OBJECTIVEWithout reference, identify basic facts about
the clinical applications of pulse oximeters with at least 70 percent accuracy.
Pulse Oximeters
Purpose Provides continuous, noninvasive
monitoring of patient oxygenation Provides rapid indication of a patient’s
changing level of oxygenation
Pulse Oximeters
Determines arterial blood oxygen saturation (SpO2) using spectrophotometric oximetry principles• Spectrophotometric Oximetry is the measurement of blood
oxygen concentration using an instrument that makes measurements based on the comparison of light being output to the amount received. The more light received the less that was absorbed by the blood.
Determines pulse rate using plethysmographic techniques
Pulse Oximeters (Continued)
Principles Differential light absorption is used to
determine the percent of oxygen saturation of hemoglobin in arterial blood
Hemoglobin - an iron-containing compound found in red blood cells that carries oxygen from the lungs to the body tissues Two different wavelengths of light
Red Infrared
Pulse Oximeters (Continued)
Emitted from a probe Passes through a pulsating arterial bed
Fingertip Earlobe Forehead
To a photodetector
Pulse Oximeters (Continued)
• Light absorption Absorption characteristics »Oxygenated hemoglobin absorbs less
than deoxygenated hemoglobin at the red wavelength
»They are more similar at the infrared wavelength
Each pulse of arterial blood causes small arteries and arterioles to expand and contract, this varies the amount of light absorbed by the arterial blood
Pulse Oximeters (Continued)
A portion of the passing light is absorbed by tissue constituents »Venous blood »Muscle »Cartilage »Bone
The absorption due to these constituents is constant allowing the microprocessor to eliminate them from the calculations
Pulse Oximeters (Continued)
Plethysmographic technique Plethysmogram corresponds to the
patient's pulse waveform This signal is used to calculate the
patient's pulse rate, and is determined from the peaks of the arterial blood waveforms
Pulse Oximeters (Continued)
• Sensor probes Transmittance probes - light from each
LED is passed through the measurement site to a single photodetector on the opposite side
Pulse Oximeters (Continued)
Reflectance probes - light scattered along the tissue surface is collected by a photodetector adjacent to the LED
Pulse Oximeters (Continued)
In both probes, LED's alternately pulse on and off
This allows differentiation between red and infrared light at the photodetector
Pulse Oximeters (Continued)
OBJECTIVEWithout reference, identify basic facts about
the clinical applications of patient monitoring systems with at least 70 percent
accuracy.
Patient Monitoring Systems
Intended Purpose -To watch or monitor a patient's vital signs and display waveforms and/or numerical data
Patient Monitoring Systems
Vital signs Heart rate and ECG
When the heart contracts an electrical signal can be detected by electrodes placed on the patient's chest and extremities
This electrical signal can be plotted as a function of time, and the resultant waveform is referred to as an electrocardiogram (ECG)
Patient Monitoring Systems
• Pulse • Temperature • Blood pressure
Systolic - the peak blood pressure felt in the circulatory system
Diastolic - the resting pressure of heart Mean - average of the systolic and
diastolic
Patient Monitoring Systems (Continued)
Respiration Arterial O2 saturation Cardiac Output Airway CO2 Concentration
Patient Monitoring Systems (Continued)
The medical and nursing staff analyze these physiological parameters To reveal changes in patient's condition To determine proper treatment
Typical locations Acute care units
Intensive care units Cardiac care units
Surgery and recovery units
Patient Monitoring Systems (Continued)
Description of Monitoring Systems Bedside monitor mainframe Has a display and possibly a printer Can be switched with any bedside
monitor Has ports for different modules or
different modules are built in
Patient Monitoring Systems (Continued)
Modules of a bedside monitor ECG module
Amplification of the cardiac signal is performed within the ECG module
Displays electrical activity of the heart by waveform presentation on CRT
Can display oHeart rate - determined from the R to R
interval oHeart irregularities
Patient Monitoring Systems (Continued)
Heart rate alarms Tachycardia - heart rate is too fast Bradycardia - heart rate is too slow
Patient Monitoring Systems (Continued)
Blood pressure module To monitor patients when fluids are
being lost; in burn victims or major surgery
To monitor patients when fluids are gained; during infusions of blood or other fluids
Patient Monitoring Systems (Continued)
To detect hypotension (low blood pressure) which can lead to vascular collapses because of hypovolemia (low blood volume)
To detect hypertension (high blood pressure) which can overload the heart because of hypervolemia (high blood volume)
Patient Monitoring Systems (Continued)
Temperature module (body temperature) Usually measured by means of a
thermistor probe Probe is inserted in mouth, armpit, or
rectum
Patient Monitoring Systems (Continued)
Respiration module Methods »Most common - impedance
pneumography - measurement of the change of impedance across patient's chest during respiration
Patient Monitoring Systems (Continued)
Pressure sensitive capsules placed on abdomen to detect body movement
Thermistor near mouth or nose to measure change in temperature between inhaled and exhaled breaths
May also include an apnea alarm
Patient Monitoring Systems (Continued)
Carbon dioxide (CO2) module • Measures CO2 concentration at the end
of an exhaled breath • Two types
Capnograph »Measures the increase and decrease
in CO2 during each inspiratory / expiratory cycle
»Displays both CO2 waveform and numerical data
Patient Monitoring Systems (Continued)
Capnometer Continuously measures CO2 Displays only numerical data When connected to a patient monitor,
becomes a capnograph
Patient Monitoring Systems (Continued)
Pulse oximeter module Noninvasive and continuous means of
monitoring percent of O2 saturation (SaO2) of arterial blood
Reduces the need for arterial puncture and blood gas analysis
Patient Monitoring Systems (Continued)
Physiological monitors are often equipped with 2 types of alarms System faults
Loose electrodes Defective electrodes
Physiological parameters have exceeded the limits set by the operator
Patient Monitoring Systems (Continued)
OBJECTIVEWithout reference, identify basic facts about
the clinical applications of electrocardiograph units with at least 70
percent accuracy.
Electrocardiograph
Intended Purpose To detect the electrical activity of the
heart and produce an electrocardiogram (ECG) which is a graphic record of voltage versus time
To diagnose cardiac abnormalities To monitor patient's response to drug
therapy
Electrocardiograph Units
To revel major changes in heart rate and cardiac rhythm (ECG disturbances) Pericarditis - inflammation of the sac
containing the heart Atria and ventricular hypertrophy -
enlargement f the walls due to obstruction
Myocardial infarctions - coagulation in the muscular tissue of the heart resulting from obstruction of circulation
Electrocardiograph Units (Continued)
Ventricular fibrillation Asystole Electrolyte concentrations and acid base
balance Increased metabolic activity Drug reactions Hypoxemia - low oxygen content in the
blood Hypothermia - low body temperature
Electrocardiograph Units (Continued)
ECG monitors typically measure and display up to three physiological parameters Electrocardiogram (ECG) Heart rate Body temperature or respiration
Electrocardiograph Units (Continued)
Elements of the ECG P-wave - represents depolarization of both
atria Begins with electrical impulse from the
SA node Impulse spreads in wave-like fashion,
stimulating both atria Both atria depolarize (contract) and
produce electrical activity
Electrocardiograph Units (Continued)
PR Segment Electrical impulse from atria passes to
the AV node There is a 1/10 second pause allowing
blood to enter the ventricles The AV node is depolarized Duration - .12 - 2.0 seconds Measures from the onset of the P-wave to
the onset of the QRS complex
Electrocardiograph Units (Continued)
QRS complex Represents the electrical impulse as it
travels from the bundle of HIS into the bundle branches into the Purkinje fibers and into the myocardial cells (causing ventricular contraction)
The depolarization of the ventricles Duration - .08 - .12 seconds
Electrocardiograph Units (Continued)
Consists of: Q-wave
First down stroke of the QRS complex Not always present
R-Wave - first upward deflection of the QRS complex
S-Wave - first downward stroke after the R-wave
Electrocardiograph Units (Continued)
ST segment Used to identify myocardial infarctions Serves as the isoelectric line from which
to measure the amplitudes of other waveforms
J-point - junction between the QRS complex and the ST segment
T-wave - represents the repolarization of the ventricles
Electrocardiograph Units (Continued)
Principles of Operation The heart rate is determined by the R to R
interval of successive QRS waves Electrocardiographs record small voltages
(about 1mv) that appear on the skins surface as a result of cardiac activity by using various electrode configurations discussed earlier
Electrocardiograph Units (Continued)
Multichannel electrocardiographs Operate similarly to single channel units
in that the user selects certain similar functions:Automatic or manual lead switching Signal sensitivity Chart speed
Electrocardiograph Units (Continued)
Unlike signal channel units, multichannel units have some advantages:Record 3 or more leads simultaneously Tracings can be held in memory Tracings are printed out in a one-page
format
Electrocardiograph Units (Continued)
Modes Manual mode »User selects three leads to be
recorded »Unit traces signal from these leads
until others are selected
Electrocardiograph Units (Continued)
Automatic mode »Each standard 12 leads are recorded
for a preset time period »Switching from one lead to another
occurs automatically »Some units can be programmed to
record tracings from any lead sequence
Electrocardiograph Units (Continued)
Units with integral timers and selectable chart speeds can also be programmed for »Stress testing »Trending »Rhythm monitoring
Semi-automatic mode »Recorder scans through first lead
group
Electrocardiograph Units (Continued)
Semi-automatic mode » Recorder scans through first lead group »Then switches to observe modeoAllows user to preview next lead group
for signal quality before recording oUser restarts recording of next group
manually• Lead hold feature
Overrides programmed timer Allowing longer recording time for a
particular lead
Electrocardiograph Units (Continued)
Sensitivity setting User selectable Determines size of the recorded ECG
waveformECG signals that become too large and
produce a waveform that goes over scale (arrhythmic beat) »Most units will automatically switch to
lower sensitivity setting immediately
Electrocardiograph Units (Continued)
Other units allow user to choose between recording »Affected channel at lower sensitivity »All channels at lower sensitivity »Waveform as is, followed by re-
recording at lower sensitivity
Electrocardiograph Units (Continued)
Frequency response Factory-set to detect ECG signals
between 0.05 and 100 Hz for diagnostic purposes
Electrical interference also occurs within this range producing artifacts by recording »Muscle movement »Line power frequency
Electrocardiograph Units (Continued)
To reduce such interference, notch filters can be selected to block these frequencies »Because filters limit frequency
response, they can affect diagnoses based on certain details (amplitude)
»Therefore, they are not usually used for diagnostic recording
Electrocardiograph Units (Continued)
ECG tracings Single-channel units require cutting
and pasting to achieve standard format Mutichannel electrocardiographs
require less preparation time - 3 leads are recorded simultaneously
In some mutichannel units, no cutting or pasting is necessary
Electrocardiograph Units (Continued)
»ECG signals from each lead are stored in memory
»Then traced all at once on a single page
»Therefore, all 12 ECG tracings are representations of the heart's electrical activity from same heart beat
Formatting options One-page formatting Formatting according to number of
pages programmed
Electrocardiograph Units (Continued)
Formatting according to number of heart beats recorded in each lead group
Formatting according to number of seconds for overall recording
Automatic formatting saves time but an atypical waveform may be missed
Some units are capable of producing multiple copies of recent ECGs
Electrocardiograph Units (Continued)
Data which can be printed at the top of ECG recordings Patient data (entered by alphanumeric
keyboard if available) Time Lead identifiers Heart rate
Electrocardiograph Units (Continued)
Recording parameters »Sensitivity setting »Chart speed »Filtered mode
Options Heart rate LED or LCD displays
Electrocardiograph Units (Continued)
Alarms »Tachycardia »Artifacts »Loose electrodes »Out-of-paper »System fault (leads/electrodes)»Automatic recording
Electrocardiograph Units (Continued)
Capability of storing rhythm strips for later retrieval
Ability to extend recording time if arrhythmia is detected
ECG report editing capability "Freeze" capability »ECG will be held and displayed
indefinitely »The current trace will be lost or
transferred to another channel (printer)
Electrocardiograph Units (Continued)
"Memory delay" feature - the last few seconds of the trace prior to an alarm will be lost or transferred to another channel or printer
Some store, compute, and display trends in data through the use of a microprocessor »Trend plot is a graph of a physiological
parameter over a period of time »Heart rate trend is an example
Electrocardiograph Units (Continued)
Where Multichannel Electrocardiographs are Found
Doctor's office Flight medicine clinics Physical exams and standards clinics Intensive care units Coronary care units Emergency rooms Cardiopulmonary labs Special care units
Electrocardiograph Units (Continued)
OBJECTIVEWithout reference, identify basic facts about the clinical applications of defibrillators with
at least 70 percent accuracy.
Defibrillators
Terms and Definitions Arrest - cessation of the electrical activity of
the heart Atrial flutter - very rapid (250-150/min)
electrical discharge and contraction of the upper chambers (atria) of the heart
Cardiogenic shock - shock resulting from the diminishment of cardiac output
Fibrillation - irregular, totally disorganized electrical activity of the atria or ventricles or both
Defibrillators (Continued)
Defibrillation - electrical termination of fibrillation
Cardioversion - the restoration of the sinus rhythm by electrical shock
Synchronous - occurring at the same time Stored energy - the energy stored within
the defibrillator by the capacitor
Defibrillators (Continued)
Joule - a unit of work; the energy expended by 1 amp flowing for 1 second through 1 ohm of resistance Also called a watt second The unit of calibration for the output of a
defibrillator
Defibrillators (Continued)
Intended Purpose To apply controlled monophasic (single
phase) or biphasic (two phase) DC defibrillating pulse to the heart Monophasic
One pulse of electricity One direction of current flow between
the paddles High amounts of energy needed
Defibrillators (Continued)
Biphasic • Current reverses itself • Two directions of current flow • Uses smaller amounts of energy • Can compensate for differences in
patient impedance Chest size Tissue density
Defibrillators (Continued)
Sync mode To perform elective cardioversion Uses the patient's generated R-wave as a
timing reference Most defibrillators also monitor the ECG
signal To verify fibrillation To verify effectiveness of treatment
Patient signals can be picked up by the external paddles which are transcutaneous leads
Defibrillators (Continued)
Paddle Types Standard adult external Anterior/posterior Internal Pediatric Neonatal (newborn) Disposable
Defibrillators (Continued)
Modes of Operation External emergency defibrillation
Discharge into the patient by pressing the 2 discharge buttons (one on each handle) simultaneously
2,000 to 4,000 volt shock For less than 20 msec Using gels and pastes to improve
conductivity between paddles and chest
Defibrillators (Continued)
AHA ( American Heart Association) Studies indicate that about 98% of patients
can be defibrillated with 300 joules or less Recommends not exceeding 360 joules
delivered to the patient Internal defibrillation
Energy is delivered directly to the exposed heart
All defibrillators are designed to limit the output energy to 50 joules to prevent injury to the heart muscle
Defibrillators (Continued)
• Paddles are small (50 mm in dia.) and able to withstand sterilization between uses
Synchronized cardio version (Sync Mode) • Uses a discharge of 25-100 joules • Used to correct certain arrhythmias
Ventricular tachycardia Atrial flutter
• Sync marker will show up on the defibrillator monitor on the R-wave
Defibrillators (Continued)
The shock is delivered On the first down stroke of the R-wave
detected after both paddle discharge buttons are pressed
Must occur within 30 msec of the R-wave
Timing is critical because discharge during the T-wave could cause fibrillation
Defibrillators (Continued)
OBJECTIVEWithout reference, identify at least four out of
six basic facts about the clinical applications of invasive and noninvasive blood pressure
monitors.
Invasive and Nonivasive Blood Pressure Monitors
Purpose The presence of an ECG signal does not
assure effective pumping of blood Automatic electronic sphygmomanometers
noninvasively measure and display a patient's arterial blood pressure
Invasive and Nonivasive Blood Pressure Monitors (Continued)
Terms and Definitions Systolic pressure - the highest arterial
pressure of the blood Diastolic Pressure - the lowest arterial
pressure of the blood Mean - midway or an average of the
systolic and diastolic pressures Pulse pressure - the difference between
the systolic and diastolic pressures
Invasive and Nonivasive Blood Pressure Monitors (Continued)
Korotkoff sounds - sounds heard through the stethoscope as the blood flow changes
Hypotension - low blood pressure Hypertension - high blood pressure Hypovolemia - inadequate blood volume Hypervolemia - excessive blood volume Noninvasive - uses a cuff Invasive - uses a catheter and puts patient
at a higher risk of infection or emboli
Invasive and Nonivasive Blood Pressure Monitors (Continued)
Normal pressure - 120/80 mmHg expressed as systolic over diastolic pressures
Principles of Blood Pressure Left ventricle of heart contracts • Blood is forced into arteries • Creates a pressure increase, peak of
which is called systolic pressure
Invasive and Nonivasive Blood Pressure Monitors (Continued)
Ventricles then relax Pressure in the arteries decrease as
blood leaves arteries and enters capillaries
Lowest point the pressure reaches before the next ventricular contraction represents the diastolic pressure
Pressure values are recorded in millimeters of mercury (mmHg)
Invasive and Nonivasive Blood Pressure Monitors (Continued)
Noninvasive Method Peripheral blood flow sounds were
correlated to systolic and diastolic pressures by Nicolai Korotkoff in 1905
Uses a cuff wrapped around patient's arm and a stethoscope
Cuff is inflated to pressure greater than systolic pressure Patient's artery closes Blood flow stops
Invasive and Nonivasive Blood Pressure Monitors (Continued)
Cuff pressure is gradually lowered, pressure falls below systolic pressure but higher than diastolic pressure Some blood forces its way through artery Blood flow not normal, the resulting
turbulence produce korotkoff sounds Sounds persist until cuff pressure falls
below the diastolic pressure and blood flow returns to normal
Invasive and Nonivasive Blood Pressure Monitors (Continued)
Techniques for Automatic Measurement Auscultatory Same principles as
sphygmomanometers, detection of korotkoff sounds Pressures at which korotkoff sounds
first begin mark the systolic pressure Pressures at which sounds disappear
marks the diastolic pressure Cuff with transducer wrapped around
patient's arm
Invasive and Nonivasive Blood Pressure Monitors (Continued)
Cuff is inflated with transducer positioned against compressed artery Transducer detects korotkoff sounds Enables user to determine both systolic
and diastolic values Oscillometric Cuff is wrapped around a patient's arm
and inflated Pressure in the cuff is released
Invasive and Nonivasive Blood Pressure Monitors (Continued)
Sensor located in the monitor detects air pressure fluctuations in the cuff Due to arterial volume changes Occur because blood is pulsing through
artery, rather than flowing smoothly Pressure at which oscillations peak
correspond to mean arterial pressure (MAP)
Unit calculates the systolic and diastolic pressures from the increasing and decreasing magnitude of the oscillations
Invasive and Nonivasive Blood Pressure Monitors (Continued)
Differential sensor Cuff with dual-head sensor inflates
around a patient's arm Cuff pressure is released
Sensor against artery detects korotkoff sounds, oscillometric pressures and artifact signals
Sensor against the cuff (air bladder) detects only oscillometric sounds and artifact signals
Invasive and Nonivasive Blood Pressure Monitors (Continued)
The monitor subtracts the two signals leaving only the korotkoff sounds
Process should remove some of the unwanted interference signals
Light-emitting diode (LED) Cuff bladder - slipped over patient's
finger or thumb
Invasive and Nonivasive Blood Pressure Monitors (Continued)
Cuff is inflated stepwise under microprocessor control Signals from optical sensor determine
mean arterial pressure which is sufficient enough to permit the artery to remain open
Procedure repeated several times in first minute until volume of finger under cuff is stabilized »Once stabilized, unit is calibrated to
patient
Invasive and Nonivasive Blood Pressure Monitors (Continued)
» Calibration procedure takes place every minute in some units
Changes in blood volume causes the optical sensor to send signals to an electropnuematic servo-controlled valve Increases and decreases the cuff pressure A transducer detects the cuff pressure and
produces a corresponding electrical signal Arterial pressure waveform can be displayed
on a monitor or sent to a printer
Invasive and Nonivasive Blood Pressure Monitors (Continued)
Advantages of Noninvasive Low risk to patient compared to invasive Simplicity - easy to set up
Locations Emergency room Intensive care unit Surgery Recovery
Invasive and Nonivasive Blood Pressure Monitors (Continued)
OBJECTIVEWithout reference, identify basic facts about
the clinical applications of infusion pumps with at least 70 percent accuracy.
Infusion Pumps
Introduction to Fluid Therapy Body fluid balance depends upon • Fluid intake • Body requirements for fluids
Functioning regulatory systems • Cardiovascular system (volume and
blood pressure) • Urinary system (Kidneys) • Nervous system • Endocrine system (Hormones)
Infusion Pumps (Continued)
Electrolytes and other chemical substances which keep body fluids in balance
Disturbances in fluid balance Dehydration - insufficient body water
Causes » Inadequate fluid intake »Vomiting and diarrhea »Fever and excessive sweating
Infusion Pumps (Continued)
Signs and symptomsThirst Weight loss Low fluid output/concentrated urine Dry membranes in mouth and eyes
Treatment Replace fluids orally when mild Replace fluids by standard IV drip when
severe
Infusion Pumps (Continued)
Edema - accumulation of excess fluid in body tissue Causes
Heart failure or vessel obstruction Protein loss (starvation, burns) Systemic infection/inflammation Kidney problems/renal failure
Infusion Pumps (Continued)
Signs and symptoms Swollen eyelids/puffy face Swollen feet and ankles Abdominal distention
Treatment Special IV fluids which pull water from
tissue into vessels Low sodium diet
Infusion Pumps (Continued)
• Other disturbances in fluid balance Dysfunction in almost any organ
system can affect fluid balance Fluid balance can be affected by
certain drugs - hormones, diuretics
Infusion Pumps (Continued))
Fluid Therapy By Intravenous Route IV regular and special use • Provides route for fluids when oral route
cannot be used or is not practical GI problems (obstruction, mal-
absorption)
Infusion Pumps (Continued)
Inability to swallow (oral surgery, unconscious patient)
Intolerance to oral fluids (nausea, vomiting)
Some medications are more effective when given by IV route (antibiotics)
Infusion Pumps (Continued)
Used pre- and post-operatively GI tract must be at rest for anesthesia
related safety purposes (i.e. no food) Gives emergency access to the
circulatory system during surgery for fluid replacements, blood, medication, etc
Infusion Pumps (Continued)
Emergency Effects of IV fluids/drugs are realized
immediately (within seconds) Gives rapid access to circulatory
system Lack of good peripheral circulation in a
shock patient causes poor absorption of IM (intramuscular) or subcutaneous injection. Therefore, IV is the method of choice
Infusion Pumps (Continued)
Limitation/problems of IV therapy • Requires special skill • Certain fluids/drugs cannot be given
through an IV • Complications associated with venous IV
site Infection Tissue breakdown due to drugs or
reaction of tissue with IV line Blood clots (embolism) Air embolus (air bubbles in blood stream)
Infusion Pumps (Continued)
Monitoring IV Therapy Drip rate - measured in cc/hr, is the correlation
between number of drops/minute with actual volume (cc)/hour Leaves room for error due to multiplier effect Changes due to filter clogging or kinked tube Ratio of drops/minute to cc/hr differs with
infusion sets and viscosity of liquid being infused Thicker fluids have slower drops/minute
Infusion Pumps (Continued)
Importance of monitoring • Assure proper amount of drug/fluid is
administered • Required to prevent too much or too little fluid
intake (edema or dehydration) Infusion Therapy
Best way to provide continuous, well controlled infusion • Controlled/preset volume • Delivery is at a constant rate • Can monitor rate, volume, or both depending on
model or style
Infusion Pumps (Continued)
Types Controllers
Use gravity feed Monitor the rate by counting drops/minute Control rate by pinching infusion line
Infusion Pumps (Continued)
Pumps - use pressure to move fluid from IV bag to the patientPeristaltic (usually not direct volumetric, but
counts drops) Piston - known volume per stroke Therefore,
rate of stroke controlled Uses - provides continuous, well controlled
administration of critical drugs/fluids when continuous levels and/or well controlled volume is required
Infusion Pumps (Continued)
• Children and infants who have a small body volume • Drug therapy
Antibiotics (systemic) Cardiac drugs Anticoagulants Insulin Electrolytes
• Hyperalimentation - providing the body with nutrition intravenously
Infusion Pumps (Continued)
Advantages of infusion pumps over standard IV methods Usually more accurate/consistent than
standard drip method Allows for better measurement of total
fluid input when this is critical (edema) Warn the staff when there are problems
like extremely high or low pressure in the IV line (occlusion or dislodged line)
Infusion Pumps (Continued)
Disadvantages - always be aware • Requires power, therefore can stop
running unexpectedly • If no battery backup, patient's movement
is limited • Pumps can build up extremely high
pressure in the IV line or patient
Infusion Pumps (Continued)
• Can be inaccurate Too little infused - insufficient Too much infused - overdose, circulatory
overload, edema, death
Only as accurate as the BMET who calibrates it!
Infusion Pumps (Continued)