United States Patent
`
`[I51
`
`3,639,907
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`
`
`
`
` Greatbatch [45] Feb. 1, 1972
`
`[54]
`
`INTERROGATED TELEMETRY ALARM
`SYSTEM FOR PHYSIOLOGICAL
`MONITORING
`
`lnventor: Wilson Greatbatch, Clarence, N.Y.
`[72]
`[73] Assignee: Mennen-Greatbatch
`Electronic,
`Clarence, N.Y.
`'
`.
`.
`Sept. 2’ 1969
`[22] Flled'
`[21] Appl. No.: 854,582
`
`Inc.,
`
`
`{:3 338'"""""""""""""340/150’ 346/33 ME’é32/2§}OA0
`[58]
`Field ofSearch
`340/150 3lll 83346/3213 ME‘
`128/2'1 A’ 2‘05 R
`
`[56]
`
`.
`References Cited
`UNITED STATES PATENTS
`
`3,434,15l
`
`3/1969
`
`Bader et al ........................ 346/33 ME
`
`Primary Examiner—Donald J. Yusko
`Attorney—Christel and Bean
`
`ABSTRACT
`[57]
`Apparatus for monitoring from a single station a physiological
`condition, of eaCh Of a plurality of remotely located patients. A
`radio transmitter at the station generates sequentially a plu-
`rality of tone signals. one for each patient and each of a dif—
`ferent frequency, on a common carrier. A radio receiver with
`each patient has a band pass corresponding to a particular one
`of the tone signals. Each receiver when addressed activates a
`radio transmitter with the patient for transmitting to a single
`receiver at
`the station a coded signal
`indicative of the
`physiological state of the patient, derived from signal generat—
`ing means operatively connected to the patient. The signals
`received at the station are sequentially routed, decoded, and
`applied to suitable indicators.
`
`3,253,588
`
`5/1966
`
`Vuilleumier et al. ..............340/ i 83 X
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`I
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`4 Claims, 2 Drawing Figures
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`|'~_—_____—'“_ ____—“~“ ~"—__|
`PATIENT
`32
`RECEIVER
`JJ
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`CONTl NUOUS
`READOUT
`CONTROL
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`57
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`DEClSlON
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`|PR2018—01093
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`Apple Inc. Ex. 1007 Page 1
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`IPR2018-01093
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`PATENTEMB 119.72“
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`7
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`35399071
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`CONTROL
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`CONTI NUOUS
`‘READOUT
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`INVENTOR.
`ZUZZS’OM GVTEaféaZ05
`BY
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`’éw‘i’ @5442
`ATTQRNEYS.
`|PR2018—01093
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`Apple Inc, Ex. 1007 Page 2
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`IPR2018-01093
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`1
`INTERROGATED TELEMETRY ALARM SYSTEM FOR
`PHYSIOLOGICAL MONITORING
`
`2
`BRIEF DESCRIPTION OF THE DRAWING FIGURES
`
`3,639,907
`
`FIG 11s a schematic block diagram of physiological moni-
`toring apparatus in accordance with the present invention;
`and
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`5
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`FIG. 2 isa schematic block diagram showing1n more detail
`a portion of the apparatus of FIG. I.
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`35
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`SUMMARY OF THE INVENTION
`
`BACKGROUND OF THE INVENTION
`.
`.
`‘1
`The present 1nvention'relates to the telemetry art and, more
`particularly, to a system for monitoring the physiological con-
`DETAILED DESCRIPTION OF THE ILLUSTRATED
`‘ dition of each of a large number of patients by the telemetry.
`EMBODIMENT
`Physiological monitoring of a large number of patients by 10
`Ina preferredarrangement of physiological monitoring ap—
`=‘automat1c means 15 becommg 1ncreasmgly necessary . as
`‘paratus constructed in accordance with the present invention,
`shortages 0f hosp1tal personnel increaseand 3.5 hosp1tal act1v1-
`the equipment designated generally at 10 on the left hand side
`‘ >t1es expand and become more h1ghly FPeC'a".Zed- Upon leav-
`of FIG. lis stationary, being in a fixed location relative to the
`mg intensive care units, pat1ents are 1n hospItal areas thh
`, often are relatively less rigidly observed, and in such areas au- 15 patients being monitored. For convenience hereafter
`the
`tomatic physiological monitoring can reduce the mortality
`componentsiin this portion of the apparatus will be designated
`rate from cardiac 3"“! and fibr1llat10n As hospltal care
`with the .term, station. The nurses's station on a hospital floor
`progresses from 't5 present state, additional intenswe care
`or the central monitoring station in an intensive care unit are
`units, each of a more specialized nature, are envisioned and 20 examples of where station apparatus 10 can be located.
`w1ll augment the need for automatlcphysmlogical momtormg.
`Station apparatus 10comprises a radio transmitter 11 hav-
`'Automat1c phys1010g1cal monitormg by telemetry has‘been
`ing a radiating antenna 12 which transmitter functions, briefly,
`'PIOI’OSed and ‘3; part1cularly advantageous because 0f_ the
`to generate a radiofrequency signal consisting of a plurality of
`‘ ability to ‘COMmUOUSlY monitor an ambulatory pat1ent.
`coded tones on a common carrier. There would be generated,
`I-Ie'retofore, the number 0f patients that COUId be accom- 25 morex'specifically, a different tone or a combination of dif-
`‘ ‘ferent tones :for each patient, and the tones would be trans-
`‘ modated economically by telemetry was limited to about 10
`mitted sequentially. A sequencing means l3‘suitable for this
`patients due to equipment and frequency spectrum limita-
`purpose is operatively connected through a line 14 to trans-
`tions. For example, there must be interference-free reception
`mitter 11. Station apparatus 10 further comprises a radio
`from one patient about 200 feet from a receiving antenna and
`receiver 15 having a receiving antenna 16 which receiver
`delivering only 2 or 3 microvolts of signal to‘the receiver, and
`functions,:briefly, tovreceive radiofrequency signals on a dif-
`yet another patient on an adjacent telemetry channel and posi-
`ferent channel relative to that of transmitter 11. More specifi-
`tioned only about 10 feet from the same antenna must not
`.cally, receiver 15 responds to signals received from patients
`contribute any crosstalk. Otherwise, an alarm might be
`being monitored which signals indicate the physiological con-
`received from the wrong patient. In addition, the channel
`dition of each patient. Receiver 15 is operatively connected
`separations must be unequal so as to avoid unwanted modula-
`through a line 17 to a decoding circuit 18 which also is opera-
`tion products from mixed transmitter signals, from mixed
`tively connected to sequencing means 13 through a line 19.
`receiver local oscillators and from var1ous I F. signals traveling
`The purpose of this arrangement
`is to route properly a
`through the system.
`received and decoded signal to a particular one of a plurality
`of indicators 20, one for each patient, which are connected to
`the output of decoder 18 through lines designated 21. Indica-
`tors 20 preferably are lamps or other visual devices which tell
`the observer immediately when a particular patient is ex-
`periencing a physiological disorder, as willbe described in
`more detail hereafter.
`
`It is, therefore, an object of this invention to provide ap-
`paratus for continuously‘monitoring the physiological condi-
`tion of each of a large number of patients, such as about ‘100,
`by telemetry.
`illt is a further object of this invention toprovide such ap-
`paratus which is readily usable with ambulatory patients.
`It is an additional object of this invention to provide such
`apparatus which provides a rapid indication of the type of pa—
`‘tient disorder giving rise to an alarm, deferred access to stored
`“physiological data, and continuous readout of data from a. pa—
`tient in‘alarm.
`, It is a further object of the“ present invention-to provide such
`apparatus which can monitor a large number of patients at a
`relatively fast rate, for example the totalnumber of patients
`every l0 or 20 seconds
`The present invention provides physiologicalmonitoring
`apparatus including a radio receiver with each patient and
`connected in controlling relation to a correspondinguradio‘
`transmitter with each patient, each receiver having‘a different
`‘ frequency passband. The receivers are addressed sequentially
`‘ by a radio transmitter. at a monitoring station which, generates
`sequentially a corresponding plurality of coded tones on a
`common carrier. Each receiver, when addressed, activates the
`transmitter whichIS controls which, in turn, transmits a coded
`*signal indicative of the patient’5 physiological condition to a
`single radio receiver at the monitoringstation whereupon the
`, signalIS routed and decoded
`The foregoing andadditionaladvantages and charactenzmg
`features of the present inventionlwillbecome clearly apparent
`upon a reading of the ensuing detail description of an illustra-
`tive embodiment together with the included drawing depicting
`‘ the same.
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`45'
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`The physiological monitoring apparatus of the present in-
`ventionzalso includes components, designated 25, 25', 25”,
`etc., in FIG. 1, there being one component or unit for each pa-
`tient, and the different units for different patients being distin~
`guished in FIG. 1 by the use of primed designations. Each unit
`‘ 25 preferably is of a size and construction readily adapted to
`be carried by an ambulatory patient and for this reason will be
`referred to as being patient—carried. Each patient-carried unit
`includes; briefly, a radio ‘receiver,ithe antenna of which is
`designated 26 in’FIG. 1, adapted to respond to a particular
`one of the coded tones generated by transmitter 11 at station
`1,10..Each.iunit 25 further includesa radio transmitter con-
`:nected in controlled relation to- the receiver and which func-
`tions, whenuactivated,
`to transmit
`from an antenna .27,
`radiofrequency signals indicative of that patients‘s physiologi—
`cal condition. These signals are received by receiver 15 at sta-
`tion‘ 10.1.Each~ unitZS further. includes input terminals 28, 29
`,65'
`‘for receiving electrical signals, indicative of the patient‘s
`physiological condition. For example,..when.the apparatus of
`‘ 'the:.present invention isused to monitor‘the cardiac behavior
`of each of a: number of patients, input-terminals 28, 29 are
`. connected directly to the patient, being placed in or on his
`70 chest in a conventional manner, and thervoltages thereon in-
`,. dicative of cardiac behavior are amplified landaprocessed by
`.Jadditionalcircuitry in component 25 as ,will be described
`: hereafter Alternatively, terminals 28, 29 may be connected to
`75the output of anappropriate transducer operatively connected
`to thepatient.
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`|PR2018—01093
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`3,639,907
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`FIG. 2 shows in more detail a preferred form of each pa-
`tient-carried unit 25 especially suitable for monitoring cardiac
`behavior. A radio receiver 30 is operatively connected to an-
`tenna 26 and has a particular frequency passband which per-
`mits reception of a particular one of the coded tones from sta-
`tion transmitter 11. Receiver 30 is connected through a line
`31 in controlling relation to a radio transmitter 32 which, in
`turn, is operatively connected to antenna 27. By virtue of this
`arrangement, receiver 30 when addressedby one of the coded
`tones from station transmitter 11 activates transmitter 32
`which, in turn, radiates from antenna 27 a coded signal indica—
`tive of that patient’s physiological condition, in this particular
`example a signal coded in terms of cardiac behavior.
`Transmitter 32 is provided with information concerning the
`patient’s cardiac behavior by the following arrangement. input
`terminals 28, 29 are connected to the input of a preamplifier
`33 which is designed to have an amplification factor of about
`1,000 when the apparatus is employed in cardiac monitoring.
`In this particular situation the signals on terminals 28, 29 in-
`dicative of the patient’s heartbeat will have an amplitude of
`only about 2—3 microvolts. The amplified signals appearing at
`the output of preamplifier 33 are applied through a line 34 to
`the input of a decision circuit 35, the purpose of which is to
`determine whether the signals are indicative of normal or ab-
`normal physiological behavior. For example, in monitoring of
`cardiac activity, the repetition rate of signals applied to circuit
`35 is the information parameter. Circuit 35, which can include
`standard frequency responsive and logic networks, in this par-
`ticular example makes a comparative determination as to
`whether the rate is normal, indicating that the cardiac condi-
`tion of the patient is satisfactory, too fast indicating tachycar-
`dia/fibrillation, or too slow indicating bradycardia/arrest. The
`frequency parameter on the input signal to circuit 35 can be
`converted therein to an amplitude or pulse width parameter
`on the output thereof. For example, circuit 35 can be con-
`structed to provide no output when the rate is normal but to
`provide an output or alarm signal when either of the above-
`mentioned disorders is detected, the particular one being
`determined by output signal amplitude, duration or even.
`polarity.
`There is also included a command circuit 36, the input of
`which is connected through a line 37 to the output of decision
`circuit 35. The output of command circuit 36 is applied
`through a line 38 to a coding means 39, operatively connected
`to transmitter 32 through a line 40. The purpose of command
`circuit 36 is to transform the signals received from decision
`circuit 35,
`indicative of the patient’s condition,
`into cor-
`responding signals which are suitable to command operation
`of coding means 39 to generate a coded signal corresponding
`to the particular condition of the patient. Coding means 39
`can have several known forms, depending upon the manner in
`which the output signal of transmitter 32 is to be modulated in
`terms of information concerning the physiological condition
`of the patient. The signal from transmitter 32 can, for exam-
`ple, be a coded tone in a one of three code indicating patient
`satisfactory, bradycardial/arrest alarm or tachycardia/arrest
`alarm. A fourth state might be added to the code indicating no
`signal from the transmitter so that the particular patient’s
`equipment can be repaired or replaced. Instead of coded
`tones, other types of modulation, for example pulse width,
`might be employed.
`It is apparent, therefore, that command circuit 36 can have
`several known forms depending upon the nature of coding
`means 39 and the type of signals required to operate it. In cer—
`tain applications it also may be possible to incorporate the
`function of command circuit 36 into either or both of decision
`circuit 35 and coding means 39.
`The patient—carried apparatus 25 also includes a tape-loop
`recorder, designated generally at 45, for providing deferred
`access to stored physiological data, for example about 10
`minutes of recorded ECG activity. The output of preamplifier
`33 accordingly is connected by lines 46 and 47 to a recording
`head 48 of tape recorder 45. Tape recorder 45 would be
`
`placed in operation at the patient’s location whenever it is
`desired that recording begin. Preferably, alarm activation
`would stop the tape so as to store the previous ten minutes of
`data preceding the event and to this end the output of decision
`circuit 35 is connected by a line 49 to a controlled tape drive
`means 50.
`The physiological monitoring apparatus of the present in-
`vention operates in the following manner. It is, in effect, an in-
`terrogation system, and is somewhat similar to the [FF system
`(Identification, Friend or Foe) used in military aircraft. The
`patient-carried radio transmitters, such as transmitter 32, all
`operate at the same frequency but transmit only when inter-
`rogated.
`ln monitoring of cardiac behavior,
`the response
`modulation can be one of four audio tones, one for “no
`alarm," the second for “bradycardia/arrest alarm," the third
`for "tachycardia/fibrillation alarm," and the fourth for ”no
`signal alarm.“
`Station transmitter 11 together with the patient-carried
`receivers, one of which is receiver 30, constitute an interroga-
`tor. Transmitter 11 operates on a frequency different from
`that on which patient-carried transmitters 32 operate so that
`the overall system uses only two radiofrequency channels. The
`coded tones provided by transmitter 11, one for each patient,
`are generated sequentially under control of sequencer 13
`which in one form can be a two—gang stepping switch. One
`gang provides sequencing of code generation by transmitter
`11, represented schematically by line 14, and the other gang
`controls routing of signals from receiver 15 through decoder
`18 to the particular one of the patient indicator 20. Since only
`a tone is elicited from each patient transmitter 32 in response
`to interrogation, i.e., the corresponding patient receiver 30
`being addressed by the particular coded tone from transmitter
`11, the patient scanning rate is very fast, sampling 100 patients
`every 10 or 20 seconds.
`The interrogator portion of the apparatus of the present in-
`vention can comprise one of several interrogation systems
`commercially available, modified so as to be coded with
`respect to the patients being monitored. One is an induction
`coupled, low frequency variety wherein station antenna 12
`would comprise a wire surrounding the patients being moni-
`tored and antennae 26, 26’, etc., each with a particular pa-
`tient, would be induction-coupled to the wire in a manner
`similar to the coupling between transformer secondary and
`primary coils. A second variety is of the radiofrequency type,
`operating in the range of about 27 to about 54 megacycles,
`and including vibrating needs in the receivers for decoding.
`Decoder 18 at the monitoring station 10 would include stan-
`dard radio receiver detector circuitry, the exact nature de-
`pending upon the type of modulation employed in the patient
`transmitters 32. It is contemplated that the speed of operation
`of sequencer 13 in relation to the time needed for a radio
`signal to travel from station 10 and for a response signal to
`return is such that one response signal will be properly routed
`to a patient indicator 20 before sequencer 13 advances to the
`next step for generation of the next coded tone in transmitter
`11. The output of decoder 18, routed to the particular line 21,
`could be one of three voltage levels depending upon the na-
`ture of the alarm received. Each indicator 20 could include
`three lamps differentiated by color or by indicia according to
`the nature of the alarm, and there would be included also
`suitable voltage level responsive circuitry for energizing the
`lamps.
`transmitters 32
`The alarm signals generated by patient
`rather than being coded tones could be microsecond duration
`pulses. In this case, three radio receivers instead of a single-
`station receiver 15, could be employed to locate the particular
`patient by vector resolution techniques. Such techniques are
`well known, for example Loran, and in this particular situation
`three receivers measure the time difference in arrival of a
`signal from a single transmitter (patient transmitter 32) rather
`than three transmitters sending signals to a single receiver
`which is the usual case.
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`3,639,907
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`6
`controlled relation to said receiver;
`c. a signal producing means adapted to be operatively con-
`nected to each patient for providing electrical signals hav-
`ing a parameter which varies in accordance with changes
`in a physiological characteristic of the particular patient;
`d. decision circuit means with each patient and having an
`input coupled to the output of said signal producing
`means, said decision circuit means comparing the varia-
`tions in said parameter with a predetermined normal
`value and providing an output alarm signal in response to
`abnormal variations in said parameter;
`e. coding means with each patient coupled to said decision
`circuit means and to said transmitter whereby the
`radiofrequency signal generated by each transmitter is
`coded in terms of the alarm state of the physiological
`characteristic of the particular patient;
`f. a radio transmitter at said station for generating sequen-
`tially a plurality of signals, the number being equal to the
`total number of patients being monitored and the
`frequency of each one corresponding to a particular pass—
`band of one of said receivers whereby said transmitter
`with each patient is periodically interrogated;
`g. a radio receiver at said station for receiving signals from
`said transmitter with each patient;
`h. decoding means connected to the output of said station
`receiver and operative sequentially in synchronism with
`said station transmitter for decoding the physiological
`state signal from each patient; and
`i. a plurality of indicating means, one for each patient,
`operatively connected to said decoding means.
`2. Apparatus as defined in claim 1 wherein each signal
`producing means comprises:
`a. an input terminal adapted to be operatively connected to
`the particular patient for sensing electrical signals indica-
`tive of cardiac behavior; and
`b. an amplifier having an input connected to said terminal
`and an output; and
`c. decision circuit means having an input connected to the
`output of said amplifier, and wherein said decision circuit
`provides
`output alarm signals in response to an abnormal rate of
`signals applied to the input thereof.
`3. Apparatus as defined in claim 2 further including mag-
`netic tape recording means, the recording element of which is
`connected to the output of said amplifier and the drive means
`of which is connected in controlled relation to the output of
`said decision circuit for stopping said tape recording means in
`response to an alarm signal.
`4. Apparatus as defined in claim 2 further including means
`connected in controlled relation to the output of said decision
`circuit for coupling the output of said amplifier directly to said
`patient transmitter in response to an alarm signal.
`*
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`5
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`The apparatus of the present invention advantageously pro-
`vides continuous monitoring of a large number, for example
`about 100, ambulatory patients. Monitoring is done at an ex-
`tremely fast rate, such as the total number of patients every 10
`or 20 seconds. Moreover, the patient-carried transmitters 32
`operate only upon interrogation,
`in a time-sharing mode,
`thereby reducing battery drain and permitting less frequent
`battery replacement. All patient transmitters are identical
`units and only the coding elements in the patient receivers 30
`are different so transmitter construction and tuning is ad-
`vantageously quite simple.
`The apparatus of the present invention can include an addi-
`tional arrangement whereby in response to the occurrence of
`an alarm, a continuous readout of the patient‘s ECG signal au-
`tomatically is transmitted to the station. To this end line 46, on
`which the ECG signal is available from the output of preampli—
`fier 33, is connected by a line 55 to the input of a component
`designated 56 in FIG. 2 for controlling the operation of trans-
`mitter 32 in this continuous readout mode. Component 56 is
`to operate only in response to the occurrence of an alarm
`signal provided by decision circuit 35, and for this reason
`component 56 is connected in controlled relation through a
`line 57 and line 49 to the output of decision circuit 35. Circuit
`56 is connected by a line 58 to transmitter 32 whereby the car-
`rier thereof is modulated with the patient’s ECG signal. Cir-
`cuit 56 in addition would be constructed to provide an addi-
`tional tone which when transmitted to station 10 would stop
`sequencing of transmitter 11 and hold it on the particular
`channel where the alarm had been received. To this end a
`frequency-responsive circuit, designated 60 in FIG. 1, is con-
`nected to the output of receiver 15 by a line 61 and adapted to
`respond to this particular tone. Circuit 60,
`in turn, is con-
`nected to sequencing means 13 by a line 62 to command
`stopping thereof.
`The receiver 15 at station 10 then would receive continuous
`ECG data from the patient and would ignore all other patients
`on the system until that particular patient’s transmitter had
`been cleared whereupon the system would again start
`sequencing through the total number of patients. Readout and
`possibly also storage of the particular patient’s continuous
`ECG signal
`is performed by conventional
`equipment,
`designated 65, connected to the output of receiver 15.
`It is therefore apparent that the present invention accom-
`plishes its intended objects. While a single specific embodi-
`ment thereof has been described in detail, this is done for the
`purpose of illustration without thought of limitation.
`lclaim:
`1. Apparatus for monitoring from a single station a
`physiological condition of each of a plurality of remotely
`located patients comprising:
`a. a radio receiver with each patient and each receiver hav-
`ing a different frequency passband;
`b. a radio transmitter with each patient and connected in
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`|PR2018—01093
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