JPH0373311B2 - - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION The present invention relates to a device for the emergency treatment of human respiratory disorders.

For example, acute upper respiratory disorders such as epiglottitis caused by foreign objects entering the mouth or throat, allergic reactions, insect bites, etc. are particularly common in children, but adults can also suffer from them and can cause serious complications. let All first aid healthcare facilities must have sufficient capacity to administer appropriate treatment for such respiratory problems. It also needs to be treated quickly and easily by emergency medical services, surgical medical services, and military medical services. However, with the exception of some specialized medical services, there is currently no place that can actually provide satisfactory treatment. This is because there is no simple, safe and suitable device to relieve respiratory problems. Instruments that have been developed to date are instruments for cutting the cricothyroid membrane, such as the conus ligament incision instrument disclosed in Swedish patent application no. 7316352-9, which are not only expensive; However, it is dangerous to use on children under the age of 5 or 6, and many doctors are afraid to use it on children under the age of 5 or 6. No other devices have been used in practice and are not available in the literature. In other words, in emergency situations such as those described above, many doctors, let alone trained medical staff, voluntarily take the slightest chance without actually taking any professional action. When there is an upper respiratory disorder and it is necessary to urgently remove the disorder and create an airway (in many cases, the patient is unable to breathe spontaneously, and even if they are able to do so, the force is weak and the patient is in a state of hypercapnia). The only option left is a tracheostomy. However, this is almost always performed in a hospital operating room and is a risky procedure. There is usually not enough time for a tracheostomy in cases of urgent upper respiratory problems. This is true even if the patient has already arrived at a hospital capable of emergency surgical treatment. At best, the following five methods can only create an unobstructed airway and are almost impossible, or even impossible, to adequately aid breathing.

The first method is ventilation using a bag through a mask. This is of little use in cases of severe upper respiratory disorders such as acute epiglottitis.

The second method is endotracheal intubation. This is extremely difficult and usually impossible even for trained anesthesiologists.

The third method is cricothyrotomy using a scalpel. It is a last resort surgical procedure performed by a specialist or doctor when there is no other option. This surgery is extremely dangerous and cannot be performed in time for emergencies, as breathing assistance or oxygen cannot be immediately provided.

The fourth method is cricothyroid cartilage incision using the conus ligament incision instrument described above. This is done in principle in the same manner as the third method. This device allows the surgery to be semi-automated and makes it easier to insert thin tubes. However, although most Scandinavian medical students are taught how to use conus ligament dissection instruments, which are standard equipment in most emergency medical facilities, many doctors do not Not interested in the method. The conus ligament dissection instrument is a last resort in extremely urgent cases, and also
Not suitable for children under the age of 6.

A fifth method is to percutaneously perforate the cricothyroid membrane using a thick cannula, such as a large cannula used to perforate the knee joint chamber or a large cannula used to insert a syringe. . This method is currently considered the most appropriate for children and the least dangerous of the insertion methods. Moreover, according to the opinion of the authorities, this method may be able to allow the patient to breathe adequately. The premise for this is that the uppermost breathing obstruction is
A one-way valve is formed at or just below the vocal cords. Breathing gas is introduced through a relatively fine cannula, and exhaled air is often able to be forced through the respiratory obstruction by auxiliary chest compression if necessary. It may be better to insert two needles to increase the cross-sectional area for inspiration. However, with this method, the posterior wall of the trachea, the esophagus, the mucous membrane of the mediastinal sinus,
There is a risk of injuring subcutaneous emphysema. Furthermore, the respiratory support necessary for life support cannot be provided satisfactorily. In other words, doctors are forced to ventilate the cannula by attaching it to the cannula, which is impractical, difficult, and inefficient. Oxygen is supplied only when the patient is breathing spontaneously and there is an imminent danger that the respiratory reflex will disappear due to hypercapnia while asleep, and the doctor should also:
They are forced to ventilate by attaching their mouths to the canyule. The position of the canyule is easy to move.
This can cause an injury and cause blood to flow into the respiratory tract. This is because the cannula is made of a non-elastic material and its tip is sharp and non-flexible. Also, if the cannula moves out of its correct position, respiratory support is immediately stopped and a new puncture must be made.

If the patient is not unconscious, he must be kept at rest to avoid injury from the hard, sharp needle. Ultimately, there is currently no safe, easy, and efficient way to create an open airway and provide respiratory assistance in emergency situations such as those described above.

Another example of a situation in which it is currently impossible to give respiratory assistance without extremely serious consequences is when a person becomes unconscious or has difficulty breathing due to a contusion of the spinal column in the neck in a road traffic accident. (Both of these may occur) when a person is seated in a car seat with their safety belt on, and the person's chin is bent toward the chest. The only way emergency personnel can help the victim breathe is by bending the victim's head back and ventilating the victim, for example through a mask. If the spinal column in the neck is contusioned, bending the head backwards poses a great risk of damaging the spinal cord, resulting in immediate death or permanent neurological incapacity such as quadriplegia. It turns out.

In other situations involving respiratory arrest, such as myocardial infarction or respiratory arrest in heart patients, traditional equipment can be used to provide artificial ventilation and administer life-sustaining drugs to patients. At times, we often find ourselves in very difficult situations, such as those mentioned above.

SUMMARY OF THE INVENTION It is therefore an object of the present invention to solve the problems of conventional methods for eliminating respiratory disorders and to provide a simple and inexpensive device for emergency treatment of respiratory disorders.

According to the present invention, there is provided an instrument for emergency treatment of endotracheal respiratory disorders in humans by percutaneous perforation of the trachea, the main body having one end opening at the front end thereof and the other end being adapted to be positioned on the patient's neck. a body comprising a through passageway opening at the rear of the body; a tube adapted for insertion into the patient's trachea, which projects from the front end of the body and forms an extension of the passageway; the stylet is retractably disposed within the passageway and/or within the tube such that in its fully inserted position, its cut end extends beyond the outer end of the tube; the tube is made of a flexible, resilient material; the end of the stylet opening proximate the rear end of the tube or passageway and/or the rear of the body; A standard sized fitting is provided to enable the ejection of the drug with a conventional syringe; and the rear portion of the body is comprised of and includes a cylindrical adapter integrally formed with the body. A device is provided having standard dimensions for coupling the device to a respiratory or anesthesia device.

By using the device of the present invention, the following effects can be obtained.

First, percutaneous puncture of the trachea (particularly through the cricothyroid membrane) is safer and simpler than incision. Blood flow to the outside or inside (such as the lungs) is minimal;
The perforation area is easily defined. Once the trachea has been perforated, it is not difficult to subsequently perform tracheostomy or endotracheal intubation, and these incisions can be performed while the instrument remains in place. Additionally, drilling techniques are commonly practiced by medical staff.

Second, flexible tubes and catheters have less risk of damaging the subglottic space, and by using optical techniques to locate within the space, an airway can be created while avoiding damage.

Third, by providing an attachment device at the posterior end of the stylet, drugs such as local anesthetics or adrenaline can be injected into the subglottic space while the device is being inserted. Resistive loss techniques can also be used to ensure that a plastic or glass syringe fits precisely against the posterior end of the stylet by inspiration or injection when the stylet enters the subglottic space. In this way, the procedure can be performed safely and effectively without damaging the posterior wall of the trachea, the esophagus, or other parts of the body.

Fourth, by providing an attachment device at the rear end of the tube, once the device is in place and the stylet or needle is retracted, the drug can be injected using a conventional plastic syringe. Examples of drugs used include anesthetics and adrenaline. Adrenaline injected directly into the windpipe and lungs has been shown to be at least as effective as intravenous injection. Anti-epileptic drugs may be used when epilepsy occurs or there is a head injury.

Fifth, the device's tubular adapter, which has standard dimensions, fits into standard ventilator bags and anesthesia machine connectors. This device can also be used to perform a technique called the bench-lily method, which has been practiced in recent years. Unlike conventional cannula attachment devices, the tubular adapter is easier to hold with the lips in the absence of a venting device, thus allowing air to be delivered to the patient through the mouth and the device. The structure of the device is also suitable for venting oxygen or air with controlled positive pressure.

Sixth, the device can be inserted anywhere in the larynx that provides access to the trachea. However, select the location where percutaneous perforation of the cricothyroid membrane is considered to be the safest.

Seventh, the device can be used quickly and without any preparation, and can be used by all physicians, by those trained in first aid, and even by laymen. No special surgical techniques are required; the basic knowledge and training known to all physicians and those in many other medical fields is sufficient.

Eighth, this device is simple and safe. The desired concentration of oxygen can be insufflated at a controlled positive pressure to deliver drugs into the trachea of patients with respiratory arrest or respiratory compromise when conventional treatments have failed or are ineffective. Can be easily injected. There is no need to inject it into a vein. The device is free of blood flow, making it less uncomfortable and dangerous than using other traditional devices.

Ninth, it can be applied not only to adults but also to children regardless of their weight.

Tenth, the configuration of the device is suitable for application to provide respiratory assistance to patients with injuries to the cervical spinal column without lifting the head at least halfway forward.

Certain embodiments of the present invention allow for the infusion of drugs directly into the patient's trachea and lungs while providing respiratory assistance, always leaving the lungs intact. In addition, it is composed of a small number of parts so that it can be widely applied to small children, large children, and adults.

Several embodiments of the invention are also set forth in the claims.

Using the device of the present invention, drugs such as epinephrine, atropine, ridecaine, and antiepileptic drugs can be injected directly into a patient's trachea or lungs. Intravascular absorption of many drugs is, according to some scientists, very effective. The present invention is particularly effective in maintaining intrapulmonary pressure at optimal positive end exhalation pressure (PEEP) during controlled positive pressure ventilation.

Hereinafter, embodiments of the present invention will be described with reference to the accompanying drawings, but these embodiments are not intended to limit the scope of the present invention.

Referring to FIG. 1, there is shown a preferred embodiment of the device according to the invention, which as can be seen basically comprises a body 2 having a through hole 3; is open at the front end 2c of the body on the one hand and at the rear end 2d of the body on the other hand. The length of the body 2 measured on the upper side and the lower side in the central plane is preferably (according to angle B) 45-55 mm and 25-45 mm, respectively. The rear part 2b of the body comprises a tubular adapter 4 which is formed integrally with the body and is positioned substantially concentrically with at least the end of a through hole opening at the rear end of the body. This adapter has standard external dimensions so that it can be connected to a normal ventilation device, which according to the so-called ISO standard has an external diameter of 15 mm at the rear end 2d of the body. Furthermore, the body has at least two wings 5, the purpose of which is as follows. Like the adapter, these wings are formed integrally with the body and the material from which they are made is preferably a suitable rigid plastic such as clear polypropylene or rigid PVC or polystyrene.

The front part 2a of the body 2 can be tapered towards the front end 2c of the body so that it does not interfere with the larynx when the instrument is inserted into the larynx.
In this connection, the upper and lower sides of the body can be inclined at an angle of approximately 10-15° (angle A) relative to the longitudinal axis of the instrument. The front part 2a can also be completely straight or sloped only on its underside (see Figures 3a and 3c), so that it can be placed on the patient's neck with a large surface. It can be installed more firmly. In this case, only the lower side of the body can be inclined, for example, at approximately 25° to the longitudinal axis of the device. In embodiments involving straight catheters, the anterior end 2c of the body is also at an angle of 15-60° with respect to a plane perpendicular to the longitudinal axis of the device.
Preferably, it can be tilted between 40 and 60 degrees (angle B), the purpose of which is to facilitate the correct oblique insertion of the catheter into the trachea.

A tube or catheter 6 is attached to the through hole 3 so as to protrude from the front end 20 of the body to form a continuous portion of the through hole 3. The forward projection of this catheter has a length of approximately 2.5 to 5 cm and is formed as a straight succession of through holes in the embodiment shown, but may have other configurations (see 3a).
(see Figures and Figure 3c). A stainless steel needle or stylet 7 is provided within the catheter 6 with its forward end 7a projecting from the outer end of the catheter. In use, this catheter 6 is inserted into the outer incision point 7a of the stylet.
It is intended to be introduced into the trachea after piercing by the trachea. The stylet, preferably made of stainless steel, is ground at its anterior end to about 20-45°, preferably 30-40° (angle C) for this incision, and also makes a so-called bevel incision to more easily penetrate the tissue. It can be provided with blades or surfaces. The incision point is preferably siliconized and positioned so that the incision cuts transversely at 90 degrees to the longitudinal axis of the trachea. Although the catheter can be made from non-rigid plastics such as ethylene-tetrafluoro-ethylene (ETFE) or Teflon (PTFE), polyurethane plastics have been shown to be particularly suitable materials due to their high biocompatibility and flexibility. It is preferable that the through hole 3 be molded integrally with the through hole 3, for example, by making it slightly protrude on a fitting 10, which will be described later. The catheter can be selectively positioned within the throughbore, but is preferably positioned so that it extends into the throughbore such that its rear end is located a short distance from the rear end 2d of the body. FIG. 3b shows another embodiment in which the adapter 4 is formed by a thin wall so that the rear end of the through hole 3 and the catheter 6 are located approximately in the middle of the body. It's open. The advantage of this is that less material is consumed and the device is lighter.

To facilitate insertion of the catheter into the trachea, its front end 6a is chamfered such that its wall thickness decreases from about 0.2 mm to about 0.05 mm over a length of about 2-3 mm.

Preferably, the device is made in two or more dimensions, in particular a child model and an adult model, and in the child model the catheter is
Outer diameter between 2.0mm and 4.0mm, preferably between 2.5mm and 3.5mm and between 1.5mm and 3.5mm, preferably between 2.0mm and
It has an inner diameter of 2.5mm. The question of whether catheters of relatively small size are sufficient for the ventilation of children has recently been discussed in Sweden as well as by foreign experts. However, this possibility is not generally accepted and has been questioned by many experts. Our studies on live pigs of various sizes with identical requirements for the air volume supplied have clearly demonstrated that smaller dimensions are quite sufficient (the results of the above studies are Presented at the International Congress of the Swedish Society of Medical Sciences, Stockholm, Sweden, November 30, 1983 and the 8th Congress of Anesthesiologists, Manila, Philippines, January 25, 1984).
If a positive pressure ventilation device with a respirator bag is used, its effectiveness is substantially enhanced and is sufficient to provide basic ventilation even for adults. In the adult model, the catheter has an outer diameter of 3.5 mm to 5.0 mm, preferably 3.9 to 4.5 mm, and an inner diameter of 3.0 mm to 4.6 mm, preferably 3.0 to 4.0 mm. For both models, the wall thickness of the catheter is preferably about 0.1 mm to 0.5 mm, preferably 0.2 mm to 0.3 mm, as described above.

The front part of the catheter has a diameter of ~1.0 mm to ensure that ventilation is not obstructed so that the opening at the front end of the plastic catheter will inadvertently come into contact with the mucous membrane and become occluded when inserted into the trachea. A plurality of side openings 9, preferably 2 to 4, of 1.5 mm are provided.

The steel stylet may have an outer diameter equal to or slightly less than the inner diameter of the catheter, which allows the stylet to be withdrawn from the device without difficulty after being inserted into the trachea. The inner diameter of the stylet should not exceed about 1 mm to 1.5 mm, at least at the anterior end closest to the incision point, which reduces the risk of occlusion during insertion. This is extremely important as tissue molecules enter the stylet and flow down into the patient's lungs with the injection of medication through the stylet. Another advantage of the relatively narrow inner passageway of this stylet is that said injection of the drug through the stylet produces a spray or jet effect on the drug as it exits the stylet, which may e.g. In order to reinforce this spraying effect when a uniform distribution of the anesthetic agent (e.g. Ridecaine) is desired, the inner passageway may also be provided with, for example, a very sharp triangular shape (Fig. 2) at the point where it opens at the front end of the stylet. Alternatively, a nozzle having a cross shape is provided. Furthermore, the stylet is in its fully inserted position, i.e. with its incision point protruding a predetermined distance from the catheter's front end 6a, with its other end 7b attached to the adapter 4.
It has a length that protrudes approximately 5 mm to 10 mm from the base. In some embodiments, if the steel stylet has a stop means (not shown), it is preferred that the incision point protrude more than 3 mm to 6 mm from the front end of the catheter.

At the rear end of the stylet 7 a tapered fitting 10 is provided, which accepts a conventional syringe (so-called Luer fitting), and a corresponding fitting 10 is also provided at the rear end of the through-bore 3 or this fitting. Separately from this, it is provided at the rear end of the catheter 6. In the latter case the fitting is formed integrally with the catheter. These fittings allow medication to be injected through the device during insertion and even after the device has been withdrawn with the steel stylet 7 into position. In conjunction with the fitting 10, the steel stylet 7 is also provided with a plastic cap to facilitate withdrawal of the stylet after piercing the trachea. To ensure that this stylet is always correctly positioned within the instrument, i.e., rotated such that the incision point is in the correct position for piercing the trachea, the fitting at the rear end of the stylet has a A locking lug is provided which engages a corresponding notch in the tapered fitting at the rear end of the tube when the stylet is in its correct position.

The front end 2a of the body is provided with fixing means for attaching the instrument to the patient's neck after insertion. According to a preferred embodiment, the fixing means 12
consists of a pair of wings 13 made of transparent PVC, for example, and is provided on both sides of the main body 2. To accommodate the patient's neck, the wings 13 are provided with hinges 14 (suitably weakened plastic material). On the front side (patient side), the wings 13 are provided with a layer of hard-pressed plastic foam 15, which has a double-sided adhesive with a foil of wax paper that is ready to be peeled off for use. are doing. Feather (board)
13 may have an opening (not shown) at its outer end. A cotton band may be passed through this opening to secure the device to the patient's face.

A steel (or thin, rigid plastic) cylinder 16 may be passed over the protrusion of the catheter and applied to the front end 2c of the catheter body to increase the strength of this portion of the catheter and prevent it from being crushed by tissue. good. The cylinder may be provided with a suitable collar 17 to prevent it from entering the trachea.

The embodiment shown in Figures 3a and 3c differs from the embodiment described above in that the catheter is sloped (bent) from the middle of the body. It is also necessary to adjust the angle of the main body and the length of the passage accordingly. However, the rest is the same as the embodiment described above. Further, the embodiments shown in FIGS. 4 to 7 can also be modified in various parts corresponding to the modifications shown in FIGS. 3a and 3b.

In the embodiment of FIGS. 4-7, for manufacturing convenience, the main body 102 has the same cross-sectional shape over almost its entire length. The forward end 102a may be formed as an extension of the rear cylindrical adapter 104 and have a reduced outer diameter in front of the wings, as described below. The front end 102c of the body is inclined at approximately 40 to 60 degrees (angle B') relative to a plane perpendicular to the longitudinal axis of the device so that the device 101 is positioned and firmly seated in the correct location on the patient's neck when inserted. I'll do what I do. As can be seen from FIGS. 4 and 7, the device includes a single wing 105 extending around the entire circumference of the body 102. Desirably, the wings 105 are widest on the sides of the device and narrower on the top and bottom sides. This makes the equipment easier to handle. The wings 105 are inclined with respect to a plane perpendicular to the longitudinal axis of the instrument, the angle D of which preferably corresponds to the angle B' of the forward end 102c of the body. The feather 105 is tilted in this way.
This is to provide additional stability when keeping the instrument in place by threading a cotton band through the openings 105a (only one shown in FIG. 7) and passing it around the patient's neck.
A notch 105b may be provided in the wing instead of the opening 105a (which may also be used in combination). Notsuchi 105
If it is b, it is easy to insert a small band. If the blades are straight, the device will tend to tilt, but if the blades are tilted and a tight band is used, the device will be much more stable.

Compared to the embodiment of FIG. 1, the central passageway 103 into which the replaceable cartridge 118 is inserted is wider. A catheter 106 is mounted within the central opening of the insert 18 and corresponds entirely to the catheter 6 of the previously described embodiment. Catheter 106 therefore receives a steel stylet 107 in the same manner as described above. To removably mount the insert 118 within the body 102, the insert 118 is locked within the body by a type of bayonet mount.
The bayonet mount preferably consists of two grooves 119a formed in the rear portion 102b connected to the rear end 102d of the body. Groove 119a is passage 1
They extend opposite each other along the periphery of 03, and the angle between them is preferably about 90° or more. moreover,
Straight groove 119b (only one is shown in Figure 5)
are provided in the body, the grooves 119b extending from respective corresponding ends of the circumferential grooves 119a. For the locking effect, the insert has two diametrically opposed lugs 120 on its exterior.
is provided. Lug 120 is guided along groove 119b and inserted into the body by entering circumferential groove 119a. The insert then moves through passage 1 until lug 120 hits the bottom of groove 119a.
Rotated within 03. In this way, and in conjunction with the locking lugs on the rear fitting of the stylet as described above, correct positioning of the cut point 107a of the stylet relative to the body is ensured. Of course, other locking means may be used to releasably lock the insert 118.

The advantage of this insert is that the same body with the same size passageway 103 can be used in devices for children, larger children, and adults. That is, each separate insert or cartridge (catheter 106 of corresponding size) is used for each patient.
and a stylet 107). The difference is that the insert 1
It is only that the wall thickness of 18 varies depending on the size of the catheter and stylet. The outer shape of the insert is always the same and fits within the passageway 103 of the body 102.

According to this embodiment, the powerful cylinder 16 described with respect to FIG.
The portion 112 may optionally be integrally formed as shown at 12 so that the portion 112 is preferably beveled to fit within the catheter 106.

The insert 118 is preferably made from the same material as the body 102, although other materials can be used.

For example, an injection channel 111a is connected to the body 102 in order to simultaneously inject a drug directly into the patient's trachea when breathing is assisted through a ventilator connected to the rear end 102d of the body.
formed through. At one end the injection channel has an external orifice 111
The other end of the injection channel 111a opens into an internal orifice 111c in the central passage 103 of the body. are doing. Furthermore, the continuous portion 111 of the injection channel 111a
d is formed on insert 118 and catheter 106. Continuous part 111 of this channel
d is positioned such that the continuous portion communicates with the injection channel 111a when the insert is inserted into the body and locked in place. In connection with the connection between the channel 111a and its continuation 111d, one or both of the channels are designed to be wide enough to always ensure proper communication between the channels, independent of possible manufacturing tolerances. is preferred.

At the location of the orifice 111b of the injection path 111a, a connecting tube 111e made of stainless steel or other suitable material is inserted.
is provided. On the free end of the connecting tube 111e is a thin plastic hose connected to a Luer lock adapter 111f.
The drug is injected into the connecting tube 111e, the injection path 111a, the path 111d, and the catheter 106 through the Luer lock adapter 111f. Preferably, the injection path 111a and its extension or continuation 111d are at an acute angle to the longitudinal axis of the device. This angle points toward the anterior end of the instrument. This configuration provides the most ideal ejection path from the pathway to the catheter and from the catheter to the patient.

The embodiment of FIG. 1 can likewise be provided with an injection path that allows simultaneous injection and ventilation. In such cases, the adapter tube must be connected to the adapter of the device, thus providing a large amount of space for connecting the breathing device. This is particularly relevant in the case of child patients, who have a narrow space between the chin and the upper part of the chest. This adapter can be straight or angled. Straight tubes are used when the patient is lying on their back or in children; slanted tubes are appropriate when the patient is in the NATD position. Both the angled tube and the straight tube are dimensioned so that one end of the tube fits into the adapter of the device and the other end fits into the breathing device. The adapter tube is made of hard plastic.
If possible, it is preferable to make it from the same material as the appliance. The adapter can also be marked (eg, "patient", "respiratory device" on each end) to facilitate connection.

The device of the present invention is used in the following manner. The patient's head is bent as far back as possible and the device of the invention is grasped with three fingers. For example, grip the stylet with the thumb on the stylet attachment, the index finger around one side of the wing, and the middle finger around the other side of the wing. If a fracture of the cervical spine is suspected, the device of the invention is inserted into the patient's trachea without bending the patient's head backwards. Palpate the cricothyroid membrane with the index finger of the other hand. The device is positioned with the markings (eg, the "top") on the top of the body pointing away from the patient's jaw or neck. If necessary, administer local anesthesia with adrenaline additives at the insertion site and into the trachea. Correctly position the instrument and push it through the skin and cricothyroid membrane. To test whether the tip of the stylet has reached the trachea, try inhaling with a syringe through the stylet attachment device. After puncturing the trachea with the tip of the stylet, the steel stylet is carefully withdrawn and the plastic catheter is pushed inwardly and downwardly. The device of the invention is further moved until the front end 2c of the main body rests on the skin of the neck. The device of the invention is secured to the patient's neck by means of a fixation device, after which an adapter tube is connected, if necessary. Figures 1 to 3
In the illustrated embodiment, the necessary injection or injection should be made previously by means of a syringe through a fitting located at the rear end of the passageway. In the embodiments of FIGS. 4 to 7, the injection is performed on the injection path 1
This can be done simultaneously while inflating the patient's lungs via 11a. Finally, a breathing device (eg, an Ambiyu, Rauldel, or Leuven respirator bag, or a breathing device with a suitable valve and oxygen supply) is connected to the device's adapter, either directly or via an adapter tube.

Even when respiratory support is not critical to the patient's life, injecting the drug directly into the patient's trachea and lungs using the device of the present invention is advantageous if it is desirable for the drug to be absorbed quickly into the bloodstream. is useful. Such a situation may occur in cases of epilepsy or heart failure. In such cases, intravenous injections cannot be performed because the syoke and vein are collapsed.

The device of the invention is sterilized and packaged for single use. In the embodiment of FIGS. 4-7, it is preferred to pack together two or possibly three inserts having different sized catheters and stylets into one body.
Thereby, the main body can be used in combination with an insert selected according to the patient to be treated. This operation can be done quickly and easily using a minimum number of parts. The insert 118 and/or the attachment device 110 are preferably colored to clearly indicate the dimensions of the catheter.
The device of the present invention is used in emergency rooms, operating rooms, ambulances, emergency hospitals, and other places where limited treatment is required. As mentioned above, for limited procedures, such as tracheostomy surgery, it is preferable to hold the device of the present invention in place and operate it to perform the surgery.

Various changes and modifications can be made to the present invention without departing from its technical scope. Examples of such modifications include selection of material and adjustment of angle and size. As examples of the above modifications, the present invention also includes those in which the various embodiments described above are replaced with other structural solutions; for example, the external design of the main body, the shape of the wing-like members, etc. may be changed in various ways. I can do it.

[Brief explanation of drawings]

FIG. 1 is a side sectional view of the device of the present invention. Second
The figure is a perspective view of the instrument of the present invention from the front side.
Figures 3a-c are partial cross-sectional views of other embodiments of the device of the invention. FIG. 4 is a side sectional view of yet another embodiment of the device of the present invention. FIG. 5 is a view similar to FIG. 4 with the insert removed. FIG. 6 is a side cross-sectional view of the removed insert.
FIG. 7 is a partial perspective view of the device shown in FIG. 4 seen from the front side.

Claims (1)

[Scope of Claims] 1. An instrument for emergency treatment of respiratory disorders in humans by percutaneous perforation of the trachea, one end of which opens at the front end 2c, 102c of the main body to be positioned on the patient's neck; The main body 2, 102 includes a through passage 3, 103 whose other end opens into the rear part 2b, 102b of the main body; a tube 6 adapted to be inserted into the patient's trachea;
106 such that the tube projects from the front end of the body and forms an extension of the passageway;
The stylet 7, 107 is disposed coaxially within the passageway;
or retractably arranged within said tube 6, 106, and in its fully inserted position, its cut end 7a, 107a projects beyond the outer end of said tube 6, 106; The tube 6, 106 is made of a flexible elastic material; the end of the stylet opening proximate the rear end of the tube or passageway and/or the rear portion 2b, 102b of the body is , a standard sized fitting 10, 110 is installed that allows the medicament to be ejected with a conventional syringe;
and the rear part 2b, 102b of the main body is constituted by a cylindrical adapter 4 formed integrally with the main body and has standard dimensions for connecting it to a breathing device or an anesthesia device; A device characterized by: 2. An instrument according to claim 1, in which the outer diameter of the tube 6 corresponds approximately to the cross-sectional dimension of the passageway 3 and is stationary within the passageway. 3. The device according to claim 1, wherein the tube 106 has a diameter smaller than the cross-sectional dimension of the passageway 103, and the tube 106 has an outer diameter smaller than the cross-sectional dimension of the passageway 103.
03 and positioned retractably from the passageway 103.
A device that stands still inside. 4. In the device according to claim 3, the insert 118 has attachment mechanisms 119a, 11
9b and 120 in a predetermined fixed position in the passageway 103. 5. In the device according to any one of claims 1 to 4, the stylet 7, 107 has an outer diameter that approximately corresponds to or slightly smaller than the inner diameter of the tube 6, 106. and at least a cut end 7
a, at its anterior end adjacent to 107a about 1 to
A device having a cross-sectional diameter of 1.5 mm. 6. In the device according to any one of claims 1 to 5, the tube 6,106 has a diameter of 2.0 to 4.0 mm, preferably 2.5 to 4.0 mm.
3.5mm outer diameter and 1.5~3.5mm, preferably 2.0~2.5mm
An instrument having an inner diameter of 7. In the device according to any one of claims 1 to 5, the tube 6,106 has a diameter of 3.5 to 5.0 mm, preferably 3.9 to 5.0 mm.
4.5mm outer diameter and 3.0~4.6mm, preferably 3.0~4.0mm
An instrument having an inner diameter of 8. The device according to any one of claims 1 to 7, wherein the front surface 2c, 102c of the main body is at an angle of 15 to 60° with respect to a plane perpendicular to the longitudinal axis of the device, preferably is 40～
is inclined at 60°, and the passageway and tube 6,
106 is an instrument extending substantially along the longitudinal axis of the instrument. 9. In the device according to any one of claims 1 to 8, the attachment device 10, 110 has an inclined internal shape adapted to a conventional syringe, which is a so-called Luer attachment device. A device that is made to have a 10. In the device according to any one of claims 1 to 9, the adapter 4, 104 is configured according to an ISO standard.
The rear end 2b, 102b of the main body has an outer diameter of 15mm,
An instrument having a slightly inclined shape in accordance with said standard. 11. In the device according to any one of claims 1 to 10, the injection paths 111a, 111d extend from the external orifice 111b located outside the main body 102 to the tube 1.
A device that extends to the inside of 06. 12. In the device according to claim 11, the external orifice 111b communicates with the Luer lock adapter 111f via a connecting tube 111e and a thin plastic tube, and the injection path 111a,
111b forms an acute angle with the longitudinal axis of the instrument, said angle being adapted to point toward the forward end 102a of the instrument. 13. The device according to any one of claims 1 to 12, wherein the main body is provided with at least one wing-like member 5, 105 on its outer surface, said wing-like member , the instrument is inclined at an angle corresponding to the angle of inclination of the front surface 2c, 102c of the body with respect to a plane perpendicular to the longitudinal axis of the instrument. 14. In the device according to any one of claims 1 to 13, a fixing means 12 consisting of a pair of plates 13 is provided close to the front end 2a of the main body 2, and the plate is pivotally connected to the body and is provided on one side with a layer of hard-pressed plastic foam having a double-sided adhesive. 15. The device according to any one of claims 1 to 14, characterized in that a reinforcing cylinder 16 is positioned through the tube 6 in close proximity to the body 2, the reinforcing cylinder 16 comprising:
This device is provided with a collar 17 to prevent the reinforcing cylinder from being inserted into the trachea. 16. The device according to any one of claims 3 to 14, in which the insert 11 is provided in the tube 6 adjacent to the body 102.
Reinforcing cylinder 1 integrally formed with 8
12 is provided. 17. The device according to any one of claims 1 to 16, wherein the drug is injected directly into the patient's trachea.