Design of an equivalent slew-rate monolithic pulse generator using bipolar-CMOS-DMOS (BCD) technology for medical ultrasound transmitters is presented in this paper. The pulse generator employs a floating capacitive coupling level-shifter architecture to produce a high-voltage (Vpp=80V) output. The performance of equivalent slew-rate in the rising and falling edge is achieved by carefully choosing the value of coupling capacitors and the size of the final stage high-voltage MOSFETs of the pulse generator. The measured output pulses show the rising and falling time of 8.6nsec and 8.5nsec, respectively with second harmonic distortion down to -40dBc, indicating the designed pulse generator can be used for advanced ultrasonic harmonic imaging systems.