are recorded at a faster than real time rate.
US 4528988 has been incorporated herein by way of reference which discloses an improved system for displaying annotated physiological signals processes the signals for two dimensional display on an oscilloscope, for annotation with time-of-day and patient information, and for marking relative to a plurality of detected, abnormal physiological events. The physiological signal is traced during a first time interval after which the time-of-day and patient information is annotated appropriately on the display during a second time interval. During a third time interval, the display is marked to identify those physiological events which have been detected by the system as being abnormal. The display is created with maximum fidelity and without loss of signal information by this three pass process. Two independent channels of physiological signals are displayed on alternate horizontal lines in the display, again without loss of signal fidelity, by tracing the first channel during a first sweep and simultaneously storing the second channel within a memory for display during a second sweep.
Further US 5206807 discloses a system and method for transducing, recording, and displaying information relating to cardiac and respiratory functions of an infant. The system and method allows immediate detection of apnea events and of bradycardia associated therewith, as well as presentation of historical charts of such events.

The general meaning of trend is a general tendency or inclination, a general direction in which something tends to move, a pattern of gradual change in a condition, output, or process, or an average or general tendency of a series of data points to move in a certain direction over time, represented by a line or curve on a graph or a generally consistent movement in the same direction over a long period in a time series.
Vital signs, or signs of life, include the following objective measures for a person: temperature, respiratory rate, heart beat (pulse), and blood pressure. When these values are between certain upper & lower value, they indicate that a person is alive & healthy. All of these vital signs can be observed, measured, and monitored. This will enable the assessment of the level at which an individual is functioning. Normal ranges of measurements of vital signs change with age and medical /pathological condition.
The purpose of recording vital signs is to establish a baseline on admission to a hospital, clinic, professional office, or other encounter with a health care provider. Vital signs may be recorded by a nurse, physician, physician's assistant, or other health care professional. The health care professional has the responsibility of interpreting data and identifying any abnormalities from a person's normal state, and of establishing if current treatment or medications are having the desired effect.
Abnormalities of the heart are diagnosed by analyzing the heartbeat (or pulse) and blood pressure. The rate, rhythm and regularity of the beat are assessed, as well as the strength and tension of the beat, against the arterial wall.
Vital signs are usually recorded from once hourly to four times hourly, as required by a person's condition. The modern bed side monitors make it possible to automatically measure & record the vital signs minute wise or continuously which is called “real time” in the field of the art.
The vital signs are recorded and compared with normal ranges for a person's age and medical condition. Based on these results, a decision is made regarding further actions to be taken.
Any abnormalities in vital signs should be reported to the health care professional in charge of care and intervention is needed to set back the normal condition.
Normal results
A normal body temperature taken orally is 98.6°F (37°C), with a range of 97.8-99.1°F (36.5-37.2°C). A fever is a temperature of 101°F (38.3°C) or higher in an infant younger than three months or above 102°F (38.9°C) for older children and adults. Hypothermia is recognized as a temperature below 96°F (35.5°C).
In the prior art nurse will tag these events and abnormalities in a paper chart hanged next to the bed.
Average respiration rates at rest are:
Infants, 34-40 per minute
Children five years of age, 25 per minute
Older children and adults, 16-20 per minute
Tachypnea is rapid respiration above 20 per minute.
The strength of a heart beat is raised during conditions such as fever and lowered by conditions such as shock or elevated intra-cranial pressure. The average heart rate for older children (aged 12 and older) and adults is approximately 72 beats per minute (bpm). Tachycardia is a pulse rate over 100 bpm, while bradycardia is a pulse rate of under 60 bpm.
Blood pressure is recorded for older children and adults. A normal adult blood pressure reading is 120/80 mmHg.
With the present invention, the cross relationship between various vital signs can also be analyzed using multiparameter trend .
After studying the prior art available and the state of the art knowledge the inventors of the present invention has realized that there is still scope of improvements in patient monitoring apparatus by designing a vital sign monitor with a Trend Representation system in a Patient Monitoring Unit for improving the quality of monitoring and diagnosis by providing a complete picture of the monitored parameters over a period of maximum 10 days or 240 Hours. This complete system includes Vital Trend, NIBP Trend, OxyCardio Respirogram Trend (Real Time trend of HR, SpO2 and RR), Online Trend (2 Hours of graphical trend on Real Time display) , CO / NICO Trend, Arrhythmia Recall (ECG Strips storage - Max 30 on detection of Arrhythmia condition), ECG Recall (Max 30 ECG Strips of 30 sec duration each can be stored by the user), Apnea Recall (Tabular trend of Apnea events) , ST Recall (Max 240 ST strip storage on detection of ST alarm), Event Recall (Exclusive Trend of events entered by the user).
This present form of representation is better as it projects the complete picture including the graphical trend, Tabular parameter values, events and alarm conditions on a single display screen whereas in other prior art patient monitors these information are available in different trend screens (like separate Tabular Trend, Graphical Trend Screen, Event Trend etc)

OBJECTS OF THE INVENTION

One object of the present invention is to overcome the disadvantages / drawbacks of the prior art.
A basic object of the present invention is to provide an improved patient monitor device that has a new multi parameter trend representation system. The tabular and graphical representation of multiple parameters is shown in a single TFT display window itself to enable a physician to view a trend and a digital data simultaneously. Additionally the alarms for all parameters are shown in the trend itself.
Yet another object of the present invention is where caregiver can also view Real Time Physiological Parameter Waveforms and Numeric values on the primary monitor and also can view the trend on an independent device without disturbing the primary monitor.

Yet another object of the invention is where the system enables the recording of the table & parameter trend File(like alarm trend, Arrhythmia Recall, Apnea Recall, Vital Trend, NIBP Trend, OxyCardio Respirogram Trend, ST & ECG Recall, Alarm Recall and Event Recall) on a portable storage medium like disc, USB pen drive etc. The 240 Hrs of Real Time data can be recorded in soft form like a non editable pdf file format.

Yet another object of the invention is providing the option for storing a minimum of four physiological parameter waveforms and digital data for a period of last 240 hours and option to download the data on a portable storage medium like USB pen drive. This date can be viewed using an PC based viewer application on which the downloaded data can be analyzed for detailed diagnosis.

Yet another object of the invention is where all other record tables like parameter trend, alarm trend can be downloaded into the said USB thumb drive. The patient data can be transferred between 2 monitors using the said thumb drive.

Yet another object of the invention is to design a vital trend representation system which is unique and which contains Graphical trend along with tabular parameter data representation for the selected area of graphical trend. Also other information like Alarm conditions (High Priority & Medium Priority - represented using Red trace for high priority and orange trace for medium priority) in graphical representation and Red and orange numeric in tabular trend and stored events are also represented (Blue dots) on the same screen. The details of the alarm conditions and stored events are represented on the respective alarm and event message areas whenever the cursor coincides with the relevant record on the graphical trend.

Yet another object of the invention is a new Vital Trend display system having a unique representation of Graphical Trend along with the numeric data of a region of graphical trend selected by the user. Even Red Alarms (High Priority Alarm) and Orange Alarm (Medium Priority Alarms) conditions are represented in the Vital Trend. The details of the alarm condition are also displayed on dedicated message areas for aiding monitoring and diagnosis.

Yet another object of the invention is where any stored events are also represented on graphical trend area by Blue Dots. The details of the events are displayed on a dedicated Event Message Area whenever the selection cursor coincides with the event representation dot.

Yet another object of the invention is advantages of this representation in terms of easier reference and its benefits in providing complete information of the patient over a period of last 240 hours in Monitoring and Diagnosis.

Yet another object of the invention is displaying multiple vital trends like OxyCardio Respirogram, NIBP & recalling them on the single screen as they also provide additional information which otherwise are not available in the Vital Trend screen.

Yet another object of the invention is design a vital sign monitor with a Trend Representation system in a Patient Monitoring Unit for improving the quality of monitoring and diagnosis by providing a complete picture of the monitored parameters over a period of maximum 10 days or 240 Hours. This complete system includes Vital Trend, NIBP Trend, OxyCardio Respirogram Trend (Real Time trend of HR, SpO2 and RR), Online Trend (2Hours of graphical trend on Real Time display) , CO / NICO Trend, Arrhythmia Recall (ECG Strips storage - Max 30 on detection of Arrhythmia condition), ECG Recall (Max 30 ECG Strips of 30 sec duration each can be stored by the user), Apnoea Recall (Tabular trend of Apnoea events) , ST Recall (Max 240 ST strip storage on detection of ST alarm), Event Recall (Exclusive Trend of events entered by the user).

Yet another object of the invention is where this new form of representation is better as it projects the complete picture including the graphical trend, Tabular parameter values, events and alarm conditions on a single screen whereas in other products all these information are available in different trend screens (like separate Tabular Trend, Graphical Trend Screen, Event Trend etc)

Yet another object of the invention is the availability of other trend display options aids in monitoring or diagnosis by providing other information which otherwise is not available on Vital Trend Screen.

Other features as well as the advantages of the invention will be clear from the following best mode of working of the invention, drawings & claims.

SUMMARY OF THE INVENTION

The following presents a simplified summary of the invention in order to provide a basic understanding of some aspects of the invention.

According to one of the aspect of the present invention the system is provided an integrated apparatus for physiological monitoring of patients, said system comprising:
an enclosure means;
a patient monitor means secured within said enclosure means, said monitor means comprising :
at least one TFT display means providing plurality of displays such as bed number/unique code/ equipment’s serial part number and the like;
at least one keyboard means having at least one audio and visual indication/alarm means amongst other components of the keyboard means ;
a noise & transient filtering means substantially placed inside said enclosure means ;
a visual alarm means comprises lamps and LED’s of various colors;
at least one micro controller means/processor means operatively connected with said display means, said keyboard means and said noise & transient filtering means adapted to process all data/signals and display is said display means;
wherein said patient monitor means comprises a multi parameter trend representation system such that tabular and graphical representation of multiple parameters is displayed in said single TFT display means to enable a physician to view a trend and a digital data simultaneously and alarm condition are also displayed on dedicated message areas for aiding monitoring and diagnosis.

Other aspects, advantages, and salient features of the invention will become apparent to those skilled in the art from the following detailed description, which, taken in conjunction with the annexed drawings, discloses exemplary embodiments of the invention.

BRIEF DESCRIPTION OF THE ACCOMPANYING DRAWING

The following drawings are illustrative of particular examples for enabling methods of the present invention, are descriptive of some of the methods, and are not intended to limit the scope of the invention. The drawings are not to scale (unless so stated) and are intended for use in conjunction with the explanations in the following detailed description.

Figure 1 illustrates the patient monitor with improved long term graphical & tabular trend representation-overall view.
Figure 2 illustrates the home screen of patient monitor with trend launcher key and main menu keys.
Figure 3 illustrates the trend launcher screen with sub-menu selection. The submenus like Patient parameters, Trend, recall & further submenus are shown. The secondary & tertiary level menus are also shown.

Figure 4 illustrates vital trend screen main menu with graphical and tabular values in single screen.
Figure 5 illustrates NIBP trend screen main menu with graphical & tabular values in single screen.
Figure 6 illustrates mark events related to major activities-main screen medication, patient status, intervention.
Figure 7 illustrates oxygen cardio respirogram main screen. Graphical trend and real time parameters side by side.

Persons skilled in the art will appreciate that elements in the figures are illustrated for simplicity and clarity and may have not been drawn to scale. For example, the dimensions of some of the elements in the figure may be exaggerated relative to other elements to help to improve understanding of various exemplary embodiments of the present disclosure.

Throughout the drawings, it should be noted that like reference numbers are used to depict the same or similar elements, features, and structures.

DETAILED DESCRIPTION OF THE ACCOMPANYING DRAWING

In the following detailed description, reference is made to the accompanying drawings that form a part hereof, and illustrate the best mode presently contemplated for carrying out the invention. Further functioning of the system and method has been discussed below to describe the way it operates. However, such description should not be considered as any limitation of scope of the present system. The structure thus conceived is susceptible of numerous modifications and variations, all the details may furthermore be replaced with elements having technical equivalence. In practice the materials and dimensions may be any according to the requirements, which will still be comprised within its true spirit.
The working of this invention where a new method of graphical & tabular trend is implemented can be easily understood by referring to the attached drawings Fig 1. Fig2. Fig 3,Fig 4, Fig 5,Fig 6, Fig 7,Fig 8.
The Fig 1 ,Part 100 shows the overall front view of the multi-parameter patient monitor which is modular and field configurable .
Part 102 is a enclosure or cabinet for the present patient monitor with improved long term multi-parameter graphical & tabular trend representation.
This enclosure 102 is plastic injection molded from master batch resins, which are biocompatible plastics and composites. This enclosure is rectangular in shape. Although for the reason of clarity in drawings only one type of enclosure with few sensor cables are explained. It is understood that other shapes of enclosures with the sensor cables not described in this invention can also be used without deviating from the sprit & scope of the invention. All such modifications improvements still fall within the scope of this invention.
The enclosure 102 contains a mains power supply, which will take the mains outlet power & convert the energy in to regulated DC.
This DC is electrically connected to DC/DC-voltage converter. This highly regulated and noise /ripple free voltage is fed to various electronic circuits assembled inside the enclosure 102.
The DC power electrically connected to the mother board residing inside the 102. This mother board is connected to a TFT– flat panel LCD display 104 which has also a touch screen panel 106 on the outer surface facing the user of the equipment.
The main /mother board inside 102 , will contain a CPU or embedded micro-controller, DDR RAM, ROM, Flash Disk, UART’s , RS232 to TTL communication circuit, to accept OEM modules, USB / LAN , HDMI port for external add on display. The TFT display 104 will display the information through Graphical user Interface so that the necessary information in text /graphic / waveform is displayed & can be understandable by human beings.

For regular use there is one capacitive touch- activated keyboard 110. The part 114 is technically known as “optical encoder” which is having a push button – vertical movement switch and position coded horizontal & circular photo switches. Together this will act like a navigation key and mimic the functions of mouse and joysticks found in computers known in the prior art.
The input commands, menu selection , navigation can be entered using optical encoder 114, configurable keyboard 122,soft touch keys in the form of icons on 104. Part 112 is one such icon switch used to jump to next screen. The hard keyboard 122 is provided with system ON/OFF 124 and few other menu keys.

The configurable switches 120,118,116 are used for quick selection of menu keys which are otherwise accessible through a maze of menu submenu selection on the touch screen 106.
For example blood pressure, temperature ,trend recording etc can be assigned to these configurable keys.
By way of an example the following keys can be assigned during startup configuration.

1. Alarm Acknowledgment/Alarm Pause: To acknowledge red, yellow & blue alarm.
2. Freeze/Defreeze: To Freeze and de-freeze all waveforms.
3. Record start/stop: To start and stop recording.

The part 130 is an electro-cardio-graphic signal acquisition cable with electrical & mechanical registration with connector 140 & having color-coded lead wires with hydrogel electrodes at proximal end. These electrodes are connected to various parts of the patient body. The connector 144 is ergonomically designed medical equipment grade, green colored connector mates with socket connector 140.
The analog signals with voltage level of few milli volts are gathered by 130 & 144,140 & fed to the noise & transient filtering circuit placed inside 102. This signal is then amplified & converted to digital form. The digitized signal reaches motherboard inside 102. The motherboard will process this signal & displays on TFT-LCD 104.

Similarly 138 is yellow colored circular connector at distal end with pulse oxymeter finger probe sensor 128 on the proximal side.

The probe sensor has got light radiation emitters & photo sensors. The patient’s finger is sandwiched between these emitters & photodiodes. The motherboard will processes this signal & displays on TFT –LCD 104.

The body temperature of the patient is detected using a thermistor based temperature sensor probes 146 & 148. The thermistor potted inside the tip of 146 & 148 will changes its resistance according to the human body temperature. The proportional signal generated , which is in analog form is again digitized after suitable filtering & amplification using the electronic circuits placed inside the 102 & sent to motherboard. The motherboard will processes this signal & displays on TFT –LCD 104.

The part 136 is hollow tube with exhaled gas collecting device at proximal end and a pneumatic connector 134 at the distal end. The exhaled gas from the human nostrils is sampled through this nasal sampling line and a gas analyzer residing inside 102 will process the samples. The amount of co2 & the shape of the waveform is generated by the motherboard residing inside 102 and displayed on TFT display 104.
The part 132 is an inflatable cuff wrapped to the upper arm of the patient at the proximal end and interfaced to a blood pressure measuring module residing inside 102 through a hollow rubber hose & pneumatic connector 126.
The various parameters related to arterial blood pressure are measured by precisely inflating & deflating the cuff and measuring the pressure waveforms which are processed by the motherboard residing inside the 102 and displayed on 104.
The part 150 is an external thumb drive which is used to store the data of all record tables like parameter trend, alarm trend which can be downloaded into the said USB thumb drive. The patient data can be transferred between 2 monitors using the said thumb drive.
Part 108 is visual alarm consisting of lamp or LEDs of various colors.
For example BLUE can be assigned to hardware error /technical problems when the electronic components residing inside 102 develop problem or the sensors 128/138,130/144/140 or 132/126 or 136/134 or 146/148 are either disconnected or faulty. The BLUE color alarm can also be associated with any events occurred.
All these events can be registered & reviewed later on in trend.
For example RED color alarm at 108 can be assigned to crossing of HIGH/LOW limit of vital sign parameters. The RED color alerts about high priority to be given by caregiver to attend.
All these events can be registered & reviewed later on in trend.
For example YELLOW or AMBER colored visual alarm at 108 can be assigned to low priority alarms related to events, high /low parameter violation.
The invention disclosed can monitor the below given parameters & store the trend for at least 240 hours.
 3/5/12L ECG
 3/5/12L ST segment of the ECG waveform-Analysis
 14 types of Arrhythmia ( Detection of abnormalities in ECG waveform & associating with mechanical defect of the heart.
 Respiration rate detection using thoracic impedance pneumography,
2 Channel Body temperature measurement using thermistor based or thermopile sensors, Dual SpO2 , Pulse Oximetry
 4 Invasive Blood Pressure Channels (IBP) ) Invasive arterial blood pressure measurement using diaphragm pressure transducers
 Non Invasive Blood Pressure (NIBP)
 Capnography Parameters – EtCO2(End tidal carbon dioxide measurement , FiCO2(First inhaled carbon dioxide measurement), RR(respiration rate),
 Invasive Cardiac output using thermodilution catheter
 Non Invasive Cardiac Output band or spot electrodes
 Inhaled Anaesthetic Gas Monitoring –By way of an example gases like Enflurane, Isoflurane, Halothane, nitrogen oxide (a.k.a. Laughing gas) ,oxygen, carbon monoxide.
The various Trend & Storage provided in the invention are as follows.
• 240 Hours Vital Trend.
• Last 240 readings NIBP Trend
• OxyCardio Respirogram Trend
• Apnea Recall
• Event Storage & Display In Trend
• ECG Strip Storage
• Arrhythmia Recall (Strip Storage )
• 240 Hours NICO Trend
• Last 48 readings of cardiac output Trend
• Last 48 readings of Alarm recall trend
Also when a parameter cable/sensor/module is connected (128/138,130/144/140 or 132/126 or 136/134 or 146/148 ) to the monitor, a waveform-display area and numeric display areas are automatically assigned on the Real Time screen for display 104 of the parameter's numeric values and waveforms.
The Fig. 2 shows the detailed view of Real Time screen display 104 which is shown in Fig 1.
The Patient monitor is switched on by pressing the ON/OFF master switch 124 for prolonged duration, The motherboard, associated analog & digital circuits, sensors 130,128,132,136,146,148 and the display 104 are switched on and patients vital physiological parameters are displayed on 104 in the form of digits & waveforms.
At location 204 ALARM related signals are displayed which are also linked with Part 108 containing visual alarm lamps. A speaker which generates tones & alarms is also residing with 108 ( Global Alarm Audio Enable/Disable Symbol)
At Location 206 name of the patient is entered. At location 208 the unique bed number is entered to show the occupancy of the bed in central nursing station. This bed can be located in ICU,CCU,NICU,OT, recovery ward ,general ward or even mobile bed located inside the ambulance.
The location 210 is for selecting the type of patient like Adult, Neonatal, Pediatric, Geriatric.
Location 212 will display real time, date ,hours ,minutes which is taken along with the vital parameters to store as trend readings(Time stamp).
The location 202 is Blue Message Area. The location 214 is white message area(Alarm Info & Message Areas).
At Location 216 the real time waveform of ECG derived from the sensor cable 130 is displayed. The digital values of ECG are displayed at location 222 which is measured as beats per Minute. At location 224 the upper & lower limits to raise alarms are displayed. These values can be altered using switch 114. All these values are taken for trend storage.
At location 218 the ECG lead selection is displayed for ECG waveform one. At location 220 type of ECG waveform is displayed for waveform one.
At location 226 whether the ECG selected is diagnostic mode or monitor mode is displayed. The monitor mode is selected when the surgery is performed in O.T or waveform is noisy. During this the ECG cable 130 will be having 3 leads or 5 leads & the system inside 102 can confirm that only 3 lead or five lead cable is used. The diagnostic mode is used for detailed analysis of heart like before and surgery. The ECG cable 130 used will be 10 or 12 lead with additional diagnostic software residing inside 102 will be used.
At location 228 the synchronized pulse oxymeter waveform is displayed.
At location 230 the pulse oxymeter numeric values are displayed . At location 232 the upper & lower limits set to raise the alarm 108 /204 are displayed.
At location 234 the respiration waveform is displayed. This can be impedance pneumography derived from ECG leads 130 or the waveform derived by respiration gas analysis using nasal cannula at 136. At location 236 the numeric values associated with respiration are displayed as breaths per minute. At location 238 the apnea /breathlessness alarm duration in seconds is selected.
The location 240 is for selecting upper & lower alarm limits to raise the alarm for respiration related parameters at 108/204.
At location 242 the body/skin temperature of the patient acquired from thermistor sensors 146 & 148 are displayed.
The location 276 is for setting upper & lower clinical temperature limits for alarm raising at 204/108. At location 244 the non-invasive blood pressure parameters derived using inflatable cuffs 132 are displayed in mmHg of mercury.
The location 246 is for setting and displaying the upper( systolic) & lower(diastolic) limit of the non-invasive blood pressure values & to raise and alarm at 204 / 108.
The soft key with icons from 248 to 274 has following functions.
248, New Patient, to admit a new patient and subsequently enter the old & new details.
250, Trend Launcher, To launch the trend screen on display 104.
252, Display format, to format the display 104 with suitable combination of vital signs.
254, Alarm settings , to set the various upper & lower limits of alarms & the time duration to raise an alarm.
258, Left scrolling key functionally similar to 114.
260, For printing the screen 104 on hard paper or for printing trend waveforms and numerical values.
262, for displaying the system information of part 100.
264, for configuring the patient monitor 100 with various types of vital sign modules & sensor cables.
266, Right scrolling key functionally similar to 114.
268, IPB Zero key for zeroing the invasive blood pressure transducer.
270. event mark, When this key is pressed, the medication given to patient at that particular time , the activities of patient, intervention done can be selected from a pull down menu & recorded in trend waveform & parameter screen.
272, Vital trend, launcher key, when pressed the vital trend screen is displayed on 104.
274, Battery status, network status key- For detailed status of battery pack located inside 102 & network connection of 102 with other patient monitors & central monitor/hospital network.
All the above features & the way of screen display is novel & hitherto unavailable in the prior art.
When any of the soft key with icons from 248 to 274 touched by the caregiver, a new screen 300, Fig 3. is shown in place of 200, Fig 2.
The user interface menu selection displayed on 104 contains maximum 4 levels of menu structure for system navigation:
• 1st Level: Main Menu Example Fig 2-> 248,250,252,254,256, 258,260,262,264,266,268,270,272,274, Fig 3-> Location 250
• 2nd Level: Primary Sub Menu , Fig 3, Location 306,310,312 etc.
• 3rd Level: Secondary Sub Menu , Fig 3, Location 308,316,320 etc.
• 4th Level: Tertiary Sub Menu , Fig 3, Location 324 etc.
These parameters in all levels can also be reviewed in trend screens shown in Fig 4,5,6 .
The selection of “TREND launcher screen” in the primary menu is done either by rotating/pressing the optical encoder 114 or by pressing the configurable push button keys 120,118,116.
The selection of “ TREND launcher screen” also can be done by capacitive switch or touch screen switch icons 250 & 272.
This screen in Fig 3- 300 contains “parameter selection” 310 window with submenu “Vital Trend Parameters 316” , “NIBP trend parameter 344”, “Trend View 312”, “RECALL VIEW 314”.
The touch icon 302 is for night mode selection where the audio volume & brightness of the display screen are lowered or muted to very low level. The trend view icon 312 is with following submenu.
VITAL TREND 318 , OxyCardio Respirogram TREND 322, NICO/CO TREND 346”.
The RECALL VIEW 314 will have following submenu “ALARM RECALL- 320”,” ARRHYTHIA RECALL 326”,
,”ECG RECALL 328”,” ST RECALL 330 “,”APNEA RECALL 332”. “EVENT RECALL 334”.

The “enable disable online trend touch icon 336 is for accessing online trend. By pressing sub menu 340 the online trend will be enabled or disabled.
The “trend & recall download” menu 342 for taking out the information from patient monitor. By touching the icon 338 & connecting 150 –USB disk the data can be exchanged between removable media & the patient monitor.
The touch icon 348 is provided to exit from the screen shown in Fig 3 & come back to the screen in Fig 2. On selection/touch of the vital trend parameter button/location 316 , Fig 2, a pop up menu will appear on the screen.
Selection/touch of the Parameter1, Parameter2 and Parameter 3 at location 316-Fig 3, will pop up a new drop down list just next to the existing screen with a list of sub-parameters as shown in table 1.
Table 1:
Parameter/vital sign Description
HR Heart rate
SpO2 Oxyhemoglobin saturation
TEMP1 Body temperature from first location on patients body.
TEMP2 Body temperature from second location
RESP RATE Breathing per minute
EtCO2 End tidal carbon dioxide
FiCO2 First inhaled carbon dioxide
ST1 ST segment analysis
ST2 ST segment analysis
ST3 ST segment analysis
EtO2 End tidal oxygen level of patient
FiO2 First inhaled oxygen by patient
EtN2O End tidal nitrogen dioxide gas exhaled by patient
FiN2O First inhaled nitrogen dioxide gas by patient
EtAA End tidal anesthetic agent
FiAA First inhaled anesthetic agent by patient
IBP1 (sys, dia, mean) Invasive blood pressure (Location 1) on the body of patient
IBP2 (sys, dia, mean) Invasive blood pressure (Location 2)
IBP3 (sys, dia, mean) Invasive blood pressure (Location 3)
IBP4 (sys, dia, mean) Invasive blood pressure (Location 4)

The default parameter for parameter 1 will be HR, likewise SpO2 for parameter 2 and RR for parameter 3. User will be allowed to select only one parameter for each PARAMETER selection.
IBP will not be present in Parameter- 1 selection
If AGM module is present, then the options EtAA, FiAA, EtO2, FiO2, EtN2O, FiN2O will be shown in the parameter list. If AGM module is not present, these options will not display in the parameter list. Similarly, if IBP3/4 (invasive blood pressure) module is present, then IBP3 and IBP4 options will be displayed, otherwise they will not be there in the list. This will prevent the display of graphical & tabular trend display with blank values.
Depending upon the type of cable 130 inserted at connector 140 the options for ST segment of ECG waveforms at 216 & 220 will be displayed to the user. The ECG waveform at 216 or 220 will have a particular shape which is identified by the letters P,Q,R,S,T. The ST portion of the ECG waveform when subjected to analysis, the mechanical defects of the heart , major arteries & veins can be diagnosed by the caregive. This can be done automatically by the hardware or micro-conroller residing inside 102 . This can also be done by acquiring hi-resolution waveform using 5 lead / 12 lead /15 lead ECG cable 130 at connector 140 and then displaying zoomed ECG waveform at 216 or 220 where ST segment of the ECG waveform is magnified & marked with PQRST letters. In this case the care-giver will visually analyze the ST segment to correlate with mechanical defects of the heart. Also the periodically acquired values & waveforms are stored & can be recalled & viewed using the “ icon – touch switch 330” which is “ST recall”.
Also there is no point is acquiring & displaying dummy values from the sensors 130,128,132,136,146,148 or any other vital sign hardware modules residing inside 102, if they are not connected properly or defective or absent. The real time as well as trend recall screen on 104 will not be useful or may confuse the caregiver or analyst who is not familiar with the biomedical hardware instrumentation. Either the respective option is not shown to the cargiver or suitable audio / visual alarm is raised at 108,204,202. All these events, alarms, faults can be stored & recalled in trend.
This facility can be applied for all the options listed in drop down table “Table 1:”
So, For 3 Lead ECG cable only ST1 option will be present. ST option will not come if ST is not enabled. CO2 ( Capnography ) selections will not come if CO2 gas analyzer module is not connected. The important novel feature of this invention is the option parameters will come only if those modules are connected & found working normally .
On selection/touch of the NIBP TREND PARAMETER Location 344 , a pop up menu will appear on the screen for NIBP trend parameter. This is elaborated in Fig.5.
When “ Patient Details touch icon –306” on Fig 3 is selected, all admitted patient list will appear for selection in drop down menu 308. User will be allowed to select required patient to view trend details. The inputs can be typed or menu selected using keyboard displayed on 104,mechanical keys 122,120,118,116 or optical encoder 114. When user changes the patient from / to any other patient, the existing duration and resolution setting will be retained with the help of the micro-controller , RAM ,solid state hard disk residing inside the 102. .

The details entered & stored using 306 & 308 are used to take printout on a thermal paper using a thermal printer located inside the 102.
These printout of patient details combined with other vital signs are used for hardcopy records & any medico-legal cases.
Default resolution will be selected on the screen portion 308. When user presses this tab resolution will go down as mentioned below. The default resolution will be 6 min and on further zoom in it will increase its resolution as follows
 30 sec
 1 min
 2 min
 3 min
 6 min
 12 min
 18 min
 30 min
 1 hour

The default duration is 24 hours; the other durations can be selectable by a drop down. The icons at screen portion 304 are used for scrolling through the drop down menu selections.
The options are
 2 hours
 4 hours
 8 hours
 12 hours
 24 hours
 48 hours
 72 hours
 120 hours
 240 hours

When the user selects the “ Download/SAVE TO USB touch icon 338” Vital Trend window, the entire stored data (Tabular & Graphical format) for the selected patient trend will be stored into USB part 150 shown in Fig 1. The entire tabular trend will be saved in excel format and graphical trend in jpg format in USB thumb drive 150. There will be a main folder with Patient Name as folder name inside which there will be two folders – Graphical & Tabular. Individual folders will be created for different patients.

The touch of the vital trend view location 312 or 318 will enable the vital trend screen as shown in Fig 4. Part 400. The parameter setting can be done in pull down menu 324 similar to 344 or 316. Here the tabular and the graphical trend will be displayed on the same screen. When the vital trend is selected, the tabular readings will come on the top tabular section for the parameters selected in parameter selection, the graphical trend will appear in the bottom graphical section in the order of the parameters selected. In the Fig 400, 406 is numeric value HR & bpm which is corresponding to graphical value 428. The tabular row 408 is spo2 which is corresponding to 436. The tabular row 410 is RR, bpm(beats per minute) which is corresponding to graphical value 442.
Default resolution --> 1.5 to 2 min
Default duration --> 24 hrs.

Default patient(206) --> patient 1/patient ID of the first patient in case name is not entered.
The latest trend will be updated on the right hand side. By default the trend scroll window (tab) will be on the latest reading i.e. on the right hand side.
The invention has got the capacity to store a minimum of 240 hrs (10 days )of trend which also can be printed on a printer. This printer can be inbuilt within 102 or can be external connected to 102 through USB connectors instead of USB thumb drive 150.
The screen can show 30 tabular trend columns at a time and each tabular trend column will occupy 5 pixels each. There is a provision of displaying 7 rows of data ( 406,408,410,412,414,416,418) for any 3 selected parameters at maximum for tabular reading.
The readings in the tabular trend are as per the present selected resolution. The default-selected resolution is 2 min and duration is 24 Hrs for vital trend. The latest date is shown to the extreme left – location at 440.
There will be an indication of Date on the blue bar 444 shown above the tabular trend. This is for better indication of a day changeover. Also in countries like USA there will be a procedure for adjusting the time according to mountain time, daylight saving time, pacific time. The blue bar indicates such changes.
The selected parameters are displayed in their respective colors.
As the trend view selection window 438 is scrolled horizontally the tabular trend columns will also scrolled automatically ( by way of an example trend columns from 11:39:00 to 11:48:30 are shown.
The 404 is one such column by way of an example. The window 438 contains a center cursor line 430 which corresponds to the highlighted center column 404. Now if the caregiver can see the values at 11:43:30 and the corresponding events and messages in 420,422,424,426. If the upper & lower limits are crossed then it can be notified by pink line & lower limit crossed as in 432 or white triangle and an event has occurred as in 434. The horizontal bar 440 is message /information area for current page/total pages, time.
The icon with question mark 408 is instant help related to medical terms, interpretation of values /messages/alarms shown in trend screen. This also contains the suggestions to be given to caregiver for the medications/drugs/injections/tablets/IV solutions to be given to patient to bring back the vital sign parameters that are crossed the upper/lower limits.
The columns 412,414,416,418 are used for displaying various other parameters like invasive blood pressure, thermo dilution cardiac output, clinical temperature .

If the user has changed the waveform colour from the default colour, the same colour will get reflected in trend also.
Suppose the trend screen is showing trend details from 5:00 PM to 6:00 PM, and the user has changed the waveform color at 5:30 PM, the trend will show the whole trend in the latest color updated.
Also if the color of the waveform is say GREEN for ECG and the upper or lower limit violation color is RED then at 432 or 434 the waveform will change its color from GREEN to RED. Similar way the EVENT occurred color for the waveform will also be changed. This will help the caregiver to get a panoramic view of the waveform with various colors.

The touch icon 446 is for page scroll back. The icon 448 is for zooming in the view for window 438. The icon 450 is for zooming out the view for window 438. The icon 454 is for left scrolling the cursor 430 inside the window 438. The icon 456 is for right scrolling the cursor 430 inside the window 438.
The icon 452 is for left scrolling the window 438. The icon 458 is for right scrolling the window 438.
The icon 460 is for print out related menu & function where the hard copy can be printed using local or network printer. The printer can be a thermal paper printer inbuilt within 102 or an external one connected to network using USB connectors instead of thumb drive 150. The icon 462 is for refreshing the values on the screen as well as background.
The icon 464 is to go back to previous menu. The icon 466 is for page scroll forward.
The icon 468 is to exit from trend view & jump back to trend launcher as shown in 300,Fig 3.
All the above features & the way of screen display described are novel & not provided in prior art.
The Fig 5 , 500 gives the elaborate explanation of NIBP screen with graphical & tabular trend in same screen.
On selection/touch of the NIBP TREND PARAMETER Location 344 , a pop up menu will appear on the screen for NIBP trend parameter as shown in 500-Fig 5 and last 240 reading will be shown in the display.
Here the tabular trend will be displayed on the same screen. When the NIBP trend is selected, the tabular readings will come on the tabular section as per the parameters selected in parameter selection 344.
Irrespective of which mode the NIBP reading is taken, the readings will be shown according to the time it was taken which is also displayed in screen portion 212, i.e. there will be a time stamp only for the time it was taken. (Only when NIBP reading is taken the time stamp will be given)

Selection/touch of the Parameter1 and Parameter2 at location 344 will pop up a new list for combination of parameters to be shown with NIBP, just next to the existing screen a list of parameters as shown below.

HR
SpO2
TEMP1
TEMP2
RESP RATE

For parameter 1, HR will be default selection, likewise SpO2 for parameter 2. Selection of an already selected parameter in Parameter 1 in Parameter 2 will give a wrong key beep. Selection/touch of the exit option in the list of parameters will return back to parameter selection screen. Similarly selection/touch of the exit button in the parameter selection window will return to the main trend screen 344, 250 and the cursor position will be on parameter selection only.
The cursor 526 will be a simple dotted line for the graphical trend and a highlighting tab 506 which shows the corresponding reading in the tabular trend.

If there are any error messages such as Cuff position error, Loose cuff.. etc then the corresponding message is shown at that particular time in the area just above the graphical trend. The 520 is RED message area,522 is ORANGE message area, 524 is BLUE message area.

The pulse rate and respiration rate can be taken from various sources. The location 504 shows abbreviation & symbol for these sources. If ‘s’ is found near the value shown in trend table then pulse rate is taken from NICO module. If ‘*’ STAR symbol is indicated then the PR is from pulse oxymeter module. If ‘#’ Hash symbol is found then PR is derived from IBP/NIBP module.

Similarly if ‘*’ is found near respiration value then respiration is derived from ECG module where impedance pnuemography is employed. If ‘#’ is indicated next to the respiration value then the respiration value is derived from capnography gas analyzer module.
In the particular combination chosen from 344 the row 508 will show heart rate in beats per minute.
The row 510 will display spo2 parameters. The row 512 will show NIBP systolic values & synchronous with 528 . The row 514 will display NIBP diastolic values & synchronous with 534.
The row 516 will show mean blood pressure values & synchronous with 530.
The location 502,518 are for additional information display.
The touch icon 536 is for displaying connector lines between each two consecutive values in 528,530,534. When these measurement points are connected it will give a graphical waveform like look. The icon 538 is for exit from NIBP trend & come back to Fig. 3, 344

Fig 6, 600 will give more information on marking particular event that takes place during patient monitoring. The events can be medication administrated by caregiver or activities, reactions/responses of the patient or intervention by the nurse staff.
Practically every function in the human body has been shown to exhibit circadian rhythm. The
three most commonly monitored vital signs are blood pressure (systolic and diastolic), heart
rate, and body temperature. Because these variables exhibit daily rhythmicity, their normal values vary with the time of day. The ranges account not only for daily variability but also for variability associated with sex, age, and individual differences.
The lowest body temperature occurs between 4 to 5 am in the morning & highest at evening 7 p.m.
The sharpest rise in blood pressure occurs around 6:30 am to 7 am and again at evening around 6:30 am to 7 am and many of the heart attacks are known to occur during this time. The invention with new trend and event marking disclosed can be programmed to alert the caregiver through visual & audio alarm 108 so that the proper care & medication is given when BP is highest.
The high alertness is at around 10 am during which surgery with anesthesia & sedatives can be avoided and greatest cardiovascular efficiency and muscle strength is at 5 pm in the evening. The physiotherapist can be alerted to provide physical exercise to the patient.
The bowel movements of the patients will be high at around 8:30 am. The care giver can be alerted to provide bedpan using this patient monitor.
Knowing circadian rhythm for general population and recording these events for the particular patients along with the other events is yet another novel feature of this invention.

MARK EVENT Fig 2. 270, event recall 334,
By touching the icon 270 on Fig 2, 200 , a “event tab” screen will be displayed.
This menu will have following options.
EVENT

Mark Event
Event setup
Exit

The minimum time gap between marking of two events is 30 seconds
A total of 24 events (max) can be stored in a span of 24 hrs for each patient. If the user marks the 25th event within 24 hrs the 1st event shall be lost (FIFO).
Event setup shall have the following two options
0Manual event >>>

0Auto event >>>

Event setup

The caregiver can select one of the above selected options and do the settings for the same.
The Default selected will be Auto event. When Auto event is selected the Mark event option will be grayed out, and when manual event is selected Mark event options is selectable.
The Manual Event pull down/pop up menu will have the following options.
Parameters Drugs & Miscellaneous
HR
SpO2
RR
IBP 1 sys
IBP 1 dia
IBP 1 mean User defined event 1
EtCO2 User defined event 2
Add parameter >> User defined event 3
Exit

The Add parameter will give the list of parameters available at that time and which is not there in the above list. The caregiver can define an event and save it under drugs and miscellaneous
The Auto event will have the list of all parameters available at that moment.

Auto event parameters
(List of all parameters available at that moment)

Parameter 1 >>>
Parameter 2 >>>
Parameter 3 >>>
Parameter 4 >>>
Exit

In the above window, when any of the parameter is selected, it will open the alarm limit settings window for that parameter. The default limits for the parameter will be the alarm limits of that parameter
The caregiver can set his own limits for that parameter. It will be appreciated by the reader that When limits are changed in this window for a parameter it will not reflect in the alarm limits settings. They are two separate Entities.
When a parameter crosses a set limit the event can be marked automatically and this marked event can be viewed in Event View in trend window 438 .

Use case 1 (Manual event selected)

When user finds any abnormality he shall select the Mark event and the following window shall appear
Parameters Drugs & Miscellaneous
0HR

0SpO2

0RR

0IBP 1 sys

0IBP 1 dia

0IBP 1 mean
0User added event 1

0EtCO2
0User added event 2

0User added parameter
0User added event 3

Done Exit

The caregiver can check on any desired parameter or options above and click on touch icon switch “Done”. After selecting the done option, a notes window will popup and user can enter any notes if he wishes to.
In the trend view, there will be 8 seconds of readings (6 seconds prior and 2 seconds after) recorded for the checked parameters.
Use case 2 (Auto event selected)
When the parameters listed in auto event setup crosses the set limits for it an event will be marked automatically without user intervention and readings will be marked for that particular event (total 8 seconds, 6 seconds prior and 2 seconds after)
Event View/recall 334

Event view is one of the options under Trend view in trend window. This window shall have only tabular readings. The events is listed one by one and the readings associated with it will also be listed.
Patients List of events
Patient 1 “Event 1”

Patient 2 “Event 2”
Patient 3 “Event 3”
“Event 4”
“Event 5”
“Event 6”
“Event 7”
Exit

Event 1 12:00:00 12:00:01 12:00:02 12:00:03 12:00:04 12:00:05 12:00:06 12:00:07
HR
SpO2
IBP mean
Notes:
Drug & miscellaneous :
Fluid / saline intake
Exit

Fig 6, 600 gives the detailed view of Mark event & drug table . The table 602 is for entering various medications & drugs that are administrated to the patient. This is a scrollable list with 614 touch icon switches are used for scrolling. The names shown are by way of an example & 608 is one such drug “Fentanyl” used as sedative.
The table 604 is for entering physical symptoms & events related to patient. By way of an example 610 is one entry mentions about “patient is eating his food”. May be sub entries can be made with the food details sent from nutritionist from his/her office. The list will have scrollable entries with buttons 616.
The table 606 is about intervention done by caregiver. By way of an example 612 is about the oxygen gas inhalation therapy given to the patient with duration/quantity. This list is scrollable with 618 touch icon switches are used for scrolling.
The improved results are conveyed by the display 104 with change in parameters at 222,230,236,242. This evidence based intervention and co-relation & report will help the caregiver to scientifically provide the healthcare. This is one more novel feature.
The touch icon 620 is to enter the event. The touch icon 622 is for editing the already entered events. The touch icon 624 is for “exit” from the event menu.
Fig 7. Part 700 gives the detailed description of cardio respirogram trend.
After selecting the OxyCardio Respirogram trend 322 in Fig 3, an OxyCardio Respirogram trend is displayed on screen same as vital trend in place of Part 300,Fig 3.
The parameters for OxyCardio Respirogram are fixed and cannot be edited. The parameters are HR, SpO2 and RR. When this button is selected the tabular trend will appear in the following order
Numeric value of HR at location 702
Numeric value of SpO2 at location 706
Numeric value of RR (respiration rate) at location 710
The graphical trend will also appear in the same order as shown above and next to the numeric.
Graphical value of HR at location 704
Graphical value of SpO2 at location 708
Graphical value of RR (respiration rate) at location 712
The touch icon 714 is for selection of pulse rate from various available source similar to 402,504
The touch icon 716 is for selecting the menu for OxyCardio Respirogram trend. The touch icon 718 is for recall menu.
The OxyCardio Respirogram display will be only for current patient and not for a previous patient. OxyCardio Respirogram Display will allow the user to view continuously with 2 sec duration. OxyCardio Respirogram storage capacity will be 8 min.
A maximum 8 min data will be monitored. After completion of Time storage duration automatically oldest data will be deleted. The new data in the screen will get added to the left side of the window and rest of the readings will get pushed to right. When entire window is full, any new data will push the entire trend window to right by one reading [depending on the current resolution], such that right most reading is lost. On entry to window cursor will be on first reading at the left most end of the window
To EXIT the OxyCardio Respirogram screen we have to press the OxyCardio Respirogram TREND touch button 714 again. Upon exiting the OxyCardio Respirogram trend, it will return to the VITAL trend screen 300.
The NICO/CO trend button 346 next to the NIBP trend will enable the CO/NICO trend screen.
CO trend will be for last 40 readings and NICO Trend duration will be 240 Hrs.
Parameters For Trend Display
In CO/NICO trend parameters for display in trend are not editable. Default CO parameters for tabular & graphical representation will be
 CO
 SV
 SVR
NICO parameters for tabular representation will be
 CO
 SV
 SVR
 CI
 SVRI
 SI
NICO parameters for graphical representation will be
 CO
 SV
 SVR
The units for the above parameters will be as given below:
1. CO -L / min
2. CI -L / min / m2
3. SV - ml / beat
4. SI - ml / beat / m2
5. SVRI - dyne.sec.cm-5.m2
6. SVR - dyne.sec.cm-5
The CO trend will appear only when the CO module is connected to 102 , otherwise the CO/NICO trend button will be grayed out. Likewise the same holds good for NICO trend.
CO Trend Requirements
The touch icon 350 at Fig 3, will open a Haemo table screen.
The CO trend like the NIBP trend will show the readings only when it is taken. In the area between tabular trend and graphical trend of CO there will be a button to view the HAEMO table. The Hemo table will show values corresponding to where the cursor is currently highlighted.
MESSAGE AREA
The message area is the area next to the page scroll buttons.
The 1st three message areas are related to the current trends, the 1st area will show any information related to the first parameter, and so will the next 2 message areas respectively in the same colour.
The last message area i.e. the event message area will show any information related to any event that has occurred in the trend print time.
The messages that appear in the message area are purely dependent on the current waveforms. If there are no messages that are worth appearing in this message box only the name of the parameter name will appear.
The lists of messages that can be displayed in the 1st three areas of the message area are For event messages in the 4th area it will just be the name of the event that had been marked, it can either be from the default list provided or the user edited list of events.

INDICATIONS ON THE WAVEFORM TREND , 432,434

Graded Alarms and event will be indicated on the waveform trend.
Orange line  higher/lower medium priority alarm limit crossed
Red line  higher/lower high priority alarm limit crossed.
Blue Dot event occurred.
There will be a similar indication in the tabular trend. The parameter that has crossed higher limit will be indicated in orange i.e. text colour will change to orange and the background of that cell will be shown in gray. Similarly the same will be followed for pink line and white triangle also.
The scroll tab in the waveform trend area corresponds to the all the tabular trends shown in the tabular trend area.
The point where the leftmost part of the scroll tab ( 438,440? )sits corresponds to the first reading in the tabular reading and where the rightmost part of the scroll sits corresponds to the last reading in the tabular reading.
The scroll will correspond to the resolution selected. It will expand or contract as per the resolution selected. If we touch anywhere on the graphical trend area the scroll tab will appear there. The point that has been touched will correspond to the dotted line in the scroll tab.
The scrolling function can also be achieved by just sliding the finger over scroll tab or using two fingers to pinch the tab or placing the two fingers on the tab & moving away in opposite direction .
RECALL VIEW main menu 314,

ALARM RECALL, 320
Alarm recall shows the list of the last 48 alarms. The alarms that occurred are shown along with date, time, the parameter and the value of the parameter.
ALARM recall cursor movement
Initially when we enter this screen, the cursor will be at the down scroll button.
The alarm recall will be shown for the current selected patient. If the user wants to select any other patient he will do so by going back to trend any changing the patient.
There will be only high priority and low priority alarms in alarm recall
ARRHYTHMIA RECALL , 326
A separate window will open on touch/selection of the graphical trend button. The screen will show waveforms of ECG when the arrhythmia occurred. The screen will show a total of 30 seconds ECG trace (5 ECG waveforms strips of 6 seconds each)
The first one will be 12 seconds prior to the time when arrhythmia occurred.
2nd --> 6 seconds prior
3rd --> the waveform when arrhythmia occurred
4th -->6 seconds after
5th --> 12 seconds after
The arrhythmia will be enabled here only if it is enabled in the production menu.
The details of the patient name, patient ID, time when arrhythmia occurred will be given on top of the screen as shown in the e.g. screen. If more than one arrhythmia occurs it can be viewed by scrolling down the page. The first arrhythmia that is shown on the screen will be the latest one. The arrhythmia will be annotated by its name along the waveform itself (on the 0 second waveform).
ECG trend recall 328.
ECG recall 328 , On pressing this touch icon a new screen appears on the screen 104 with ECG waveforms. The various ECG waveforms are displayed on 104. Top portion of the screen contains tabular format & bottom will contain graphical format.
ST trend recall 330
On pressing the touch icon 330 a new screen will appear to show ST segment analysis recall window. The various ST segments are displayed for a selected patient.
APNEA RECALL for TREND , 332
After selection of the APNEA RECALL 332 a new screen will appear on the display to indicate the Apnea data in tabular format. Last 24 Apnea will be stored & displayed on 104.
Date Start Time Duration HR SpO2
16/05/2010 14:25:30 60 Sec* 140 97
16/05/2010 18:48:00 1 min 10 Sec# 140 88


*-Source: -CO2
#- Source: - Respiration
EVENT RECALL, 334
After selection of the EVENT RECALL touch icon 334 on Fig 3-300, a new screen will appear on the display to indicate the Event data in tabular format. Last 240 Hr Events will be stored & displayed.
Date Time Event HR SpO2
16/05/2010 14:25:30 Snoring 140 97
16/05/2010 18:48:00 Snoring 140 88

The following are the Connectivity Options provided inside 102 in this invention.
The events occurred with these also can be recorded & reviewed in trend.

• Wired (802.3) or Wireless (802.11b/g) Connectivity to CNS.
• Wired (802.3) Connectivity to Network laser Printer.
• Barcode Scanner Interface through USB 2.0 port
• Bed To Bed connectivity via Wired (802.3) or Wireless (802.11b/g) n/w.
• Remote System Diagnosis (Over HSDPA/3G network)
• Remote View through Sky View Server.
• DVI Port for slave display connection.
• Data output in HL7 for HIS interface through Wired (802.3) or Wireless (802.11b/g) port.
• Patient data (trend & patient information) download using USB thumb drive.
• Patient transfer (trend & patient information) using USB thumb drive.
• Software upgrade through USB thumb drive
The panel mounted connector 152 on 102 ,Fig 1 is for an external computer display monitor available as a standard part in market with SVGA/HDMI/LVDS interface. When this monitor ( not shown in Fig 1) is connected the details shown in screen 104 are also shown in the said slave monitor.
The distance between this computer display & the patient monitor 102 can be several meters and may be placed in a distant location. The trend screen shown in Fig 3,Fig 4,Fig5,Fig 6,Fig 7 can be separately viewed in this slave monitor whereas the primary screen Shown in Fig 2 can be viewed in 104.

WE CLAIM:

1. An integrated apparatus for physiological monitoring of patients , said system comprising :
an enclosure means;
a patient monitor means secured within said enclosure means, said monitor means comprising :
at least one TFT display means providing plurality of displays such as bed number/unique code/ equipment’s serial part number and the like;
at least one keyboard means having at least one audio and visual indication/alarm means amongst other components of the keyboard means ;
a noise & transient filtering means substantially placed inside said enclosure means ;
a visual alarm means comprises lamps and LED’s of various colors;
at least one micro controller means/processor means operatively connected with said display means, said keyboard means and said noise & transient filtering means adapted to process all data/signals and display in said display means;
wherein said patient monitor means comprises a multi parameter trend representation system such that tabular and graphical representation of multiple parameters is displayed in said single TFT display means to enable a physician to view a trend and a digital data simultaneously and alarm condition are also displayed on dedicated message areas for aiding monitoring and diagnosis.

2. Apparatus as claimed in claim 1 wherein said monitor means displays real time physiological parameter waveforms and numeric values on the primary monitor and also displays the trend on an independent device without disturbing the primary monitor.

3. Apparatus as claimed in claim 1 further comprising a portable storage means such as disc, USB pen drive and the like.

4. Apparatus as claimed in claim 1 wherein said storage means enables selective recording of the table & parameter trend file and 240 Hrs of Real Time data.

5. Apparatus as claimed in claim 1 wherein said storage means storing at least four physiological parameter waveforms and digital data from said sensor means for a period of last 240 hours .

6. Apparatus as claimed in claim 1 wherein further comprises a USB thumb drive operatively connected with said enclosure means enabled to store record tables like parameter trend, alarm trend and patient data can be transferred between 2 monitors using the said thumb drive.
7. Apparatus as claimed in claim 1 wherein said multi parameter trend representation system comprises Graphical trend along with tabular parameter data representation for the selected area of graphical trend.

8. Apparatus as claimed in claim 1 wherein said multi parameter trend representation system displays alarm conditions in graphical representation on the same screen such that the details of the alarm conditions and stored events are represented on the respective alarm and event message areas whenever the cursor coincides with the relevant record on the tabular trend.

9. Apparatus as claimed in claim 8 wherein said alarm conditions comprising high priority alarm condition.

10. Apparatus as claimed in claim 8 wherein said alarm conditions comprising medium priority alarm condition.

11. Apparatus as claimed in claims 8 and 9 wherein said high priority alarm condition is represented by red trace.

12. Apparatus as claimed in claims 8 and 10 wherein said medium priority alarm condition is represented by orange trace.

13. Apparatus as claimed in claim 1 wherein said multi parameter trend representation system having a unique representation of Graphical Trend along with the numeric data of a region of graphical trend selected by the user.

14. Apparatus as claimed in claim 1 comprising representing any stored events on graphical trend area by Blue Dots.

15. Apparatus as claimed in claim 1 comprises of providing complete information of the patient over a period of last 240 hours in Monitoring and Diagnosis.

16. Apparatus as claimed in claim 1 wherein said multi parameter trend representation system comprising displaying multiple vital trends like Vital Trend, NIBP Trend, OxyCardio Respirogram Trend, Online Trend, CO / NICO Trend, Arrhythmia Recall, ECG Recall , Apnoea Recall, ST Recall, Event Recall.

17. Apparatus as claimed in claim 16 wherein said OxyCardio Respirogram Trend selectively comprising Real Time trend of HR, SpO2, RR and the like.

18. Apparatus as claimed in claim 16 wherein said online trend comprising at 2 hours of graphical trend on real time display.

19. Apparatus as claimed in claim 1 wherein said multi parameter trend representation system provide a complete picture of the monitored parameters over a period of maximum 10 days or 240 Hours.

20. An integrated apparatus for physiological monitoring of patients as herein substantially described and illustrated with the accompanying drawings & screenshots.