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Description  |
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BACKGROUND OF THE INVENTION
This invention relates to apparatus for endotracheal and esophageal
intubation and more particularly to such apparatus which is adapted to
establish an airway rapidly in a patient regardless of whether or not the
air way is initially established to the trachea or to the esophagus.
Heretofore in the art to which my invention relates, difficulties have been
encountered in establishing an airway rapidly in a patient under emergency
conditions due to the fact that the airway is sometimes initially
established to the esophagus rather than to the trachea whereby the
apparatus must be removed and reinserted or the passageway to the
esophagus must be closed to prevent air from being forced into the stomach
and also to prevent regurigation. Where the passageway to the esophagus is
closed, other means must be provided for communicating the apparatus with
the trachea, such as by providing passageways in the upper portion of the
apparatus which may be open at the time the passageway into the esophagus
is closed. The Kenneth L. Davidson U.S. Pat. No. 3,874,377 shows apparatus
wherein an adaptor is inserted into an elongated tubular member whereby a
portion of the tubular member is sealed upon insertion of the adaptor into
the tubular member or upon rotation of components of the adaptor relative
to each other to close a portion of the elongated tube. The insertion of
such adaptors or the movement of one portion of the adaptor relative to
another after insertion into the patient is very difficult and requires a
considerable amount of time. Also, it is difficult to determine positively
whether or not the passageway to the esophagus has been closed. The
patents to Schossow U.S. Pat. No. 3,087,493 and Doherty U.S. Pat. No.
3,460,541 also show conventional types of endotracheal tubes.
SUMMARY OF THE INVENTION
In accordance with my invention, I provide apparatus which may be employed
either for endotracheal or esophageal intubation whereby an air passageway
is provided to the trachea in the event the initial air passageway is
established to the esophagus rather than to the trachea. On the other
hand, when the initial air passageway is established to the trachea, the
apparatus is adapted for direct endotracheal intubation. Accordingly, a
single tube performs the function of two tubes due to the fact that means
is provided for communicating the elongated tube with the trachea whether
the initial air passageway is established to the trachea or the esophagus.
My improved apparatus embodies an elongated tubular member having a first
portion with an open outer end and a second portion with an open inner end
and a lumen extending therebetween. A first inflatable member surrounds
the outer walls of the second portion of the tubular member in spaced
relation to the inner end thereof for inflation within a body canal to
form a seal. A second inflatable member is mounted within the lumen of the
tubular member for sealing the lumen when inflated. Means is provided
between the outer end of the tubular member and the second inflatable
member for selectively communicating the lumen of the tubular member with
the exterior portion thereof so that the apparatus is adapted for
endotracheal intubation when the lumen is open for fluid communication
between the outer and inner ends of the tubular member and is not in
communication with the exterior surface of the upper portion of the
tubular member. The apparatus is adapted for esophageal intubation when
the second inflatable member is inflated to seal the lumen and the lumen
is in fluid communication with the exterior of the tubular member to thus
supply air to the trachea.
DESCRIPTION OF THE DRAWING
Apparatus embodying features of my invention is illustrated in the
accompanying drawing, forming a part of this application, in which:
FIG. 1 is a longitudinal sectional view showing the components of my
improved apparatus in position for esophageal intubation;
FIG. 2 is a side elevational view showing the upper portion of the
elongated tubular member with the components thereof in the position shown
in FIG. 1;
FIG. 3 is a side elevational view showing an insert which is adapted to
telescope within the upper portion of the tubular member shown in FIG. 2
for selectively communicating the lumen of the elongated tubular member
with the exterior thereof;
FIG. 4 is an end elevational view showing the outer end of the apparatus
with the insert attached to the upper portion of the elongated tubular
member;
FIG. 5 is a sectional view taken generally along the line 5--5 of FIG. 1;
FIG. 6 is a sectional view taken generally along the line 6--6 of FIG. 1;
and,
FIG. 7 is a sectional view corresponding to FIG. 6 but showing the insert
rotated 90.degree. from the position shown in FIG. 6 whereby the apparatus
is adapted for endotracheal intubation.
DETAILED DESCRIPTION
Referring now to the drawing for a better understanding of my invention, I
show an elongated tubular member 10 having a first portion 11 with an open
outer end and a second portion 12 with an open inner end, as shown. A
lumen 13 extends between the outer and inner ends of the elongated tubular
member 10, as clearly shown in FIG. 1. Preferably, the first portion 11 of
the elongated tubular member 10 is generally cylindrical in shape and is
provided with a reduced diameter portion 14 which is of a size to
telescope into the open end of an elongated flexible tube, as shown, which
provides the second portion 12.
Telescoping downwardly within the outer portion 11 is a tubular insert 16
having an elongated, longitudinally extending slot 17 therethrough which
is adapted to move into alignment with and into communication with
longitudinally aligned openings 18 provided in the upper portion 11 of the
elongated tubular member 10 whereby the lumen 13 is adapted to communicate
with the exterior of the upper portion 11. Upon rotation of the insert 16
90.degree. from the position shown in FIG. 6, the insert 16 is rotated to
the position shown in FIG. 7 whereby the elongated slot 17 moves out of
alignment with the openings 18 whereby the lumen 13 of the elongated
tubular member 10 no longer communicates with the exterior portion
thereof.
To lock the insert 16 selectively in the position shown in FIGS. 6 and 7,
angularly spaced recesses 19 are provided in a lateral, annular flange 21
provided at the outer end of the outer portion 11. As shown in FIGS. 1 and
3, a lateral, annular flange 22 is carried by the insert 16 in position to
engage the annular flange 21 when moved to the position shown in FIG. 1. A
depending projection 23 is carried by the lateral flange 22 in position to
engage selectively the recesses 19 provided in the lateral flange 21.
Accordingly, to detachably attach the insert 16 to the upper portion 11 of
the elongated tubular member 10, the insert 16 is moved downwardly whereby
the projection 23 snaps into a selected one of the recesses 19 to thus
retain the insert 16 in either the position shown in FIG. 6 or the
position shown in FIG. 7.
A first inflatable member 24 is carried about the outer walls of the second
portion 12 of the elongated tubular member 10 in spaced relation to the
inner end thereof for inflation within a body canal to form a seal with
the walls thereof. That is, the inner end of the second portion 12 of the
elongated tubular member 10 is adapted to enter the trachea or the
esophagus of a patient and after insertion therein, the inflatable member
24 is inflated to form a seal between the portion 12 of the elongated
tubular member 10 and the trachea or the esophagus, as the case may be.
The inflatable member 24 is shown as being secured at its upper and lower
ends to the outer surface of the portion 12 of the elongated tubular
member 10 to form a cavity 26 between the inflatable member 24 and the
outer surface of the portion 12 whereby the inflatable member 24 is
adapted to move from the inflated or solid line position to the deflated
or dotted line position. An air tube 27 communicates with the cavity 26,
as shown in FIG. 1 whereby air may be introduced into or exhausted from
the inflatable member 24. The air passageway 27 may be in the form of a
small tubular member which extends outwardly of the elongated tubular
member 10 and is connected to a pilot bult 28 which indicates inflation or
deflation of the inflatable member 24. An elongated groove is provided in
the outer surface of the side wall of the outer portion 11 for receiving
the tube 27 whereby the tube 27 is concealed at the point it passes the
mouth area of the patient, thus preventing damage to the tube by the teeth
of the patient. The air tube 27 preferably extends through the pilot bult
28 and is in communication therewith with the outer end of the tubular
member 27 being attached to a conventional releasable, check valve 29
which permits the inflatable member 24 to be inflated or deflated by
employing a conventional syringe or the like. In view of the fact that the
pilot bulb 28 and the means 29 for introducing and exhausting air from the
tube 27 are conventional and other suitable means may be employed, no
further description thereof is deemed necessary.
As shown in FIG. 1, a second inflatable member 31 is mounted within the
lumen 13 of the portion 12 of the elongated tubular member 10 for sealing
the lumen when inflated. The inflatable member 31 is shown as being a
balloon-like member mounted adjacent the inner surface of the lumen 13 in
position to extend alongside the inner surface of the lumen when deflated
to the dotted line position shown in FIG. 1. Accordingly, while the
inflatable member 31 is in the solid line position, it closes the lumen 13
whereby air cannot pass through the portion 12 of the elongated member 10.
On the other hand, upon deflating the inflatable member 31, the member 31
moves to the dotted line position alongside the inner wall of the lumen 13
to thus permit free passageway of air through the lumen of the elongated
member 10. The inflatable member 31 is provided with a cavity 32 therein
which communicates with an air tube 27, as described hereinabove. That is,
the air tube 27 extends outwardly of the elongated tubular member 10 and
carries a pilot bulb 28. Also, the free end of the tubular member 27
communicates with a releasable valve member 29 which permits introducing
air into the inflatable member 31 or exhausting air therefrom.
As shown in FIG. 1, the inner end of the portion 12 of the tubular member
10 is generally concave as at 33, as viewed in side elevation, with the
juncture of the outer side of the portion 12 of the tubular member 10 and
the inner end of the portion 12 being rounded as at 34 whereby there is a
minimum injury to the air passages of the patient as the apparatus is
inserted or removed from the patient. As shown in FIGS. 1 and 5 the
portion 12 of the tubular member 10 is provided with oppositely disposed
passageways 36 in its walls adjacent and inwardly of the inner end thereof
so that one opening 36 will remain open in the event the other opening 36
should be in engagement with a body canal, such as the trachea or the
esophagus.
The outer end of the upper portion 11 of the tubular member 10 is connected
to a suitable source of air, not shown. In view of the fact that the means
for supplying air to and exhausting air from such apparatus is well known
in the art to which my invention relates, no further description thereof
is deemed necessary.
From the foregoing description, the operation of my improved apparatus will
be readily understood. The insert 16 is inserted into the open outer end
of the portion 11 of the elongated tubular member 10, as shown in FIG. 1,
in either the esophagus position shown in FIG. 6 or the trachea position
shown in FIG. 7. That is, in the esophagus position, the elongated slot 17
is in alignment and communicates with the openings 18 in the portion 11 of
the elongated tubular member 10 whereby the lumen 13 of the upper portion
11 communicates with the exterior of the outer portion 11. The insert 16
is detachably secured to the upper portion 11 of the elongated member 10
by pressing downwardly on the insert 16 whereby the projection 23 snaps
into the selected opening 19 to hold the insert in either the position
shown in FIG. 6 or the position shown in FIG. 7. In the position shown in
FIG. 7, the elongated slots 17 are moved out of alignment with the
openings 18 whereby the lumen 13 of the outer portion 11 of the elongated
member 10 is no longer in communication with the exterior of the portion
11.
In operation, the inner portion 12 of the elongated member 10 is inserted
into the patient in an attempt to pass the inner end of the tubular member
10 into the trachea. In the event the inner end of the tubular member
enters the trachea, the inflatable member 24 is inflated and the insert 16
is rotated to the position shown in FIG. 7, if it is not already in that
position before insertion. Accordingly, air is free to pass directly
through the elongated tubular member 10 to the trachea.
In the event the inner end of the elongated member 10 does not enter the
trachea but enters the esophagus, the inflatable member 24 and the
inflatable member 31 are both inflated whereby the lumen 13 is closed and
the outer surface of the portion 12 of the elongated member 10 is sealed
against the walls of the esophagus to thus avoid regurigation. The insert
16 is rotated to the position shown in FIG. 6, if it is not already in
that position at the time of insertion whereby the elongated slot 17 moves
into alignment with and communicates with the longitudinal lined openings
18 in the upper portion 11 of the tubular member 10. The air introduced
into the lumen 13 of the portion 11 of the elongated tubular member 10
then passes outwardly through the openings 18 to the exterior of the
portion 11 of the elongated tubular member 10 whereby the air then is
introduced into the trachea or is exhausted therefrom through the aligned
passageways 17 and 18.
To remove the apparatus from the patient, the inflatable member 24 is
deflated whereby it moves to the dotted line position alongside the outer
surface of the elongated tubular member 10.
From the foregoing, it will be seen that I have devised improved apparatus
for both endrotracheal and esophageal intubation. By providing the
inflatable member 31 within the lumen of the tubular member for sealing
the lumen when inflated, I provide rapid means for establishing an airway
and at the same time I eliminate regurigation since fluids from the
stomach cannot pass outwardly through the tubular member 10. By providing
the inflatable member 24 in combination with the inner inflatable member
31, my apparatus is particularly adapted for prolonged intubation due to
the fact that there is a minimum of air passage to and from the stomach of
the patient in the event the inner end of the tubular member enters the
esophagus rather than the trachea. Also, by providing the insert 16 which
permits selective communication of the lumen of the tubular member 10 with
the exterior thereof, my improved apparatus is adapted to convey the air
to the trachea through the aligned passageways 17 and 18 while the
inflatable member 31 is inflated within the esophagus of a patient.
Accordingly, successful insertion of my improved apparatus is accomplished
regardless of whether or not the tubular member enters the esophagus or
the trachea.
While I have shown my invention in but one form, it will be obvious to
those skilled in the art that it is not so limited, but is susceptible of
various changes and modifications without departing from the spirit
thereof.
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