fig3 illustrates a parallel measurement alarm processor 300 . the alarm processor 300 has a sensor signal input 301 responsive to a physiological parameter and provides one or more alarm outputs 303 to indicate that the physiological parameter may have exceeded particular limits . the alarm processor 300 also has multiple parameter processors 310 , which do not necessarily have the same or similar internal configurations . the multiple parameter processors 310 input the sensor signal 301 and provide parallel measurements 312 of the physiological parameter , each measurement having differing characteristics , such as response time or bandwidth to name a few . the alarm processor 300 further has an alarm indicator 320 that inputs the parallel parameter measurements 312 and generates the alarm outputs 303 based upon alarm conditions 305 . the alarm outputs 303 change state to indicate that the parameter may have exceed one or more limits and to trigger an alarm accordingly . the alarm conditions 305 define particular limits with respect to one or more of the measurements 312 . the alarm conditions 305 may be predefined , such as by user input , or determined by a separate process , such as a measurement of sensor signal quality or data confidence as described in u . s . patent application ser . no . 09 / 858 , 114 entitled “ pulse oximetry data confidence indicator ,” assigned to masimo corporation , irvine , calif . and incorporated by reference herein . the alarm processor 300 may also have a display driver 330 that processes one or more of the parameter measurements 312 and provides one or more display outputs 307 . fig4 illustrates a pulse oximeter embodiment 400 of the alarm processor 300 ( fig3 ) described above . a pulse oximeter sensor ( not shown ) provides a signal input 301 that is responsive to arterial oxygen saturation , as described with respect to fig1 , above . the alarm processor 400 has dual oxygen saturation processors 310 . an integrator oxygen saturation ( spo . sub . 2 ) processor 410 outputs a slow spo . sub . 2 measurement 412 , i . e . a measurement having a slow response time to changes in the spo . sub . 2 parameter . a predictor spo . sub . 2 processor 420 outputs a fast spo . sub . 2 measurement 422 , i . e . a measurement having a fast response time that tracks changes in the spo . sub . 2 parameter . the slow spo . sub . 2 measurement 412 is input to a display driver 330 , which provides an oxygen saturation display output 307 . for example , the display output 307 may be input to a digital display that provides a numerical readout of oxygen saturation to a caregiver . both the slow spo . sub . 2 measurement 412 and the fast spo . sub . 2 measurement 422 are input to an alarm indicator 320 that generates at least one alarm output 303 based upon alarm conditions 305 , as described in further detail with respect to fig5 - 8 , below . the integrator spo . sub . 2 processor 410 , advantageously , provides a smoothed measurement of oxygen saturation suitable for threshold detection . the predictor spo . sub . 2 processor 420 , advantageously , provides a curve - fitting or a predictive measurement of oxygen saturation that detects trends in oxygen saturation , as described in further detail with respect to fig5 and fig6 a - b , below . further , the predictor spo . sub . 2 processor 420 advantageously tracks oxygen saturation details that may signal a critical physiological event , as described in further detail with respect to fig7 - 8 , below . the integrator spo . sub . 2 processor 410 and predictor spo . sub . 2 processor 420 may be a pulse oximeter as described in u . s . patent application ser . no . 09 / 586 , 845 entitled “ variable mode averager ,” assigned to masimo corporation , irvine , calif . and incorporated by reference herein . fig5 illustrates a trend embodiment of an alarm indicator 320 , which has a threshold detector 510 , a slope detector 520 and alarm detector 530 . the threshold detector 510 has a slow spo . sub . 2 measurement 412 and a threshold alarm condition 305 as inputs and a logic output below 512 . the slope detector 520 has a fast spo . sub . 2 measurement 422 input and a logic output positive / 522 . the alarm detector 530 has below 512 and positive / 522 logic inputs and generates an alarm output 303 . the threshold detector 510 is a comparator that asserts below 512 while the slow spo . sub . 2 measurement 412 is less in value than the value of the threshold 305 . the slope detector 520 is a differentiator and comparator that asserts positive / 522 while the slope of the fast spo . sub . 2 measurement 422 is non - positive , i . e . while the derivative of the fast spo . sub . 2 measurement 422 is zero or less than zero . the alarm detector 530 performs a logical and function , asserts the alarm output 303 and indicates an alarm when below 512 and positive / 522 are both asserted . in this manner , an alarm output 303 only changes state when the slow spo . sub . 2 measurement 412 is below a threshold 305 and the fast spo . sub . 2 measurement 422 has not begun to increase in value . advantageously , the trend recognition alarm indicator 320 reduces false alarms by suppressing a threshold - based alarm on the slow spo . sub . 2 measurement 412 when the fast spo . sub . 2 measurement 422 determines that a patient &# 39 ; s oxygen saturation is in recovery , as described in further detail with respect to fig6 a - b , below . fig6 a - b illustrate operation of the trend recognition alarm indicator 320 ( fig5 ). in fig6 a , a graph 600 has an spo . sub . 2 axis 601 and a time axis 602 . shown along the spo . sub . 2 axis 601 is a constant spo . sub . 2 value 606 corresponding to a threshold 305 ( fig5 ). the graph 600 shows a first plot of spo . sub . 2 versus time 610 corresponding to a fast spo . sub . 2 measurement 422 ( fig5 ). the graph 600 also shows a second plot of spo . sub . 2 versus time 620 corresponding to a slow spo . sub . 2 measurement 412 ( fig5 ). a suppressed alarm interval 640 along the time axis 602 corresponds to an alarm that would be indicated by the threshold detector 510 ( fig5 ) but is suppressed as occurring during a positive slope portion 630 of a fast spo . sub . 2 measurement 610 . the alarm detector 530 ( fig5 ) would not assert an alarm output 303 ( fig5 ) during this interval . in fig6 b , a graph 650 shows a first plot of spo . sub . 2 versus time 660 corresponding to a fast spo . sub . 2 measurement 422 ( fig5 ). the graph 650 also shows a second plot of spo . sub . 2 versus time 670 corresponding to a slow spo . sub . 2 measurement 412 ( fig5 ). an alarm interval 690 along the time axis 602 corresponds to an alarm period triggered by the alarm output 303 ( fig5 ). this alarm interval 640 occurs while a slow spo . sub . 2 measurement 670 is below the threshold 606 and before a positive slope portion 680 of a fast spo . sub . 2 measurement 660 . fig7 illustrates a pattern recognition embodiment of an alarm indicator 320 , having a threshold detector 710 , a pattern extractor 720 , a pattern memory 730 and a pattern comparator 740 . further , the alarm indicator 320 has slow spo . sub . 2 412 and fast spo . sub . 2 422 measurement inputs in addition to threshold 701 and reference pattern 732 alarm condition inputs 305 . the threshold detector 710 has a slow spo . sub . 2 measurement 412 and a spo . sub . 2 threshold 701 as inputs and a first alarm output 712 . the threshold detector 710 changes the state of the first alarm output 712 when the value of the slow spo . sub . 2 measurement 412 crosses the spo . sub . 2 threshold 701 . for example , the first alarm output 712 changes state to trigger an alarm when the slow spo . sub . 2 measurement 412 becomes less than the spo . sub . 2 threshold 701 . as shown in fig7 , the pattern extractor 720 has a fast spo . sub . 2 measurement 422 and a pattern threshold 734 as inputs and an extracted pattern output 722 . the pattern extractor 720 identifies features of the fast spo . sub . 2 measurement 422 that may be used for pattern matching . features may be , for example , the number of times the fast spo . sub . 2 measurement 422 crosses the pattern threshold 734 within a certain time period , or the duration of each time period that the fast spo . sub . 2 measurement 422 is less than the pattern threshold 734 , to name a few . the pattern memory 730 has a pattern selection input 705 and a reference pattern output 732 . the pattern memory 730 stores values for particular features that are identified by the pattern extractor 720 . the reference pattern output 732 transfers these stored values to the pattern comparator 740 . the pattern memory 730 may be nonvolatile and one or more patterns may be stored at the time of manufacture or downloaded subsequently via a data input ( not shown ). one of multiple patterns may be determined via the pattern selection input 705 , by a user or by a separate process , for example . the pattern threshold 734 may be generated in response to the pattern selection input 705 or in conjunction with a selected reference pattern 732 . also shown in fig7 , the pattern comparator 740 has the extracted pattern 722 and the reference pattern 732 as inputs and generates a second alarm output 742 . that is , the pattern comparator 740 matches extracted measurement features provided by the pattern extractor 720 with selected features retrieved from pattern memory 730 , changing the state of the second alarm output 742 accordingly . for example , the second alarm output 742 changes state to trigger an alarm when features of the fast spo . sub . 2 measurement 422 match the reference pattern output 732 . advantageously , the pattern recognition alarm indicator 320 reduces missed events by supplementing the threshold - based first alarm output 712 responsive to the slow spo . sub . 2 measurement 412 with a pattern - based second alarm output 742 responsive to detail in the fast spo . sub . 2 measurement 422 . in this manner , if a patient &# 39 ; s oxygen saturation is , for example , irregular or intermittent , the second alarm output 742 may trigger a caregiver alert when the first alarm output 712 does not , as described in further detail with respect to fig8 , below . fig8 illustrates operation of a pattern recognition alarm indicator 320 ( fig7 ), as described above . a graph 800 has a spo . sub . 2 axis 801 and a time axis 802 . the graph 800 shows a spo . sub . 2 plot versus time 810 corresponding to the slow spo . sub . 2 measurement 412 ( fig7 ). shown along the time axis 802 is a constant spo . sub . 2 value 812 corresponding to the spo . sub . 2 threshold 701 ( fig7 ). due to the short duration of irregular and intermittent drops in spo . sub . 2 , the slow spo . sub . 2 measurement 810 does not fall below the spo . sub . 2 threshold 812 . thus , the first alarm output 712 ( fig7 ) does not trigger an alarm in this example . also shown in fig8 , the graph 800 shows a spo . sub . 2 plot versus time 820 corresponding to the fast spo . sub . 2 measurement 422 ( fig7 ). shown along the time axis 802 is a constant spo . sub . 2 value 822 corresponding to the pattern threshold 734 ( fig7 ). a corresponding graph 805 has a logic level axis 806 and a time axis 807 . the graph 805 shows a logic level plot versus time 830 corresponding to the extracted pattern output 722 ( fig7 ). the logic level plot 830 has a “ 1 ” level when the fast spo . sub . 2 plot 820 is above the pattern threshold 822 and a “ 0 ” level when the fast spo . sub . 2 plot 820 is below the pattern threshold 822 . in this manner , the logic level plot 830 indicates the number and duration of times the fast spo . sub . 2 plot 820 falls below a threshold value 822 . further shown in fig8 , an alarm interval 870 along the time axis 802 corresponds to an alarm period indicated by the pattern comparator 740 ( fig7 ). this alarm interval 870 occurs after a reference pattern 732 ( fig7 ) is detected as matching an extracted pattern 722 ( fig7 ) and ends , correspondingly , when there is no longer a match . for example , assume that the reference pattern output 732 ( fig7 ) has the alarm criteria that at least three below threshold periods of minimum duration t . sub . 1 must occur during a maximum period t . sub . 2 , where the value of t . sub . 1 and t . sub . 2 are illustrated along the time axis 807 . the below threshold time periods 831 - 834 are each greater in duration than t . sub . 2 and a first set of three , below - threshold time periods 831 - 833 occurs within a time period t . sub . 1 = t . sub . 2 , as illustrated . thus , the alarm interval beginning 872 is triggered by the second alarm output 742 ( fig7 ). a second set of three , below - threshold time periods 832 - 834 also occurs within a time period t . sub . 2 = t . sub . 2 , as illustrated . thus , the alarm interval 870 continues . there is no third set of three , below - threshold time periods . thus , after the end of the time interval t . sub . 3 = t . sub . 2 , the alarm interval end 874 is triggered . this example illustrates how the pattern recognition alarm indicator 320 ( fig7 ) can trigger an alarm on an event , such as a period of irregular heartbeats , that might be missed by a threshold - based alarm responsive to the slow spo . sub . 2 measurement 412 . although some alarm processor embodiments were described above in terms of pulse oximetry and oxygen saturation measurements , one of ordinary skill in the art will recognize that an alarm processor as disclosed herein is also applicable to the measurement and monitoring of other blood constituents , for example blood glucose and total hemoglobin concentration to name a few , and other physiological parameters such as blood pressure , pulse rate , respiration rate , and ekg to name a few . in an embodiment , multiple pattern processors , each including a pattern extractor , pattern memory and pattern comparator , such as described with respect to fig7 , above , have as inputs one or more of fast spo . sub . 2 measurements , a pulse oximeter plethysmograph and pulse rate measurements . an arrhythmia alarm is generated based upon irregular heartbeat patterns being matched or otherwise detected in one or more combinations of spo . sub . 2 measurements , a pulse oximeter plethysmograph and pulse rate measurements . a physiological trend monitor 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 .
a physiological trend monitor has a sensor signal responsive to multiple wavelengths of light transmitted into a tissue site . the transmitted light is detected after attenuation by pulsatile blood flow within the tissue site . a processor has an input responsive to the sensor signal and a physiological parameter output . features are extracted from the physiological parameter output . criteria are applied to the features . an alarm output is generated when the criteria are satisfied .