U.S. patent application number 16/222853 was filed with the patent office on 2019-04-25 for assistive capnography device.
The applicant listed for this patent is MASIMO CORPORATION. Invention is credited to Ammar Al-Ali.
Application Number | 20190117930 16/222853 |
Document ID | / |
Family ID | 53881221 |
Filed Date | 2019-04-25 |
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United States Patent
Application |
20190117930 |
Kind Code |
A1 |
Al-Ali; Ammar |
April 25, 2019 |
ASSISTIVE CAPNOGRAPHY DEVICE
Abstract
Systems and method for monitoring patient physiological data are
presented herein. A gas analyzing measurement head can be provided
to sample and analyze respiratory gases of a patient. In one
embodiment, the gas analyzing measurement head can read information
on an information element of an airway adapter or resuscitation
bag. Such information can be used to generate instructions for
manual ventilation using the gas analyzing measurement head, airway
adapter, and resuscitation bag. Manual ventilation instructions can
be displayed on the gas analyzing measurement head or can be
transmitted for display on another device, such as a clinician's
mobile computing device.
Inventors: |
Al-Ali; Ammar; (San Juan
Capistrano, CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
MASIMO CORPORATION |
Irvine |
CA |
US |
|
|
Family ID: |
53881221 |
Appl. No.: |
16/222853 |
Filed: |
December 17, 2018 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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14627500 |
Feb 20, 2015 |
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16222853 |
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61943263 |
Feb 21, 2014 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 2560/0443 20130101;
A61B 5/0836 20130101; A61B 5/097 20130101; A61M 16/1005 20140204;
A61B 5/082 20130101; A61M 16/04 20130101; A61M 16/208 20130101;
A61M 2230/432 20130101; A61M 16/0051 20130101; A61M 16/021
20170801; A61M 2205/35 20130101; A61B 2505/01 20130101; A61M 16/06
20130101; A61M 16/085 20140204; A61M 16/0003 20140204; A61M 16/01
20130101; A61B 5/7445 20130101; A61M 16/0084 20140204; A61B 5/4836
20130101; A61M 2205/505 20130101; A61M 2016/103 20130101 |
International
Class: |
A61M 16/10 20060101
A61M016/10; A61M 16/00 20060101 A61M016/00; A61M 16/08 20060101
A61M016/08; A61B 5/083 20060101 A61B005/083 |
Claims
1.-24. (canceled)
25. (canceled)
26. A physiological monitor including an electronic display device,
which provides respiration guidance to assist in timing respiration
events, the physiological monitor comprising: at least one sensor
configured to measure information responsive to at least one
physiological parameter; at least one processor configured to
provide guidance for respiration event sequences; and a display
configured to provide a visual indication of the guidance, the
visual indication comprising a graphic that expands and contracts
to indicate a timing of a desired respiratory sequence.
27. The physiological monitor of claim 26, wherein the display
device is a smartphone.
28. The physiological monitor of claim 26, further comprising a
first housing for the sensor and a second housing for the
display.
29. The physiological monitor of claim 26, wherein the graphic
comprises a plurality of circles.
30. The physiological monitor of claim 26, wherein the at least one
processor is further configured to detect a time of performance of
the respiration event sequences; and generate feedback for the user
based on a predetermined rate and the detected time of
performance.
31. The physiological monitor of claim 30, wherein the
predetermined rate is based on reminder settings corresponding to
certain time or cycle.
32. The physiological monitor of claim 26, wherein the respiration
event sequences correspond to cardiopulmonary resuscitation
(CPR).
33. The physiological monitor of claim 26, wherein the
physiological parameter comprises respiration rate and wherein the
at least one processor is configured to determine that the
respiration rate of the user is outside of threshold readings and
select guidance based on the determination.
34. The physiological monitor of claim 26, wherein the guidance
includes a rate of conducting the respiration event sequences and
wherein the at least one processor is further configured to
generate stimulatory feedback to guide the user to follow the
rate.
35. The physiological monitor of claim 34, wherein the at least one
processor is configured to update the rate based on the determined
physiological parameter.
36. The physiological monitor of claim 34, wherein the stimulatory
feedback includes a vibrational feedback.
37. The physiological monitor of claim 26, wherein the expansion
and contraction is correlated with breathing of the user.
38. The physiological monitor of claim 26, wherein the at least one
processor is configured to display heart rate after the performance
of the respiration event sequences.
39. A method of providing respiration guidance to assist in timing
respiration events, the method comprising: measuring, with at least
one sensor, information responsive to at least one physiological
parameter; generating guidance for respiration event sequences; and
displaying a visual indication of the guidance, the visual
indication comprising a graphic that expands and contracts to
indicate volume of desired breathing in respiratory sequence.
Description
INCORPORATION BY REFERENCE TO ANY PRIORITY APPLICATIONS
[0001] The present application claims priority benefit under 35
U.S.C. .sctn. 119(e) to U.S. Provisional Application No.
61/943,263, titled "DIGITAL INSTRUCTIONS IN CAPNOGRAPHY DEVICE,"
filed Feb. 21, 2014.
[0002] The present application also claims priority to any and all
applications for which a foreign or domestic priority claim is
identified in the Application Data Sheet as filed with the present
application, including without limitation the above-mentioned
provisional application, are hereby incorporated by reference in
their entirety under 37 C.F,R, .sctn. 1.57 and for all
purposes.
FIELD OF THE DISCLOSURE
[0003] The invention relates generally to systems, devices, and
methods for monitoring a patient's respiratory system and health,
including capnographers and other devices that monitor patient
respiratory gases. In particular, this disclosure relates to
respiratory gas measuring devices capable of recognizing attached
airway adapters and resuscitation bags and providing assistance for
manual ventilation.
BACKGROUND
[0004] In respiratory care, it is often desirable to analyze and
monitor the gas composition of a patient's exhaled and/or inhaled
breathing gases. Various requirements for gas analyses exist in
health care. For instance, measurement of respiratory CO.sub.2,
O.sub.2, N.sub.2O and anesthetic agents, such as halothane,
isoflurane, enflurane, sevoflurane or desflurane, is useful in the
care of critically ill patients undergoing anesthesia or mechanical
ventilation, while for emergency care such as manual ventilation it
is typically sufficient to monitor breathing of a patient with a
simple CO.sub.2 analysis.
[0005] Respiratory gases can be analyzed in accordance with many
different measuring principles. The most common method of
respiratory gas analysis, however, is through the medium of
non-dispersive spectroscopy. This measuring principle is based on
the fact that many gases absorb infrared energy at a wavelength
specific to the substance concerned. Main flow gas analyzers based
on non-dispersive spectroscopy measure light absorption at specific
wavelengths directly in the patient's respiratory circuit.
Capnography is the monitoring of the concentration or partial
pressure of CO.sub.2 in respiratory gases, and provides real-time
information regarding CO.sub.2 exhalation and respiratory rates as
well as a rapid and reliable assessment of a patient's ventilatory,
circulatory and metabolic function. Although the terms capnography
and capnometry are sometimes considered synonymous, capnometry
suggests measurement without a continuous written record or
waveform. Typically in capnography and capnometry, a main flow
measuring head is placed as close as possible to the patient's
mouth or trachea to sample exhaled and/or inhaled breathing gases
and calculate gas concentrations directly in the respiratory
circuit of the patient.
[0006] Measurement of end tidal CO.sub.2 can also provide useful
information such as regarding CO.sub.2 production, pulmonary (lung)
perfusion, alveolar ventilation, respiratory patterns, and
elimination of CO.sub.2 from an anesthesia breathing circuit or
ventilator. The gas sample measured at the end of a person's
exhalation is called the "end-tidal" gas sample. The amount of
carbon dioxide in a person's breath can indicate the overall
efficiency of the cardio-pulmonary system and quality of breathing.
For example, the concentration of carbon dioxide can indicate
shallow breathing and poor oxygen intake. Thus, capnographers are
used in hospitals and other medical institutions for monitoring the
condition of a patient's respiratory system, pulmonary perfusion,
and metabolism, and are most often used for patients in intensive
care and under anesthesia.
[0007] In many clinical and emergency settings, respiratory
assistance is accomplished through use of bag-valve mask (BVM)
ventilation systems. Main flow measuring heads can be useful for
implementation in BVM ventilation systems and other manual
ventilation systems to measure end tidal respiratory gases during
respiratory assistance. BVM ventilation is a life-saving skill of
an emergency physician or pre-hospital care provider that can
easily be overlooked because of its apparent simplicity. However,
BVM ventilation is a difficult skill to master, and poor BVM
ventilation technique can lead to the need for more invasive means
of airway management and their inherent complications. Implementing
BVM ventilation with a low rate of bag compression can lead to
hypoventilation and inadequate oxygen supply to the patient.
Hyperventilation due to overzealous BVM ventilation can be harmful
by increasing intra-thoracic pressure, which decreases venous blood
to the heart and subsequently decreases cerebral and coronary
perfusion pressures. The appropriate rate of bag compression for
proper patient oxygenation differs based on factors such as the age
of the patient and the size of the bag. Therefore, there is a need
for measuring heads that are capable of providing instructions and
feedback to manual ventilation providers.
SUMMARY
[0008] Advantageously, in certain embodiments, a physiological
monitoring system can be designed to include a respiratory gas
measurement head with a processing board or card as well as an
airway adapter and resuscitation bag each including an information
element that can identify the airway adapter and resuscitation bag
to the measurement head. For example, an airway adapter information
element can identify the airway adapter to the measurement head as
an adult or infant adapter, and a resuscitation bag information
element can identify a volume of the resuscitation bag to the
measurement head. The system may be connectable to a mobile
computing device, such as a smartphone, such that display of the
instructions for manual ventilation based on monitored
physiological data may occur on the computing device. The board or
card may communicate the instructions and data for display with the
mobile computing device wirelessly or through a physical and
electrical connection with the cable assembly. Alternatively, the
measurement head can include a display to provide instructions to
the care giver.
[0009] Physiological monitoring systems such as are described
herein advantageously enable adaptive display of manual ventilation
instructions to a medical care provider. This improves patient care
and provides a higher likelihood of a positive outcome for the
patient. For instance, upon or after assembly of an airway adapter
and resuscitation bag to a capnographic measurement head, the
measurement head can identify a type of the airway adapter and a
volume of the resuscitation bag. In one example, a processor of the
measurement head can perform the identification by communicating
with an information element located on one or both of the airway
adapter and the resuscitation bag. The identification of the
adapter and ventilation bag can provide many useful parameters. For
example, the parameters can include, for example, the type of
patient, such as an adult patient or an infant patient, the volume
of the bag, the length of the airway adapter and any other useful
parameters helpful in determining proper operation of the manual
ventilation system. As a result of being able to identify the
airway adapter and resuscitation bag, the measurement head provides
appropriate instructions for the parameters of the manual
ventilation system.
[0010] The present disclosure allows a medical care provider to
receive real time (or near real time) feedback regarding their
manual ventilation efforts through analysis of the patient's
physiological data such as end tidal gas values taking into account
the characteristics of the adapter airway and resuscitation bag. To
illustrate, a resuscitation bag that is identified as having a high
volume should be compressed more slowly and/or less frequently than
a resuscitation bag identified as having a small volume in order
for appropriate oxygen delivery to the patient. The present
disclosure allows the ventilation system to provide feedback to
pace the caregiver's efforts. Further, for an individual who is
untrained in manual ventilation but is called to perform such
techniques in an emergency setting, the present system provides
critical manual ventilation instructions based on real time
monitored conditions of the patient.
[0011] For purposes of summarizing the disclosure, certain aspects,
advantages and novel features of the inventions have been described
herein. It is to be understood that not necessarily all such
advantages can be achieved in accordance with any particular
embodiment of the inventions disclosed herein. Thus, the inventions
disclosed herein can be embodied or carried out in a manner that
achieves or optimizes one advantage or group of advantages as
taught herein without necessarily achieving other advantages as can
be taught or suggested herein.
BRIEF DESCRIPTION OF THE DRAWINGS
[0012] Throughout the drawings, reference numbers can be re-used to
indicate correspondence between referenced elements. The drawings
are provided to illustrate embodiments of the inventions described
herein and not to limit the scope thereof.
[0013] FIG. 1A illustrates an embodiment of a physiological
monitoring system.
[0014] FIG. 1B illustrates an embodiment of a measuring head.
[0015] FIG. 1C illustrates an embodiment of an airway adapter.
[0016] FIG. 1D illustrates another embodiment of an airway
adapter.
[0017] FIGS. 2A-2C illustrate various embodiments of a ventilation
assembly.
[0018] FIG. 3 illustrates a schematic block diagram of one
embodiment of a physiological monitoring system.
[0019] FIG. 4A illustrates an embodiment of a software application
for display of ventilation instructions.
[0020] FIG. 4B illustrates another embodiment of a software
application for display of ventilation instructions.
[0021] FIGS. 5A-5D illustrate various embodiments of display
interfaces on a measuring head.
[0022] FIG. 6 illustrates an embodiment of a manual ventilation
kit.
[0023] FIG. 7 illustrates an embodiment of a manual ventilation
process.
[0024] FIG. 8 illustrates an embodiment of a process for providing
ventilation instructions.
DETAILED DESCRIPTION
I. Example Physiological Monitoring Systems
[0025] FIGS. 1A-1D illustrate embodiments of a physiological
monitoring system 100. The physiological monitoring system 100
shown in FIG. 1A includes a capnographic measurement head 105 and
an airway adapter 120. The measurement head 105 can include a
display 110 having an indication 115 regarding when instructions
are available and a connection port 120 for insertion of the airway
adapter 130. FIG. 1B illustrates an example of the measurement head
105 illustrated without an airway adapter in place. FIG. 1C
illustrates an example of an airway adapter 130a that can be used
in adult or pediatric ventilation assistance, the airway adapter
130a includes an information element 135. FIG. 1D illustrates an
example of an airway adapter 130b that can be used in infant or
neonate ventilation assistance, the airway adapter 130b has an
information element 135.
[0026] The physiological monitoring system 100 can be used to
monitor physiological parameters such as end tidal respiratory
gases including oxygen (O.sub.2), carbon dioxide (CO.sub.2), and
nitrous oxide (N.sub.2O), among others, as well as patient
respiratory rate. A system capable of measuring these parameters is
commercially available from Masimo Corporation of Irvine, Calif.,
marketed under the name EMMA'. The physiological monitoring system
100 can also measure anesthetic agents and perform agent
identification in some examples. The physiological monitoring
system 100 can be used for proof of intubation (that is, to show
that an endotracheal tube has been correctly placed in the trachea,
and not the esophagus, of a critically ill patient), short-term
CO.sub.2 monitoring for ventilation during emergency patient
transport, CO.sub.2 monitoring during cardiopulmonary resuscitation
(CPR), among other uses.
[0027] The measurement head 105 can be configured to analyze
respiration rate and concentration of gases in a patient's exhaled
respiratory gases, among other things. Some embodiments of the
measurement head 105 can be compact, portable for flexible use at
multiple points of care including pre-hospital, emergency medicine,
operating rooms, intensive care units, and long-term acute care.
The measurement head 105 can be provided with display 110 for
illustrating monitored physiological parameters to a clinician.
Although end tidal CO.sub.2 and respiratory rate in breaths per
minute are illustrated in the example display 110, other
embodiments can analyze and display these and/or the additional
parameters discussed above. In addition, in some embodiments the
measurement head 105 can be configured to communicate with an
external display. In some embodiments, the display 110 may be
omitted. Display 110 also includes an indicator 115 to highlight to
a clinician when usage instructions are available for a connected
airway adapter and/or resuscitation bag, as will be discussed in
more detail below. The measurement head 105 can also be provided
with visual and/or audible alarms, a capnograph waveform display,
and various user interface features such as a power button. Some
embodiments of the measurement head 105 may be battery operated and
contain a power source housing.
[0028] As in the illustrated embodiment, the measurement head 105
can be a mainstream capnometer or capnographer placed directly into
a patient's airway or coupled to an airway adapter 130 placed in
the patient's airway. The measurement head 105 can house an
infrared light source and photodetector in some embodiments, such
as a non-dispersive infrared gas analyzer. The measurement head 105
can be, in other embodiments, a sidestream capnometer or
capnographer sampling a patient's respiratory gases through a tube
or lumen from the patient's airway to the measurement head 105.
[0029] The airway adapter 130 can be provided for insertion into or
placement adjacent the patient's mouth. The airway adapter 130 is
configured to transfer or guide gases exhaled from the patient to
the measuring head 105. In some embodiments, the airway adapter 130
can be about 1 inch, about 2 inches, about 4 inches, or about six
inches long. In other embodiments, the airway adapter 130 can be no
longer than about 5 inches. As illustrated in FIGS. 1C and 1D, the
airway adapter can have different configurations for patients of
different ages. For example an airway adapter such as airway
adapter 130a can be used in adult or pediatric ventilation
assistance, while an airway adapter such as airway adapter 130b can
be used in infant or neonate ventilation assistance. In some
embodiments, the airway adapter 130 can be replaceable and/or
disposable while the measurement head 105 is reusable. The airway
adapter 130 may have a hydrophilic inner surface to create a film
of water condensed from a patient's exhaled breath such that the
film does not scatter an infrared beam used to measure gas
concentrations. The inner surface can also be etched in some
embodiments to further control the formation of condensation within
the airway adapter 130.
[0030] The airway adapter 130 can be placed into connection port
120 in the measuring head 105 to provide fluid communication
between a patient's respiratory circuit and a measuring chamber of
the measurement head 105. Exhaled respiratory gases can pass into
the airway adapter 130 through a breathing mask or a sampling line,
and the exhaled gases can pass through an output opening in a side
of the airway adapter into a measuring chamber of the measurement
head 105. In one example, the measuring chamber of the measurement
head 105 can be compressed to a size of 50 .mu.l to provide
accurate measurements under extreme conditions, such as for young
patients with very high breathing rates, delivering approximately a
50 mL/min sampling flow that can accommodate respiratory monitoring
for patients of a wide range of ages, from adults to neonates.
[0031] The measurement head 105 can be configured to measure a
physiological parameter of the patient by analyzing the respiratory
gases in the measuring chamber. In one implementation of gas
analysis, the light from an infrared emitter can pass through the
gas mixture in the measuring chamber and the light can be filtered
by a narrow-band optical band-pass filter. The gases can absorb the
infrared light at known, gas-specific wavelengths during passage of
the light through the gas mixture. The partially absorbed light can
be detected by an infrared detector and the intensity of the
detected light can be determined, for example by a processor of the
measurement head 105 or by the processor of another computing
device. By measuring the intensity of the light that was not
absorbed into the gas mixture, a quantification of the
concentration of a gas or gases in the gas mixture can be obtained.
In this manner, an embodiment of the measurement head 105 can
analyze an unknown gas mixture and identify which gases and/or
agents are present in the mixture.
[0032] Accordingly, the measurement head 105 can include an
emitter, an optical filter, and at least one sensor (not
illustrated) for conducting analysis of gas concentrations in
respiratory gas samples received from the airway adapter 130. The
emitter, filter, and sensor can be positioned in the measuring
chamber within the measurement head 105, for example near the
output opening in the airway adapter. An emitter can be configured
to emit light at one or more wavelengths into a measuring chamber
containing a gas sample, and a sensor can be configured to detect
the emitted light. An optical filter (not illustrated) can be
included in the measurement head 105. For example, the filter can
be a narrow band optical filter, and can be manufactured using a
film deposition process that can balance out film layer thickness
variations created by changes in temperature in order to reduce
center wavelength drift with temperature.
[0033] A sensor, such as an infrared detector, can be included in
the measurement head 105 to receive the light emitted by the
emitter. In one embodiment, the sensor or sensors can be a
spectrometer used to detect slight changes in infrared radiation to
precisely determine gas concentrations in a mixture by measuring
absorption caused by molecules in the gas sample. In some
embodiments, the spectrometer can detect changes in multiple
wavelengths of light, for example at nine different wavelengths in
the long-wavelength infrared (LWIR) spectrum. The LWIR wavelength
band contains strong absorption peaks for CO2, N2O, and various
anesthetic agents, with negligible interference from alcohol,
acetone, and other gases and vapors that could potentially degrade
measurement accuracy. In another embodiment, the sensor(s) can be
carbon dioxide sensors, for example nanotechnology carbon dioxide
sensors, nanoelectric sensors, pyroelectric detectors, thermopile
detectors, or infrared sensors. In multigas monitoring embodiments
of the measurement head 105, the sensor(s) can be configured to
trace gas sample compositions across multiple pre-selected narrow
band optical filters. In some embodiments multiple sensors may be
mounted in a thermally stable array, for example a block of
aluminum.
[0034] The measurement head 105 can also include a processor (not
illustrated) generally including circuitry that can process the
physiological parameter signal(s) generated by the sensor(s) prior
to display or storage of the parameters. The processor can include
instructions to process analog pressure, temperature, and flow
signals combined with data from the sensor(s). The processor can
analyze the data received from the sensor(s) and determine a
physiological parameter or parameters of the patient. For example,
the processor can include any of a variety of front-end signal
conditioners, such as filters, amplifiers, buffers, memories and/or
analog-to-digital (A/D) converters known to those of skill in the
art. The processor can extract one or more optical filter signals
from the sensor data and can filter the signal(s) to remove noise
in some embodiments, such as high and low frequency noise. The
processor can analyze the sensor data and/or filtered data to
determine gas and agent identification and measurement. In one
example, the processor can be a 32-bit RISC microprocessor. In
another example, the processor can be a 41-MIPS RISC DSP and can
provide power to a spectrometer of the measurement head 105. The
processor can be designed to be compact and power-efficient in some
embodiments. The processor can be a digital signal processor (DSP)
or analog processor or combination of both.
[0035] The processor can also include instructions to communicate
with the information element 135 of an airway adapter 130, the
information element of a resuscitation bag, and/or the information
element of another respiratory assistance component. Such
information elements can be placed at any location on the airway
adapter or resuscitation bag that can be in electrical contact with
the measurement head 105, and the measurement head 105 can have
corresponding reading element(s) for contacting the information
element(s). Though discussed primarily in the context of airway
adapters and resuscitation bags, such information elements can be
provided on any ventilation assistance component such as gas
sampling lines and breathing masks, to name a few other
examples.
[0036] In some embodiments, the processor of the measuring head 105
can read data stored on an information element upon or after
physical and electrical connection to the corresponding reading
element. The processor can use the data to identify an attached
ventilation assistance component. The information element 133 can
be an active circuit such as a transistor network, memory chip,
EEPROM (electronically erasable programmable read-only memory),
EPROM (erasable programmable read-only memory), or other
identification device, such as multi-contact single wire memory
devices or other devices, such as those commercially available from
Dallas Semiconductor or the like. The information element can be,
in some embodiments, a resistor, a capacitor, a microchip, a RAM, a
ROM, or any other information storage element. In addition, the
information element can include a combination of one or more of any
of the above.
[0037] In other embodiments, the processor and information element
may communicate wirelessly. For example, radio communications can
be used to identify an attached ventilation assistance component
and/or its characteristics. In one embodiment, radio-frequency
identification (RFID) can enable communication between an
information element and the processor. A passive RFID tag can be
included in or on an airway adapter and/or resuscitation bag, the
tag containing electronically stored information. The RFID tag can
act as a passive transponder to emit radio waves that can be
detected by an active reader element associated with the processor
of the measurement head. In another embodiment, near field
communication (NFC) technology can enable communications between an
unpowered NFC chip on an airway adapter or resuscitation bag and an
NFC reading component communicating with the measurement head
processor. As another example, the measurement head can be equipped
with an optical scanning means for scanning a barcode, matrix
barcode, or other optical machine-readable representation of data
on an airway adapter or resuscitation bag. In some embodiments,
various ventilation assistance components can implement the same or
different communication means as discussed above.
[0038] An information element can store information specific to the
corresponding ventilation accessory component. For example, an
airway adapter information element 135 can include data to identify
an intended age group of the airway adapter, for example by
identifying the airway adapter as one of an adult/pediatric airway
adapter 130a or an infant/neonate airway adapter 130b. Such
information can be used by the processor to provide age-specific
ventilation instructions to a clinician. Though two examples of
airway adapters are illustrated in FIGS. 1C and 1D, other sizes of
airway adapters are possible in other embodiments. As another
example, a resuscitation bag information element can include data
to identify characteristics of the resuscitation bag such as
volume, compressive resistance, or the like. Such information can
be used by the processor to provide instructions regarding
compression rate and compression depth, as well as other manual
ventilation techniques. Such information elements can also be used
to store instructions specific to the component to which they are
attached.
[0039] In addition, such information elements can store information
about the use of the airway adapter or resuscitation bag in order
to prevent overuse or reuse. During use, airway adapters and
resuscitation bags collect condensation from a patient's exhaled
respiratory gases. As such, it can be unsanitary to reuse such
components from patient to patient. Accordingly, an information
element can store data indicating that the component has already
been attached to a measurement head, and therefore has presumably
been used. In some embodiments, the measurement head may not
perform measurements when a used component is detected and/or may
output an indication to replace the component with a new
component.
[0040] The instructions can enable clinicians to assess the
effectiveness of cardiopulmonary resuscitation (CPR) and can guide
manual ventilation. For example, the measurement head 105 can use
the physiological data to determine whether adequate ventilation is
occurring, and the measurement head 105 can use communications with
a resuscitation bag information element to provide feedback on the
depth and effectiveness of compressions of the resuscitation bag.
As another example, the measurement head 105 can use communications
with an airway adapter information element 135 to provide
ventilation instructions appropriate for the patient's age group
based on whether the airway adapter is an adult airway adapter 130a
or an infant airway adapter 130b.
[0041] Some embodiments of display 110 can be sized and configured
to display the instructions on the measurement head 105. In other
embodiments the processor may communicate the instructions to an
external display, such as a medical terminal or a clinician's
mobile device. The instructions can be a graphical representation
of compression rate and compression depth in one example. As
another example, an auditory signal can be provided to guide
compression rate and compression depth. Indications of the quality
of manual ventilation technique can be provided including an alarm,
an icon, or a color that generally represents the quality of a
measured physiological parameter. The instructions can include, in
some embodiments, instructions for proper assembly of the
physiological monitoring system 100 and/or proper placement on a
patient. The measurement head 105 can update or alter the
instructions during the course of manual ventilation assistance
based at least partly on the physiological data of the patient in
some embodiments.
[0042] The system 200a as illustrated in FIG. 2A shows a measuring
head 205 coupled to an airway adapter 210, with the airway adapter
210 coupled to a breathing mask 215. The system 200a can be placed
over a patient's mouth for safe delivery of rescue breaths during
CPR, for example during cardiac arrest or respiratory arrest. The
system 200a can also be attached to other manual or mechanical
ventilation components.
[0043] The system 200b as illustrated in FIG. 2B shows a measuring
head 205 coupled to an airway adapter 210, with the airway adapter
210 coupled to a breathing mask 215, similar to the system 200a of
FIG. 2A. The system 200b also includes a resuscitation bag 225
coupled to the airway adapter 210 for operation by a care provider
240. The breathing mask 215 of system 200b is illustrated placed
over a patient's 230 mouth for delivery of manual ventilation
therapy. A care provider must ensure that the mask is substantially
sealed around the patient's face such that pressure needed to
force-inflate the lungs is not released into the environment.
Though illustrated with a mask 215 over a patient's mouth, other
implementations of the system 200b can be adapter for connection to
an endotracheal tube or laryngeal mask airway.
[0044] System 200b can be used to provide positive pressure
ventilation to patients who are not breathing or are not breathing
adequately without assistance. The resuscitation bag 225 acts as a
flexible air chamber that, when squeezed, forces air through a
one-way valve into the patient's lungs. When released, the
resuscitation bag 225 self-inflates through the end not coupled to
the airway adapter 210, drawing in either ambient air or an oxygen
flow supplied by a regulated cylinder, while also allowing the
patient's lungs to deflate to the ambient environment.
[0045] The system 200b can be available in different sizes to fit
infants, children, and adults in some embodiments. The sizes of the
face mask 215, airway adapter 210, and bag 225 may vary independent
of one another. For example, a pediatric sized bag might be used
with different masks for multiple face sizes, or a pediatric mask
might be used with an adult sized bag for patients with smaller
faces. In order to be effective, a bag valve mask must generally
deliver between 500 and 800 ml of air to a normal male adult
patient's lungs, however if supplemental oxygen is provided 400 ml
may still be adequate. This amount can vary for females, children,
and infants. Generally, squeezing the bag once every 5-6 seconds
for an adult or once every 3 seconds for an infant or child can
provide adequate respiratory rate (determined as 10-12 respirations
per minute in an adult and 20 per minute in a child or infant). As
such, based on the patient as well as the size of the face mask
215, airway adapter 210, and bag 225, a care provider performing
the manual ventilation is required to use different compression
rates and depths of compression in order to provide suitable
ventilation assistance. The presently described device can provide
feedback to a user based on current patient parameters and device
parameters in order to assist a user to provide optimal manual
ventilation to a patient.
[0046] FIG. 3 illustrates a schematic block diagram of one
embodiment of a physiological monitoring system including a
reusable gas analyzer 300, an airway adapter 310, and a
resuscitation bag 320. The airway adapter 310 includes an
information element 315 and the resuscitation bag 320 includes an
information element 325. As discussed above, the information
element 315 can serve to identify characteristics of the airway
adapter 310 to the reusable gas analyzer 300, and the information
element 325 can serve to identify characteristics of the
resuscitation bag 320 to the reusable gas analyzer 300.
[0047] Information element 315 can store data identifying
characteristics of the airway adapter 310. For example, the data
can include a size of the airway adapter 310 such as adult, child,
infant, or neonatal. The data can also include a type of the airway
adapter such as an airway adapter designed to connect to a
breathing mask or an airway adapter designed to connect to an
endotracheal tube. In some embodiments, the data can include
information regarding a manufacturer of the airway adapter 310.
This data can be used to determine whether to recommend
instructions to a care provider and/or which instructions to
recommend to a care provider. For example, an airway adapter 310
from a known manufacturer may be associated with a specific set of
instructions, while an airway adapter 310 from an unknown
manufacturer may not be associated with instructions. As another
example, an infant airway adapter may be associated with
instructions for a more rapid rate of compression relative to the
instructions associated with an adult airway adapter. Information
element 315 can store data representing instructions associated
with use of the airway adapter 310 in some embodiments. In an
embodiment, the information can store a formula or algorithm that
the measurement head can use in addition to other data to determine
proper compression rates. For example, the information from the
airway adapter can be combined with end tidal CO.sub.2 to determine
an adjusted compression rate depending on the patient's
responsiveness.
[0048] Information element 325 can store data identifying
characteristics of the resuscitation bag 320. For example, the data
can include a size or volume of the resuscitation bag 320
corresponding to an adult, child, infant, or neonatal patient's
lung volume and respiratory needs. Adult bags, in some embodiments,
can deliver volumes of 240-2,000 ml of room air or oxygen with each
compression. Child and infant bags can be designed to deliver
smaller volumes of room air per compression. In some embodiments,
the data can include information regarding a manufacturer of the
resuscitation bag 320. This data can be used to determine whether
to recommend instructions to a care provider and/or which
instructions to recommend to a care provider. For example, a
resuscitation bag 320 from a known manufacturer may be associated
with a specific set of instructions, while a resuscitation bag 320
from an unknown manufacturer may not be associated with
instructions. As another example, an infant resuscitation bag may
be associated with instructions for a more rapid rate of
compression relative to the instructions associated with an adult
resuscitation bag. Compression rate and depth instructions can also
be based on a comparison of a volume of the resuscitation bag as
communicated by the information element 325 and an age or size of
the patient as input by a care provider. Information element 325
can store data representing instructions associated with use of the
resuscitation bag 320 in some embodiments.
[0049] Information elements 315, 325 can be provided through a
circuit that contacts a corresponding portion in the reusable gas
analyzer 300, for example a transistor network, memory chip, EEPROM
(electronically erasable programmable read-only memory), EPROM
(erasable programmable read-only memory), multi-contact single wire
memory device, a resistor, a capacitor, a microchip, a RAM, or a
ROM, or any other information storage element. Information elements
315, 325 can also be provided through a wireless communication
means such as RFID or NFC, or through optical scanning technology.
Information elements 315, 325 can be configured using the same or
different technologies. For example, in some embodiments
information element 315 of the airway adapter 310 may be in
physical contact with the reusable gas analyzer 300, while
information element 325 of the resuscitation bag 320 may
communicate wirelessly with the reusable gas analyzer 300.
[0050] The reusable gas analyzer 300 may communicate with the
information elements 315, 325 once in some embodiments, for example
upon connection of the airway adapter 310 and resuscitation bag
320, or when the information elements 315, 325 are in wireless
communication range. In some embodiments the reusable gas analyzer
300 may communicate with the information elements 315, 325 when
powered on. In other embodiments reusable gas analyzer 300 may
communicate with the information elements 315, 325 at various
points during ventilation therapy.
[0051] FIG. 4A illustrates an embodiment of an application for
display and management of manual ventilation instructions 405 and
also, in some embodiments, physiological monitoring data. Some
embodiments of the software application may be used with a mobile
computing device of a clinician, illustrated here as smartphone
400. Although specific reference may be made to smartphones in this
disclosure, persons skilled in the art will understand that a
mobile computing device compatible with the physiological sensor
system may be one of a wide range of mobile devices such as a
laptop, tablet computer, netbook, PDA, media player, mobile game
console, stationary or portable medical terminal, or other
microprocessor based device configured to interface with a
physiological sensor. Some embodiments of the mobile computing
device may be used with the system for display of instructions
and/or data as well as storage of data. Cables used to connect
smartphone 400 to a reusable gas analyzer (for example, measurement
head 105 of FIG. 1 discussed above) can be flex cables or other
cables, including cables having triboelectric properties, and some
devices may be configured to connect wirelessly to the reusable gas
analyzer.
[0052] Smartphone 400 may include a display screen such as an LED
or LCD screen, and may include touch sensitive technologies in
combination with the display screen. Smartphone 400 may include
software configured to display manual ventilation instructions 405
as well as some or all of the output measurement data on the
display screen. The instructions can include steps for proper
assembly or placement of a ventilation assistance system and/or
steps for operation of the ventilation assistance system. The
operation steps can be based on data read from information elements
on components of the ventilation assistance system, as discussed
above. A measurement data display may comprise numerical or
graphical representations of end tidal O.sub.2, CO.sub.2, N.sub.2O,
and/or patient respiratory rate and some embodiments may
simultaneously display numerical and graphical data
representations.
[0053] The smartphone 400 may include software such as an
application configured to enable interaction with the instructions
405 as well as to manage output measurement data from the
measurement head processing module. The instruction application
functionality can include provision of assembly or operation
instructions prior to and during ventilation assistance, allowing
clinician input of patient and/or equipment characteristics, and
provision of feedback during ventilation assistance based on
physiological parameters. The data management functionality of the
application can include trend analysis, current measurement
information, alarms associated with above/below threshold readings,
reminders to take measurement data at certain times or cycles,
display customization, iconic data such as hearts beating, color
coordination, bar graphs, gas bars, charts, graphs, or the like,
all usable by a caregiver or smartphone user to enable helpful and
directed medical monitoring of specified physiological
parameters.
[0054] In some embodiments, software capable of analyzing the
output measurement data received from the processing module and
making the data available in an appropriate manner health
management is installed on the smartphone 400. The smartphone 400
may also be able to alert the user to an abnormal data reading and
to update the manual ventilation instructions 405 accordingly. For
example, an abnormally low or high carbon dioxide reading may cause
the smartphone 400 to buzz, vibrate or otherwise notify the user of
an abnormal reading. The smartphone 400 can also issue a graphical
warning. In some embodiments, the instructions can be updated based
on the abnormal reading to provide an updated compression rate
and/or compression depth for a resuscitation bag.
[0055] The smartphone 400 can include graphical instructions 405
for review by the clinician prior to manual ventilation therapy as
well as a selectable option 410 to begin therapy. In some
embodiments, the smartphone 400 can determine that therapy has
begun based on input physiological parameter data and the option
410 can be omitted. The instructions 405 can be replaced or
supplemented, upon commencement of ventilation therapy, with a
compression rate and/or compression depth indicator providing
visual or auditory feedback to a provider regarding depth and
timing of resuscitation bag compressions.
[0056] For example, as illustrated in FIG. 4B, a visual indicator
415 can be accompanied by text 420 in one embodiment indicating
compression rate and compression depth determined to be suitable
for the patient based at least partly on the information elements.
Some embodiments of the software application may also allow for
input by a physician or other care provider and can use the input
to determine the compression rate and compression depth. The visual
indicator 415 can be, in one example, a plurality of concentric
circles. In some embodiments, the circles can be sequentially
illuminated from the outer circle toward the inner circle to
simulate squeezing of the resuscitation bag in order to provide a
physician with visual feedback regarding depth and timing of
compressions. The text 420 can indicate to the physician
compression rate in breaths per minute, a length of time for each
compression, and a percentage of compression of the bag, among
other things.
[0057] In certain embodiments, a software application for
presenting resuscitation instructions may be downloadable from a
computer network at a cost, by subscription, pay-per-use, or the
like. Other embodiments may advantageously be incorporated into
caregiver-specific applications which include reminders for timed
measurements or protocols. For example, a caregiver for a surgical
patient may desire measurement data at regular intervals to assess
the presence and effects of anesthetic agents. A caregiver-specific
application may be advantageously programmed to accomplish such a
protocol. Other caregiver-specific applications may provide
animated or textual instructions, links to online information
regarding certain monitoring situations, ailments, or other useful
patient research.
[0058] FIGS. 5A-5D illustrate various embodiments of display
interfaces on a respiratory gas analyzing measuring head 500. The
measuring head 500 comprises a display 505, which may include a
plurality of display portions in which a plurality of physiological
parameters may be displayed, such as end tidal carbon dioxide
(ETCO.sub.2) and respiratory rate. The display 505 can also include
a portion for manual ventilation compression instructions 510. The
configuration of these various display portions is meant for
illustrative purposes, and one skilled in the art would appreciate
that the parameter and instruction displays could be rearranged
relative to one another, displayed alone, or the user interface
could be modified to include other parameter display portions.
Further, although some of the parameter display portions employ
numerical representations of the physiological data, some
embodiments may employ graphical representations, for example a
contracting/expanding lung icon may indicate respiratory rate.
[0059] As illustrated in FIG. 5A and FIG. 5B, manual ventilation
compression instructions 510 can be graphically represented using a
plurality of concentric circles in one embodiment. The circles can
be sequentially illuminated or filled from the inner circle towards
the outer circle in some embodiments to indicate compression rate
and compression depth. To illustrate, in one embodiment the timing
between the innermost circle first being illuminated, the expansion
of the illumination toward the outer circle, and the contraction of
the illumination toward the inner circle until no circle is
illuminated can correspond to the length of time for one
compression and decompression of a resuscitation bag. As the
illumination begins expanding outward the clinician can slowly
apply pressure on the resuscitation bag. When the illumination
reaches its outermost point and begins contracting inward the
clinician can slowly release pressure on the resuscitation bag. As
another illustration, the amount of illumination of compression
instructions circles can correspond to an amount of compression
applied to the resuscitation bag in some embodiments. When no
circles are illuminated, no compression should be applied to the
bag. When the outermost circle is illuminated the bag should be
fully compressed. When circles between the inner and outer circle
are illuminated, the bag should be partially compressed
corresponding to the positioning of the largest illuminated circle
relative to the outer circle. According to one embodiment of the
instructions, a bag may not need full compression for suitable
patient ventilation so the outermost circle would not be
illuminated. In other embodiments, the circles can be sequentially
illuminated from the outer circle toward the inner circle to
simulate squeezing of the resuscitation bag. Similarly, the circles
can be sequentially un-illuminated from the inner circle to the
outer circle as the bag is decompressed.
[0060] The compression rate and/or compression level can be set at
the initialization of instructions based on data read from the
information element of an attached airway adapter and/or
resuscitation bag. The compression rate and/or compression level
can be varied during therapy based on physiological parameters from
the patient's respiratory gases or other physiological parameters
from other physiological sensors.
[0061] The illustrated graphical example is just one means by which
the measuring head 500 or an associated display can provide a
clinician with instructions or feedback for manual ventilation
therapy. Animated graphical representations of compression can be
used, such as an animated graphic of a hand squeezing and releasing
a bag, an icon of lungs inflating and deflating, or the like.
Auditory representations can be used such as verbal instructions or
a sound that increases or decreases in pitch or volume. These
examples are meant to illustrate and not to limit the manual
ventilation instruction capabilities of the systems discussed
herein.
[0062] As illustrated in FIG. 5C and FIG. 5D, the measuring head
500 display can be used to provide feedback such as a warning to a
care provider. One example of a warning can be an indication that
ventilation is too slow 515, indicating that the care provider
should increase a rate of compressing a resuscitation bag. Another
example of a warning can be an indication 520 to apply more
pressure to a resuscitation bag. Other warnings and indications are
possible in other embodiments.
[0063] FIG. 6 illustrates an embodiment of a manual ventilation kit
600. In the illustrated embodiment, the kit 600 can include an
airway adapter 605 and a resuscitation bag 610. In other
embodiments the kit 600 can include multiple airway adapters and
multiple resuscitation bags. The airway adapter 605 and
resuscitation bag 610 can be matched according to patient age or
size, for example an adult airway adapter and an adult
resuscitation bag. Another example of a kit can include an infant
airway adapter and an infant resuscitation bag. The kit can be
packaged so as to keep the contents sterile. One or both of the
airway adapter 605 and resuscitation bag 610 can include an
information element as described above.
II. Example Physiological Monitoring Processes
[0064] FIG. 7 illustrates an embodiment of a manual ventilation
process 700. The process 700 can be implemented using systems and
components as are described above with respect to FIG. 1A through
FIG. 6, or by any manual ventilation system having the
component-recognizing and instruction-generating capabilities
discussed herein.
[0065] The process 700 begins at block 705 when a clinician or
other care provider connects a disposable airway adapter to a
reusable respiratory gas measurement device. This can cause
electrical or wireless connection of an information element located
on the airway adapter with a processor of the measurement device,
as discussed above. The measurement device can determine whether
the airway adapter has an information element and, if so, whether
data on the information element identifies a size, type, or
manufacturer of the airway adapter.
[0066] At block 710, the clinician connects a resuscitation bag to
the measurement device. This can cause electrical or wireless
connection of an information element located on the resuscitation
bag with a processor of the measurement device, as discussed above.
The measurement device can read the information element as
discussed above.
[0067] At block 715, the clinician can receive instructions for
ventilation therapy performed using the connected airway adapter
and resuscitation bag. The instructions can include one or more of
assembly instructions, patient placement instructions, or therapy
instructions. The therapy instructions can include one or both of
compression rate and compression depth for the resuscitation bag.
As discussed above, the clinician can receive the instructions on
the measurement device or a connected display such as the
clinician's smartphone.
[0068] At block 720, the clinician can perform therapy as needed
according to the instructions. In some embodiments, the
instructions can be updated based on physiological parameters of
the patient as determined by the measurement device.
[0069] FIG. 8 illustrates an embodiment of a process 800 for
providing active feedback ventilation instructions. The process 800
can be implemented using systems and components as are described
above with respect to FIG. 1A through FIG. 6, or by any manual
ventilation system having the component-recognizing and
instruction-generating capabilities discussed herein.
[0070] The process 800 begins at block 805 when a respiratory gas
measurement device detects a connected airway adapter. A
measurement device can be the measurement head 105 of FIGS. 1A-1B
in some embodiments. The airway adapter can be detected using an
information element, pressure sensing, clinician input, or other
known means. The measurement device can detect the airway adapter
in preferred embodiments using electrical or wireless connection of
an information element located on the airway adapter with a
processor of the measurement device, as discussed above. The
measurement device can determine whether the airway adapter has an
information element in some embodiments or whether the airway
adapter is an unknown adapter with no information element.
[0071] At block 810, the respiratory gas measurement device detects
a connected resuscitation bag. The resuscitation bag can be
detected using an information element, pressure sensing, clinician
input, or other known means. The measurement device can detect the
resuscitation bag in preferred embodiments using electrical or
wireless connection of an information element located on the
resuscitation bag with a processor of the measurement device, as
discussed above. The measurement device can determine whether the
resuscitation bag has an information element in some embodiments or
whether the resuscitation bag is an unknown bag with no information
element.
[0072] At decision block 815, the measurement device can determine
whether the adapter and bag are recognized. A recognized adapter or
bag in one example can be an adapter or bag associated with
instructions. The instructions can be stored locally on the
measurement device in some embodiments, or in other embodiments can
be stored in another location such as on an information element
read by the measurement device or on a server accessed by the
measurement device through a network. In one embodiment, if one or
both of the adapter and bag are not recognized, then the process
800 can end. In another embodiment, only if both of the adapter and
bag are not recognized will the process 800 end.
[0073] If one or both of the adapter and bag are recognized, then
the process transitions to block 820. At block 820, the measurement
device provides instructions for ventilation therapy performed
using the connected airway adapter and resuscitation bag. The
instructions can include one or more of assembly instructions,
patient placement instructions, or therapy instructions. The
therapy instructions can include one or both of compression rate
and compression depth for the resuscitation bag, and can be
delivered graphically or through auditory devices. As discussed
above, the clinician can receive the instructions on the
measurement device or a connected display such as the clinician's
smartphone.
[0074] Optionally, at block 825, the measurement device can
determine whether the ventilation therapy is being performed
correctly. For example, the measurement device can determine the
concentration of a desired substance (such as carbon dioxide,
oxygen, etc.), in exhaled gases of the patient. The concentration
can be compared to a range or threshold indicating that adequate
ventilation is being provided to the patient. If therapy is being
performed correctly, then the process 800 can loop back to block
820 to continue providing instructions for ventilation to the
clinician. The process 800 can periodically or continuously perform
the determination of block 825.
[0075] If, at block 825, the measurement device determines that
ventilation therapy is not being performed correctly, then the
process 800 transitions to optional block 830. Optionally, at block
830, the measurement device can provide feedback or a warning to
indicate that the patient is receiving inadequate ventilation. For
example, the feedback can include a change to the instructions,
such as an increase or decrease in compression rate. The feedback
can also include textual or spoken instructions regarding changes
in therapy technique. As another example, a warning can be issued
indicating that ventilation is too fast or too slow.
[0076] The process 800 can then transition to optional block 845 to
determine whether therapy is on-going or has ceased. This can be
determined based on clinician input, prompting the clinician to
indicate whether therapy is continuing, or by monitoring patient
physiological parameters. If therapy is not continuing then the
process 800 can end. If therapy is continuing then the process 800
can loop back to block 820 to continue providing instructions for
ventilation to the clinician. In some embodiments, block 845 can be
omitted and the process 800 can continue as long as the measurement
device is powered on and/or connected to an airway adapter and
ventilation bag.
III. Terminology
[0077] Many other variations than those described herein will be
apparent from this disclosure. For example, depending on the
embodiment, certain acts, events, or functions of any of the
algorithms described herein can be performed in a different
sequence, can be added, merged, or left out altogether (e.g., not
all described acts or events are necessary for the practice of the
algorithms). Moreover, in certain embodiments, acts or events can
be performed concurrently, e.g., through multi-threaded processing,
interrupt processing, or multiple processors or processor cores or
on other parallel architectures, rather than sequentially. In
addition, different tasks or processes can be performed by
different machines and/or computing systems that can function
together.
[0078] The various illustrative logical blocks, modules, and
algorithm steps described in connection with the embodiments
disclosed herein can be implemented as electronic hardware,
computer software, or combinations of both. To clearly illustrate
this interchangeability of hardware and software, various
illustrative components, blocks, modules, and steps have been
described above generally in terms of their functionality. Whether
such functionality is implemented as hardware or software depends
upon the particular application and design constraints imposed on
the overall system. The described functionality can be implemented
in varying ways for each particular application, but such
implementation decisions should not be interpreted as causing a
departure from the scope of the disclosure.
[0079] The various illustrative logical blocks and modules
described in connection with the embodiments disclosed herein can
be implemented or performed by a machine, such as a general purpose
processor, a digital signal processor (DSP), an application
specific integrated circuit (ASIC), a field programmable gate array
(FPGA) or other programmable logic device, discrete gate or
transistor logic, discrete hardware components, or any combination
thereof designed to perform the functions described herein. A
general purpose processor can be a microprocessor, but in the
alternative, the processor can be a controller, microcontroller, or
state machine, combinations of the same, or the like. A processor
can also be implemented as a combination of computing devices,
e.g., a combination of a DSP and a microprocessor, a plurality of
microprocessors, one or more microprocessors in conjunction with a
DSP core, or any other such configuration. Although described
herein primarily with respect to digital technology, a processor
may also include primarily analog components. For example, any of
the signal processing algorithms described herein may be
implemented in analog circuitry. A computing environment can
include any type of computer system, including, but not limited to,
a computer system based on a microprocessor, a mainframe computer,
a digital signal processor, a portable computing device, a personal
organizer, a device controller, and a computational engine within
an appliance, to name a few.
[0080] The steps of a method, process, or algorithm described in
connection with the embodiments disclosed herein can be embodied
directly in hardware, in a software module executed by a processor,
or in a combination of the two. A software module can reside in RAM
memory, flash memory, ROM memory, EPROM memory, EEPROM memory,
registers, hard disk, a removable disk, a CD-ROM, or any other form
of non-transitory computer-readable storage medium, media, or
physical computer storage known in the art. An exemplary storage
medium can be coupled to the processor such that the processor can
read information from, and write information to, the storage
medium. In the alternative, the storage medium can be integral to
the processor. The processor and the storage medium can reside in
an ASIC. The ASIC can reside in a user terminal. In the
alternative, the processor and the storage medium can reside as
discrete components in a user terminal.
[0081] Conditional language used herein, such as, among others,
"can," "might," "may," "e.g.," and the like, unless specifically
stated otherwise, or otherwise understood within the context as
used, is generally intended to convey that certain embodiments
include, while other embodiments do not include, certain features,
elements and/or states. Thus, such conditional language is not
generally intended to imply that features, elements and/or states
are in any way required for one or more embodiments or that one or
more embodiments necessarily include logic for deciding, with or
without author input or prompting, whether these features, elements
and/or states are included or are to be performed in any particular
embodiment. The terms "comprising," "including," "having," and the
like are synonymous and are used inclusively, in an open-ended
fashion, and do not exclude additional elements, features, acts,
operations, and so forth. Also, the term "or" is used in its
inclusive sense (and not in its exclusive sense) so that when used,
for example, to connect a list of elements, the term "or" means
one, some, or all of the elements in the list.
[0082] While the above detailed description has shown, described,
and pointed out novel features as applied to various embodiments,
it will be understood that various omissions, substitutions, and
changes in the form and details of the devices or algorithms
illustrated can be made without departing from the spirit of the
disclosure. As will be recognized, certain embodiments of the
inventions described herein can be embodied within a form that does
not provide all of the features and benefits set forth herein, as
some features can be used or practiced separately from others.
* * * * *