An alarm suspend system utilizes an alarm trigger responsive to physiological parameters and corresponding limits on those parameters. The parameters are associated with both fast and slow treatment times corresponding to length of time it takes for a person to respond to medical treatment for out-of-limit parameter measurements. Audible and visual alarms respond to the alarm trigger. An alarm silence button is pressed to silence the audible alarm for a predetermined suspend time. The audible alarm is activated after the suspend time has lapsed. Longer suspend times are associated with slow treatment parameters and shorter suspend times are associated with fast treatment parameters.
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18. A physiological measurement system comprising:
a noninvasive physiological sensor means for outputting configured to output a signal responsive to a noninvasive measurement of attenuated light transmitted through a tissue site a physiological condition of a patient;
a memory configured to store a first alarm activation threshold; and
a processing means one or more processors in communication with the noninvasive physiological sensor means and configured to:
process the signal to determine a first measurement of a the first measured physiological parameter based at least in part upon the signal;
receive, from a user, an indication of a determine that a first alarm suspension should be initiated for a first parameter-specific alarm suspension period of time corresponding to the physiological parameter, the first parameter-specific alarm suspension period of time corresponding to the first measured physiological parameter and being selected from a plurality of parameter-specific alarm suspension periods of time, the parameter-specific alarm suspension period of time being different from at least one other a second parameter-specific alarm suspension period of time corresponding to at least one other a second measured physiological parameter for which the one or more processors are configured to determine a second measurement;
activate an alarm in response to determining an determine that the first measurement satisfies the first alarm activation threshold has been satisfied by the physiological parameter measurement; receive an alarm suspension indication; and
in response to receiving the alarm suspension indication, suspend the activation of a first alarm for the indicated first parameter-specific alarm suspension period of time and then activate the first alarm.
1. A physiological measurement system comprising:
a noninvasive physiological sensor including: a plurality of light emitting diodes configured to transmit wavelengths of light onto a tissue site of a patient; and at least one detector configured to measure an indication of the wavelengths of light after attenuation by tissue of the patient and be positioned on a patient and output a signal responsive of the attenuated light to a physiological condition of the patient; and
one or more processors in communication with the noninvasive physiological sensor, the one or more processors configured to electronically:
process the signal to determine a measurement of a physiological parameter based at least in part upon the signal;
determine that an alarm should be activated in response to the measurement of the physiological parameter satisfying an alarm activation threshold;
receive, from a user, determine that an indication of alarm suspension should be initiated for a parameter-specific alarm suspension period of time corresponding to the physiological parameter, the parameter-specific alarm suspension period of time being selected from one of at least a plurality of parameter-specific alarm suspension periods of time, the parameter-specific alarm suspension period of time being different from at least one other parameter-specific alarm suspension period of time corresponding to at least one other physiological parameter for which the one or more processors are configured to determine at least one measurement; activate an alarm in response to determining that an alarm activation threshold has been satisfied by the physiological parameter measurement; receive an alarm suspension indication; and in response to receiving the alarm suspension indication,
suspend the alarm for the indicated parameter-specific alarm suspension period of time; and
activate the alarm when the measurement of the physiological parameter satisfies the alarm activation threshold after the parameter-specific alarm suspension period of time has passed.
13. An A method of electronically delaying an alarm while an electronically calculated measurement of a physiological parameter satisfies an alarm activation threshold, the measurement of the physiological parameter responsive to a signal from a noninvasive sensor positioned at a monitored patient, the method comprising:
measuring electronically processing a signal from a noninvasive sensor to determine a first measurement of a first physiological parameter and a second measurement of a second physiological parameter using a patient monitoring device, the patient monitoring device including a processor and a memory device configured to store;
electronically storing, in the memory device, a first parameter-specific alarm suspension period of time corresponding to the first physiological parameter and a second parameter-specific alarm suspension period of time corresponding to the second physiological parameter, the first parameter-specific alarm suspension period of time being different from the second parameter-specific alarm suspension period of time;
electronically determining when the first measurement of the first physiological parameter satisfies a first alarm activation threshold;
receiving, from a user, an indication of a electronically determining that a first alarm suspension should be initiated for the first parameter-specific alarm suspension period of time corresponding to the physiological parameter, the parameter-specific alarm suspension period of time being selected from a plurality of parameter-specific alarm suspension period periods of time, the parameter-specific alarm suspension period of time being different from at least one other parameter-specific alarm suspension period of time corresponding to at least one other physiological parameter; activating an alarm in response to determining an alarm activation threshold has been satisfied by the physiological parameter measurement; receiving an alarm suspension indication;
and in response to receiving the alarm suspension indication, electronically suspending the a first alarm for the first physiological parameter for the indicated first parameter-specific alarm suspension period of time; and
electronically activating the first alarm when the first measurement of the first physiological parameter satisfies the first alarm activation threshold subsequent to the first parameter-specific alarm suspension period of time passing.
2. The physiological measurement system of
provide a user interface to the user including at least a plurality of user-selectable elements, each of the selectable plurality of user-selectable elements corresponding to one of the plurality of parameter-specific alarm suspension periods of time.
3. The physiological measurement system of
constructing a pop-up window for a display; and
displaying the plurality of user-selectable elements in the pop-up window.
4. The physiological measurement system of
5. The physiological measurement system of
6. The physiological measurement system of
associate the a selected parameter-specific alarm suspension period of time is with the physiological parameter.
7. The physiological measurement system of
8. The physiological measurement system of
process the signal to determine a measurement of a second physiological parameter measurement based at least in part upon the signal;
determine that a second alarm should be activated in response to the measurement of the second physiological parameter satisfying a second alarm activation threshold;
receive, from the user, determine that a second indication of alarm suspension should be initiated for a second parameter-specific alarm suspension period of time corresponding to the second physiological parameter, the second parameter-specific alarm suspension period of time being selected from one of a second plurality of parameter-specific alarm suspension periods of time; activate a second alarm in response to determining a second alarm activation threshold has been satisfied by the second physiological parameter measurement; and in response to receiving the alarm suspension indication,
suspend the second alarm for the indicated second parameter-specific alarm suspension period of time; and
activate the second alarm when the measurement of the second physiological parameter satisfies the second alarm activation threshold after the second parameter-specific alarm suspension period of time has passed.
9. The physiological measurement system of
provide a user interface to the user including at least a first plurality of user-selectable elements and a second plurality of user-selectable elements, wherein each of the first plurality of user-selectable elements corresponds to one of the plurality of parameter-specific alarm suspension periods of time, and each of the second plurality of user-selectable element corresponds to one of the second plurality of parameter-specific alarm suspension periods of time.
10. The physiological measurement system of
construct a pop-up window for a display; and
display both the first and second plurality of user-selectable elements in the pop-up window.
11. The physiological measurement system of
12. The physiological measurement system of
14. The method of
15. The method of
providing a user interface to the user including at least a plurality of user-selectable elements, each of the selectable plurality of user-selectable elements corresponding to one of the a plurality of parameter-specific alarm suspension periods of time,
wherein the plurality of parameter-specific alarm suspension periods of time comprise the first parameter-specific alarm suspension period of time.
16. The method of
constructing a pop-up window for a display; and
displaying the plurality of user-selectable elements in the pop-up window.
17. The method of
19. The physiological measurement system of
process the signal to determine a the second physiological parameter measurement based at least in part upon the signal;
receive, from the user, determine that a second indication of a alarm suspension should be initiated for the second parameter-specific alarm suspension period of time corresponding to the second physiological parameter, the second parameter-specific alarm suspension period of time being selected from a second plurality of parameter-specific alarm suspension periods of time;
activate a second alarm in response to determining a determine that the second measurement satisfies a second alarm activation threshold has been satisfied by the second physiological parameter measurement; and
in response to receiving the alarm suspension indication, suspend activation of the second alarm for the indicated second parameter-specific alarm suspension period of time and then activate the second alarm.
20. The physiological measurement system of
provide a user interface to the user including at least a first plurality of user-selectable elements and a second plurality of user-selectable elements, wherein each of the first plurality of user-selectable elements corresponds to one of the a first plurality of parameter-specific alarm suspension periods of time, and each of the second plurality of user-selectable element elements corresponds to one of the a second plurality of parameter-specific alarm suspension periods of time,
wherein the first plurality of parameter-specific alarm suspension periods of time comprise the first parameter-specific alarm suspension period of time, and the second plurality of parameter-specific alarm suspension periods of time comprise the second parameter-specific alarm suspension period of time.
21. The physiological measurement system of
22. The physiological measurement system of
0. 23. The physiological measurement system of claim 1, wherein the alarm comprises an audible alarm.
0. 24. The physiological measurement system of claim 1, wherein the one or more processors are further configured to output a visual indicator with modification for the parameter-specific alarm suspension period of time and then output the visual indicator without modification.
0. 25. The physiological measurement system of claim 1, wherein the physiological parameter is indicative of the physiological condition of a circulatory system of the patient.
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This application is an application for reissue of U.S. Pat. No. 9,153,121, issued on Oct. 6, 2015 and titled “Alarm Suspend System,” which is a continuation of U.S. patent application Ser. No. 14/036,496, filed Sep. 25, 2013 and titled “Alarm Suspend System,” which is a continuation of U.S. patent application Ser. No. 13/476,725, filed May 21, 2012 and titled “Alarm Suspend System,” which is a continuation of U.S. patent application Ser. No. 12/510,982 filed Jul. 28, 2009 and titled “Alarm Suspend System,” which claims priority benefit under 35 U.S.C. § 119(e) to U.S. Provisional Patent Application Ser. No. 61/084,615, filed Jul. 29, 2008, titled “Alarm Management System.” ;” more than one reissue application has been filed for the reissue of U.S. Pat. No. 9,153,121, including U.S. patent application Ser. No. 15/583,922 (the present application), U.S. patent application Ser. No. 15/583,948, and U.S. patent application Ser. No. 15/583,935. All of the above-referenced applications are hereby incorporated by reference herein in their entireties.
Pulse oximetry for measuring constituents of circulating blood has achieved acceptance in a wide variety of medical applications, including surgical wards, intensive care and neonatal units, general wards, home care, physical training, and virtually all types of monitoring scenarios. A pulse oximeter generally includes a two-wavelength optical sensor applied to a patient, a monitor for processing sensor signals and displaying results and a patient cable electrically interconnecting the sensor and the monitor. The monitor typically provides a numerical readout of physiological parameters such as oxygen saturation (SpO2) and pulse rate (PR). Advanced physiological monitors utilize multiple wavelength sensors and enhanced measurement capabilities to provide readouts of additional parameters, such as carboxyhemoglobin (HbCO), methemoglobin (HbMet) and total hemoglobin (Hbt).
Pulse oximeters capable of reading through motion induced noise are disclosed in at least U.S. Pat. Nos. 6,770,028, 6,658,276, 6,650,917, 6,157,850, 6,002,952, 5,769,785 and 5,758,644; low noise pulse oximetry sensors are disclosed in at least U.S. Pat. Nos. 6,088,607 and 5,782,757; all of which are assigned to Masimo Corporation, Irvine, Calif. (“Masimo”) and are incorporated by reference herein.
Physiological monitors and corresponding multiple wavelength optical sensors are described in at least U.S. patent application Ser. No. 11/367,013, filed Mar. 1, 2006 and titled Multiple Wavelength Sensor Emitters and U.S. patent application Ser. No. 11/366,208, filed Mar. 1, 2006 and titled Noninvasive Multi-Parameter Patient Monitor, both assigned to Masimo Laboratories, Irvine, Calif. (Masimo Labs) and both incorporated by reference herein.
Further, physiological monitoring systems that include low noise optical sensors and pulse oximetry monitors, such as any of LNOP® adhesive or reusable sensors, SofTouch™ sensors, Hi-Fi Trauma™ or Blue™ sensors; and any of Radical®, SatShare™, Rad-9™, Rad-5™, Rad-5v™ or PPO+™ Masimo SET® pulse oximeters, are all available from Masimo. Physiological monitoring systems including multiple wavelength sensors and corresponding noninvasive blood parameter monitors, such as Rainbow™ adhesive and reusable sensors and RAD-57™ and Radical-7™ monitors for measuring SpO2, pulse rate (PR), perfusion index (PI), pleth variability index (PVI), signal quality, HbCO and HbMet among other parameters are also available from Masimo.
Monitor alarms are triggered by out-of-limit parameters and system failures, the latter including monitor or sensor failures or improper sensor placement, to name a few. Alarms can be visual, audible or both. Alarms can also have different levels of priority, which are reflected in the type of visual and audible alarms. In an embodiment, parameters exceeding limits such as low SpO2, high HbCO, high HbMet and low and high BPM trigger high priority alarms. System failures due to sensor off, no sensor or defective sensor also trigger high priority alarms. Parameters exceeding limits such as high SpO2, low and high PI, low and high PVI, for example, trigger medium priority alarms. Parameters exceeding limits such as low HbCO and low HbMet along with a system low battery indication are examples of low priority alarms.
An audible alarm may be temporarily suspended by pressing an alarm silence button so as to prevent unnecessary disturbance to the patient and distraction of the caregiver. During alarm suspension, visual alarms remain active. If an alarm condition persists after a predetermined alarm suspend period, the audible alarm resumes. The alarm suspend period is typically long enough to give a caregiver sufficient time to intervene with appropriate patient treatment yet short enough to ensure that patient health is not endangered if intervention is ineffective. For conventional pulse oximetry, an alarm suspend may be, for example, a maximum of 120 seconds.
Alarm suspension on advanced blood parameter monitors is problematic. With conventional pulse oximetry, treatment for abnormal parameter measurements can be quickly applied and a patient response is typically fast. For example, a treatment for low oxygen saturation is the application of an oxygen mask or an increase in oxygen flow. By contrast, the duration of treatment for parameters measured by advanced monitors is highly dependent on the alarm-triggering parameter. For example, the treatment for high methemoglobin is the injection of methylene blue, and the patient response to such an injection is slow. When patient treatment time exceeds the maximum alarm suspend period, an audible alarm will constantly reactivate. Thus, a single alarm suspend duration for all parameters is inadequate to cope with the many different types of parameters measured by advanced monitors.
One aspect of an alarm suspend system for silencing the alarms is an alarm trigger responsive to any of various parameters and predetermined limits corresponding to the parameters, where the parameters are partitioned according to treatment time, i.e. the relative length of time it takes for a person to respond to medical treatment for a parameter measurement outside of the predetermined limits. An audible alarm is responsive to the alarm trigger. An alarm silence button is actuated so as to suspend the audible alarm. A timer tracks the duration of the suspended alarm and is initiated by actuation of an alarm silence button. The timer retriggers the audible alarm after the timed duration has lapsed/expired. In an embodiment, a long duration suspend time is associated with slow treatment parameters and a short duration suspend time is associated with fast treatment parameters. Fast treatment parameters may include, for example, parameters relating to normal blood hemoglobin constituents and slow treatment parameters may include parameters relating to abnormal blood hemoglobin constituents.
In various embodiments, a short duration suspend time is less than or equal to about two minutes and a long duration suspended time is greater than about two minutes. A default duration associated with the fast treatment parameters is about two minutes and a default duration associated with the slow treatment parameters is about fifteen minutes. The alarm suspend system may also have an alarm suspend override responsive to a predetermined unit change in the parameter triggering a suspended alarm. The override results in reactivation of the suspended alarm. A physiological monitor having an alarm suspend system may also have a pop-up window that appears on the monitor display in response to actuation of the silence button, where the pop-up window presents a choice of alarm suspend durations.
Another aspect of an alarm suspend system is a partition of measured parameters into at least a first group and a second group. An audible alarm is triggered if at least one parameter is outside of predetermined limits. The audible alarm is suspended in response to a silence request. A first duration is associated with the first group and a second duration is associated with the second group. The audible alarm is reactivated after at least one of the first duration and the second duration. The first duration may be set so as to generally correspond to a first range of treatment times for the first group of parameters. Likewise, the second duration may be set so as to generally correspond to a second range of treatment times for the second group of parameters, where the first range of treatment times and the second range of treatment times are non-overlapping.
In various embodiments, suspended audible alarms are overridden if the triggering parameter has greater than a predetermined unit change before the suspended alarm expires according to either the first duration or the second duration. The first and second groups are defined in relation to normal hemoglobin measurements abnormal hemoglobin measurements, respectively. The first duration is set to be less than or equal to two minutes and the second duration is set to be greater than two minutes, with default durations of about two minutes corresponding to the first group and about fifteen minutes corresponding to the second group. In an embodiment, a pop-up window for a monitor display is constructed and the first duration and the second duration are selected from a range of durations presented within the pop-up window.
A further aspect of an alarm suspend system deactivates an audible alarm for one of a short duration and a long duration according to the alarm-triggering parameter. A first group of parameters is associated with the short duration and a second group of parameters is associated with the long duration. The first group and the second group are partitioned according to a fast treatment time and a short treatment time associated with the parameters. An override reactivates the audible alarm if the trigger parameter changes more than a predetermine amount during the corresponding duration. In various embodiments, the first group comprises parameters related to the measurement of normal hemoglobin and the second group comprises parameters related to the measurement of abnormal hemoglobin. The long duration is greater than about 120 seconds and the short duration is less than or equal to about 120 seconds. A pop-up window for the display allows selection of the long duration and the short duration in response to the silence button.
The monitor 101 has a front panel 110 providing a display 120, touch keys 130, controls 140, a speaker 150, a sensor port 160 and status indicators 170. The display 120 shows parameter readouts, limits and waveforms among other items. The display 120 also has touch key icons 122 that indicate touch key 130 functions. The speaker 150 provides an audible alarm in response to physiological measurements that violate preset conditions, such as an out-of-limit parameter, as well as system failures, such as a low battery condition. The controls 140 include an alarm silence button 144 that is pressed to temporarily suspend out-of-limit parameter alarms and system alarms, such as low battery. The display 120 provides visual alarms, which include a bell-shaped alarm status indicator 124 that illuminates during an alarm condition and parameter readouts 210 and limits 220 that flash when parameters are out-of-limit. Status indicators 170 also provide visual alarms. When there are multiple alarm conditions, the parameter displays 202 indicate parameters with the highest alarm priority. Touch keys 130 and corresponding icons 122 include an alarm menu access button for setting alarm conditions, such as high or low alarm limits for SpO2, HbCO, HbMet, PR and PI. The alarm silence button 144 is pressed to temporarily suspend audible alarms. Advantageously, an alarm suspend system provides a parameter-dependent variation in the alarm suspend duration, as described below, utilizing a common silence button or other suspend initiator.
As shown in
Also shown in
As shown in
In an alarm suspend system embodiment, parameters are classified according to the typical time it takes for medical treatment to transition an out-of-limit measurement to a within-limit measurement. Suspend durations 324 (
In an embodiment, an override 436 occurs if slow treatment parameters such as HbCO, HbMet or PVI increase or Hbt decreases by a certain unit change during the alarm suspend duration. The unit change is adjustable for each parameter, such as from 1-15 in increments of 1. TABLE 1 shows a default embodiment of override unit changes for these parameters.
TABLE 1
Override Unit Changes for Selected Parameters
Parameter
Unit Change
Direction
HbCO
5
Increase
HbMet
2
Increase
Hbt
2
Decrease
PVI
OFF
Increase
An alarm suspend system is described above with respect to alarms triggered by measured parameters and limits associated with those measured parameters. Limits may correspond to levels of a measured parameter, such as a percentage oxygen saturation to name but one example. Limits may also correspond to trends of a measured parameter, such as a rate-of-change of oxygen saturation, for example. Limits may also correspond to patterns in a measured parameter or a comparison of one measured parameter with another measured parameter, as further examples.
An alarm suspend system is described above with respect to a two-tier grouping of parameters, such as slow treatment and fast treatment parameters and alarm suspend durations associated with those groups. Groupings of parameters with respect to alarm suspend durations may be multi-tier, such as slow, medium and fast treatment parameters, to name but one example.
An alarm suspend system has been disclosed in detail in connection with various embodiments. These embodiments are disclosed by way of examples only and are not to limit the scope of the claims that follow. One of ordinary skill in the art will appreciate many variations and modifications.
Kiani, Massi Joe E., Olsen, Gregory A., Cebada, Steve L.
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