![](/uploads/1/2/7/4/127460723/563076152.jpg)
Norton Ghost 12 Dos Version Of Grep 3,8/5 4129votesOk, Norton Ghost 2003 clearly has problems with HDDs = 1TB in size. Symantec Ghost Corporate Edition 11.5.0.2165 (is that the latest update?) does indeed support DOS (and I think HDDs = 1TB as well). However, the latest Norton Ghost 14 seems to have abandoned DOS altogether in favour of a VistaPE CD or something.
Now my question is, since the Corp.Seems to be based on an older 11.x version of Norton Ghost, is that the last version to support DOS (and huge HDDs)? Or did Norton Ghost 12 and 13 support DOS (and huge HDDs) as well?
Also, I have an external Seagate USB 2.0 FreeAgent Desktop HDD (. Ghost has had an interesting evolution through the versions. Ghost 2003 was the last consumer version of Ghost that used DOS and the virtual partition method for imaging. Starting with Ghost 9, the consumer version used Win PE for image restores and the powerquest based technologies found in Drive Image, Live State Recovery, and Backup Exec System Recovery.Meanwhile, Ghost corporate became the Ghost Solution Suite and is up to GSS 2.0 the last I heard.
I believe GSS 2 will support greater than 1 TB, but I'm not sure. I would recommend going to the Enterprise forum at and asking there. They should be able to answer your question with respect to GSS.
As to tips with the external USB, make sure you only have one USB connection. DOS has problems with trying to use more than one active USB connection.Norton Ghost, free and safe download.
That are justifiably defined as business or trade secrets,. 03 01 A) naming the County as the Alternate Employer, and the. Of the parties that Contractor will provide the County with de-identified data. Manual, Section P-3700 or a successor provision;.
Norton Ghost latest version: Automatically back up and recover everything on your computer. Norton Ghost helps you back up your. Download Ghost 12.0 For Dos - best software for Windows. Norton Ghost: Norton Ghost 15.0 protects PCs including all applications, settings, folders, and files with. Name: - Symantec Norton GHOST (DOS) Version: 11.5 Official website: Symantec Norton GHOST (DOS) Anti-Virus Deployment Diagnostics. Post navigation.
A patient monitoring system comprises a non-invasive cardiac output sensor and a patient monitor console. The non-invasive cardiac output sensor is capable of acquiring a signal from a patient indicative of blood flow through a heart of the patient. The patient monitor console includes an analysis module and a display. The analysis module is coupled to the non-invasive cardiac output sensor and processes the signal from the patient indicative of blood flow to produce a value pertaining to cardiac output.
The display is coupled to the analysis module and displays the value pertaining to cardiac output. FIELD OF THE INVENTIONThe invention relates to a patient monitoring systems and methods and, particularly, to patient monitoring systems and methods for non-invasively monitoring cardiac output of a patient. BACKGROUND OF THE INVENTIONThere is an ongoing need for medical equipment and procedures that allow for quick and accurate diagnosis of patient conditions. For example, in the context of myocardial infarctions, patients frequently arrive at emergency rooms of hospitals complaining of chest pain. The chest pain may be a symptom indicating the patient is experiencing a myocardial infarction or, alternatively, the chest pain may be a symptom indicating the patient is experiencing a lesser medical condition such as heartburn or indigestion. Statistics show that quickly identifying whether a patient is having a myocardial infarction and treating such condition may minimize the amount of damage to the heart. Therefore, there is an ongoing need for systems that can be used to quickly identify whether a patient has had a myocardial infarction.Additionally, in the context of congestive heart failure, patients benefit from the use of intermittent inotrope infusions, such as milrinone.
These infusions, while usually beneficial, are also costly and carry attendant risks such as dysrhythmias and infection, from both indwelling infusion catheters and pulmonary artery catheters used to document the necessity of inotropic support. Therefore, there is an ongoing need for systems that can be used to conduct a pre-assessment of patients scheduled for intermittent inotrope infusion to ascertain whether or not such infusions are needed.Further, in the context of circulatory deficiencies, acutely ill emergency room patients often have circulatory deficiencies that ultimately lead to shock, organ failure, and death. Early diagnosis is often difficult and subjective, and therefore these deficiencies are currently diagnosed in late stages when therapy is ineffective.
Diagnosing these circulatory deficiencies in their early stages allows the patient to be treated before the course of these deficiencies becomes irreversible. Therefore, there is an ongoing need for systems that can be used to assist early detection of such circulatory deficiencies.It has been found that cardiac output monitoring is useful for diagnosing medical conditions such as those described above. Impedance cardiography techniques for non-invasive monitoring cardiac output are known in the art. However, existing devices that are capable of monitoring cardiac output are cumbersome to utilize.
Therefore, improved patient monitoring systems and methods that are capable of monitoring cardiac output would be highly beneficial. BRIEF SUMMARY OF THE INVENTIONAccording to one preferred aspect, an embodiment of a patient monitoring system comprises a non-invasive cardiac output sensor, a multi-lead electrocardiogram (ECG) sensor, and a patient monitor console. The non-invasive cardiac output sensor being capable of acquiring a signal from a patient indicative of blood flow through a heart of the patient. The multi-lead ECG sensor comprises a plurality of ECG electrodes capable of acquiring a plurality of ECG signals from the patient. The patient monitor console includes an analysis module and a display.
The analysis module is coupled to the non-invasive cardiac output sensor and to the multi-lead ECG sensor, and processes the signal from the patient indicative of blood flow to produce a value pertaining to cardiac output. The display is coupled to the analysis module, and displays the value pertaining to cardiac output and an ECG waveform generated based on the ECG signals.According to another preferred aspect, an embodiment of a patient monitoring system comprises a non-invasive cardiac output sensor, a communication interface, and a patient monitor console. The non-invasive cardiac output sensor is capable of acquiring a signal from a patient indicative of blood flow through a heart of the patient. The communication interface is capable of establishing a communication link between the patient monitoring system and a local area network of a medical facility in which the patient monitoring system is located. The patient monitor console includes an analysis module and a display. The analysis module is coupled to the non-invasive cardiac output sensor, and processes the signal from the patient indicative of blood flow to produce a value pertaining to cardiac output. The display is coupled to the analysis module, and displays the value pertaining to cardiac output.
The communication interface is capable of transmitting the value pertaining to cardiac output over the local area network.Other features and advantages of the invention will become apparent to those skilled in the art upon review of the following detailed description, claims, and drawings. BRIEF DESCRIPTION OF THE DRAWINGSFIG. 1 is a schematic diagram of a patient monitoring system according to a preferred embodiment of the invention;FIG. 2 is a diagram showing electrode placement for a preferred non-invasive cardiac output sensor used in the patient monitoring system of FIG. 3 is a top level menu displayed by a display of the patient monitoring system of FIG.
4 is a top level cardiac output menu displayed by the display of the patient monitoring system of FIG. 5 is a patient information menu displayed by the display of the patient monitoring system of FIG. 6 is a fast look menu displayed by the display of the patient monitoring system of FIG. 1, in which cardiac output data is displayed in a units of measure format;FIG.
7 is a fast look menu displayed by the display of the patient monitoring system of FIG. 1, in which cardiac output data is displayed in a normal ranges format;FIG. 8 is a secondary parameters menu displayed by the display of the patient monitoring system of FIG. 9 is a limits menu displayed by the display of the patient monitoring system of FIG. 10-12 are help menus with different help information windows displayed by the display of the patient monitoring system of FIG. 13 is a waveform menu displayed by the display of the patient monitoring system of FIG.
14 is a speed menu displayed by the display of the patient monitoring system of FIG. 15 is a signal quality menu displayed by the display of the patient monitoring system of FIG.
16 is a beat average menu displayed by the display of the patient monitoring system of FIG. 17 is a change normals menu displayed by the display of the patient monitoring system of FIG.
18 is a check leads menu displayed by the display of the patient monitoring system of FIG. 19 is a check leads menu corresponding to FIG. 18 in which a failed lead condition is detected;FIGS. 20A-20B are flowcharts showing the preferred operation of the patient monitoring system of FIG. 21 is a block diagram showing the patient monitoring system of FIG.
1 networked with other monitoring devices. DETAILED DESCRIPTION OF PREFERRED EMBODIMENTSReferring now to FIG. 1, a patient monitoring system 100 according to a preferred embodiment of the invention is schematically shown.
In general terms, the system 100 includes one or more input devices 105, a patient monitor console 110, a data entry device 115 connected to the console 110, and one or more output devices 120 connected to the console 110. In the preferred embodiment, the patient monitor console is portable and is implemented using a GE Medical Systems Information Technologies, Inc. DASH® 3000 Pro™ brand portable monitor, modified to incorporate additional features described below.The input devices 105 include a multi-lead ECG sensor comprising a plurality of electrodes E 1, E 2. E n that are connectable to a patient. The electrodes are capable of acquiring ECG signals generated by the patient. The number of electrodes E 1, E 2.
E n may vary. For example, three, five, ten or twelve ECG leads may be used. In the preferred embodiment, the number of electrodes is equal to ten and the leads are connected to the patient in a standard twelve-lead configuration for 12SL processing.The electrodes E 1, E 2. E n are connected to the console 110 by an interface cable 125.
The interface cable 125 provides direct communication between the electrodes E 1, E 2. E n and an input port 130. The input port 130 comprises a connector that mates with a corresponding connector on the cable 125. The interface cable 125 allows for transmission of the acquired ECG signals from the patient to the console 110. The interface cable 125 is preferably a passive cable but, alternatively, the cable 125 may contain active circuitry for amplifying and combining the ECG signals into ECG leads (discussed further below). In other embodiments, the electrodes E 1, E 2. E n may be in communication with the console 110 through a telemetry-based transmitter transmitting a radio frequency (“RF”) signal to one or more antennas connected to console 110 through a conventional RF receiver.The input devices 105 further include one or more sensors which are connectable to the patient and acquire additional physiological signals from the patient.
Example sensors may include an invasive and/or non-invasive blood pressure sensor 141, a pulse-oximetry sensor 142, a temperature sensor 143, a carbon dioxide sensor 144, a respiration sensor 145, and a cardiac output sensor 146. Similar to electrodes E 1, E 2. E n and for the embodiment shown, the sensors 140 may be connected to the console 110 at respective input ports 150 by interface cables 152 or via telemetry transmitters as described above.Additional sensors may also be connected to the console 110.
For example, many commercially available sensors are capable of transmitting data via an RS-232 link. 1, respective RS-232 links may be used to transmit data from a plurality of additional sensors 155 to an interface 157, with the interface 157 retransmitting the data to the console 110 by a serial or network link. The sensors 155 may be the same or different types of sensors as the sensors 141- 146.The input signals from the sensors 141- 146 are processed at the console 110 by amplifying-and-filtering circuitry 165, analog-to-digital (A/D) conversion circuitry 170, and an analysis module 175. Depending on the manner in which the sensors 155 provide data to the console 110, the signals from the sensors 155 may be processed by some or all of this circuitry as well. The amplifying-and-filtering circuitry 165, the A/D conversion circuitry 170, and the analysis module 175 may be discrete circuitry, may be incorporated as an integrated circuit (e.g., an application specific integrated circuit), or may be a combination of both.The amplifying-and-filtering circuitry 165 receives the physiological signals from the input ports 130 and 150, and amplifies and filters (i.e., conditions) the physiological signals. For example, the amplifying-and-filtering circuitry 165 includes an instrumentation amplifier 180. The instrumentation amplifier 180 receives the ECG signals, amplifies the signals, and filters the signals to create a multi-lead ECG.
The number of leads of the multi-lead ECG may vary without changing the scope of the invention.The A/D conversion circuitry 170 is electrically connected to the instrumentation amplifier 180. The A/D conversion circuitry 170 receives the amplified and filtered physiological signals and converts the signals into digital physiological signals (e.g., a digital multi-lead ECG). The digital physiological signals are then provided to the analysis module 175 which is electrically connected to the A/D conversion circuitry 170.The analysis module 175 reads the digital physiological signals, analyzes the signals from the A/D conversion circuitry 170, and displays the signals and the resulting analysis to an operator.
The analysis module 175 includes a controller or microprocessor 182 and internal memory 185. The internal memory 185 includes program storage memory 190 for storing a software program and data storage memory 195 for storing data. The microprocessor 182 executes the software program to control the monitoring system 100.
The implementation of the software program, including the operator interface, is discussed in further below.The console 110 also includes a power supply 196. The power supply 196 powers the console 110 and receives input power from either an external power source 194 or an internal power source 198.
The console 110 is preferably capable of being connected to the external power source 194 by way of a port or docking station. The internal power source 160 is preferably a rechargeable battery and is capable of being recharged when the console 110 is received by the docking station.The data-entry device 115 allows an operator (e.g., a technician, nurse, doctor, etc.) to enter data into the console 110. The data-entry device 115 may be incorporated within the console 110 (e.g., a dial control device) or, alternatively, may be a stand-alone device (e.g., a stand-alone keyboard). Other example data-entry devices 115 include a keypad, a touch screen, a pointing device (e.g., a mouse, a trackball), etc.The output devices 120 preferably include a printer 201, a display 202, a storage device (e.g., a magnetic disc drive, a read/write CD-ROM, etc.) 203, and a speaker 204, any or all of which may be integrally provided with the console 110. The output devices 120 further include a central monitor 205 and one or more additional patient monitors 206. The patient monitoring system 100 is connected to the central monitor 205 and the patient monitor 206 by way of a communication interface 197 and a medical communication network 210 of the medical facility in which the patient monitoring system is located. Of course, other output devices may be added or attached (e.g., a defibrillator), and/or one or more output devices may be incorporated within the console 110.
Additionally, not all of the input devices 105 and output devices 120 are required for operation of the monitoring system 100.Referring now to FIG. 2, the cardiac output sensor 146 is shown in greater detail. The cardiac output sensor 146 is non-invasive and preferably employs impedance cardiography to measure cardiac output. Impedance cardiography utilizes changes in thoracic electrical impedance to estimate changes in blood volume in the aorta and fluid volume in the thorax. The changes in thoracic electrical impedance are measured by measuring changes in voltage in response to an applied current.
Specifically, an excitation signal is applied to the patient using electrodes 221 a- 221 b and 222 a- 222 b The electrodes 221 a 14 221 b are placed vertically along each side of the neck, directly below the earlobe. The superior thoracic electrodes 222 a- 222 b are located in-line with the xiphoid process on either side of the thorax along the mid-auxiliary line. The electrodes 221 a- 221 b are positioned directly opposite each other, as are the electrodes 222 a- 222 b. The excitation signal is a low amplitude (e.g., 1-4 milliamps), high frequency (e.g., 30-100 kHz), constant magnitude alternating current which is applied to the thoracic volume.A response signal indicative of blood flow is produced in response to the excitation signal. The response signal is acquired by another pair of electrodes 223 a- 223 b below the current injecting electrodes 221 a- 221 b on the neck, and another pair of electrodes 224 a- 224 b above the current injecting electrodes 222 a- 222 b on the lower thorax. When the constant magnitude current is applied to the thorax, the voltage of the response signal is proportional to the impedance between the electrodes 223 a- 223 b and the electrodes 224 a- 224 b. This impedance is a function of an amount of blood located in a blood flow path that passes through the heart of the patient.Thus, in the embodiment of FIG.
2, the total thoracic impedance Z(t) at any time is equal to the overall thoracic impedance Z 0 plus changes in impedance ΔZ corresponding to both the ventilation and pulsatile blood flow: Z(t)=Z 0+ΔZ(t). The overall thoracic impedance Z 0 is determined by the impedances of the various tissues of the thorax including cardiac and skeletal muscle, fat, lung, bone, vascular tissue, and the ratio of air to liquids in the thorax. The changes in impedance ΔZ corresponding to both the ventilation and pulsatile blood flow result from the fact that blood is highly conductive.
Thus, blood volume increases in the thoracic aorta and, to a lesser extent, in the pulmonary artery, are presumed to cause a decrease in impedance to current flow. Beat-to-beat dynamic impedance (ΔZ(t)), for practical purposes, is the impedance change due to ventricular ejection. The change in impedance caused by respiration can be removed using electronic filtering techniques because it is of larger magnitude and lower frequency. The cardiac output sensor 146 in the embodiment of FIG. 2 is manufactured by CardioDynamics, 6175 Nancy Ridge Drive, San Diego, Calif. 92121.The following tables describe exemplary parameters which pertain to cardiac output and which are measured (Table 1) or calculated (Table 2) by the monitoring system 100.TABLE 1 Measured Parameters Label Parameter Definition Normal Ranges Derivation/Formula TFC Thoracic Fluid Content The electrical conductivity of the chest cavity, which is primarily determined by the intravascular, intraalveolar, and the interstitial fluids in the thorax. Males 30-50/kohm Females: 21-37/kohm TFC = 1 TFI.
EDO 2I Estimated The rate of oxygen Dependent on DO 2I = Cl SpO 2 1.38 Delivered transport in the clinical pathology Hb 10 Oxygen arterial blood. (estimated value) Index PEP Pre Ejection The time interval Depends on Time interval from Period from the beginning HR preload and beginning of Q wave on of electrical contractility the ECG to the B point on stimulation of the the dZ/dt waveform ventricles to the opening of the aortic valve (electrical systole). Wherein, when the cardiac output parameter window is highlighted, and the dial operator input device is pressed while the cardiac output parameter window is highlighted, the display displays a plurality of cardiac output menu options, the cardiac output menu options being selectable by an operator to cause the display to display additional information pertaining to cardiac output to the operator and to receive inputs from the operator to adjust processing of the signal from the cardiac output sensor. Wherein, when the cardiac output parameter window is highlighted, and the dial operator input device is pressed while the cardiac output parameter window is highlighted, the display displays a plurality of cardiac output menu options, the cardiac output menu options being selectable by an operator to cause the display to display additional information pertaining to cardiac output to the operator or to receive inputs from the operator to adjust processing of the signal from the cardiac output sensor. Wherein, when the non-invasive cardiac output parameter window is highlighted, and the dial operator input device is pressed while the non-invasive cardiac output parameter window is highlighted, the display displays a plurality of non-invasive cardiac output menu options, the non-invasive cardiac output menu options being selectable by an operator to cause the display to display additional information pertaining to non-invasive cardiac output to the operator or to receive inputs from the operator to adjust processing of the signal from the non-invasive cardiac output sensor. Wherein, when the non-invasive cardiac output parameter window is highlighted, and the dial operator input device is pressed while the non-invasive cardiac output parameter window is highlighted, the display displays a plurality of non-invasive cardiac output menu options, the non-invasive cardiac output menu options being selectable by an operator to cause the display to display additional information pertaining to noninvasive cardiac output to the operator and to receive inputs from the operator to adjust processing of the signal from the non-invasive cardiac output sensor.
![](/uploads/1/2/7/4/127460723/563076152.jpg)