US 3262446 A
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Description (OCR text may contain errors)
July 26, 1966 G. H` sToNER RESUSCITATOR Original Filed Nov. 4, 1960 United States Patent O 1 claim. (el. 12s-29) This application is a continuation of my application Serial No. 67,367, filed Nov. 4, 1960, and now abandoned.
This invention relates to a manually operable and portable resuscitator. More particularly, the invention relates to an artificial respiration device of the kind having a hand bulb and a breathing mask and various air-flow passages 'and valves which provide for forcible injection of fresh air into a patient during manual compression of the bulb and for the discharge of air from the patient to the atmosphere upon release of the bulb.
The invention especially concerns improvements in the manufacturing techniques and in the structure of the device which attain significant safety features as compared with various prior devices.
Preliminarily it is pointed out that various types of emergency conditions make it very desirable to have an emergency artificial respiration device capable of quick, easy and sure operation over relatively long periods of time by personnel not highly trained. Such emergencies arise, for example, in situations involving a severe electric shock resulting in the suspension of normal breathing, or in near drowning situations in which the patients lungs cease to function.
Prior devices have used a foam rubber hollow bulb -generally ellipsoid-al in shape land of a size somewhat smaller than a football. By constructing the bulb from foam rubber it is .possible to provide for ease of operation without excessive fatigue of the operator and for ease of feel by the operator of the flow of air into a patient.
Since the foam rubber bulbis porous and therefore not proof against air leakage, and since foam rubber is quite susceptible to mechanical erosion, prior devices have provided for the encasement of the foam rubber bulb within an outer bulb or casing made of a smooth, limp, flexible and elastic sheet material, such as latex rubber.
It has been known to provide various .air and oxygen flow passages in opposite ends of the ellipsoidal bulbs so as to permit the delivery of fresh air from the bulb through a breathing mask to a patient during compression of -the bulb and to permit the intake of fresh air (and oxygen as desired) into the bulb while the bulb is expanding to relaxed condition and air is exhausting from the patient to the atmosphere.
Since the passages through the bulb to accommodate air flow members, valves, etc. are of relatively small cross section while vthe foam rubber interior member of the bulb of relatively large section, considerable manufacturing difficulty is'encountered in getting the foam rubber insert successfully and securely inside of the airimpervious casing while, at the same time, guarding against the introduction of air leaks in the impervious casing.
Normally, the exterior casing is built up of a number of pieces cut from a sheet of latex rubber. These pieces may be assembled and vulcanized along seams disposed generally similar to those of a football, but one such seam of substantial extent has heretofore always been left open during the vulcanization of the balance of the seams of the casing. The open seam has been considered to be necessary in order to make possible the insertion of the foam rubber insert. After the foam rubber insert is inserted and tacked into place by spot cement- P ICC ing in a number of places, the open seam is brought into closed position and secured in some manner, for instance by cementing or vulcanizing in situ.
It is the final cementing or vulcanizing of the open seam which gives rise to numerous manufacturing diiculties and which results in a relatively large number of imperfect casings in a given production run of casings. Minute leaks are quite difficult to avoid under such conditions and, if present, are difficult to discover without a testing and inspection procedure too complicated and cumbersome for use in normal commercial production. Still further, such minute leaks may not turn up immediately after manufacture and may only develop after a short period of use in the field. Thereafter the exterior casing is no longer air impervious and the functioning of the device is impaired.
Furthermore, prior devices have involved the use of one access port for the intake of fresh air and a separate access port for the intake of oxygen, each of the two access ports being general-ly in the form of a valve stem having a check valve therein. The oxygen intake valve stem may be connected to a source of oxygen under pressure. Such devices require careful and accurate handling in order to avoid severe hazards.
In the first place, if an operator unintentionally or unknowingly holds the bulb temporarily in compressed condition, oxygen under pressure can flow into the bulb, notwithstanding the depressed condition, and can thus build up a positive pressure higher than desired within the bulb. Since the device normally includes a separate non-rebreathing valve associated with the breathing mask which permits flow from the device into the patient in one valve position and permits ow from the patient to the atmospherein another valve position, the build up of a positive pressure within the bulb can seriously impair lche correct functioning of the non-rebreathing valve. For example, if the pressure builds up sufficiently to hold the valve member in one position only wherein it occludes the exit passage through which air is normally exhausted from the patient during the expansion motion of the bulb, hazardous exposure of the patient to prolonged inhalation without sufficient exhalation can occur.
Furthermore, the build up of positive pressure beyond normal within the bulb may lead to distortion and damage and possible leakage of the bulb.
Still further, the condition outlined above may lead to an undesirable concentration of oxygen within the bulb which can expose thefpatient to the inhalation of excessive quantities of oxygen.
Other difficulties of prior devices include the acute discomfort which may be caused a patient by reasons of the projection into his lungs of minute particles of foam rubber rubbed loose Within the foam rubber bulb. This condition is aggravated by a construction involving the exposure of raw edges of foam rubber, for example, around an aperture, during use of the device.
With the foregoing in mind, an important object of the invention is the provision of an artificial respiration device, and a method for the assembly thereof, utilizing a foam rubber interior member and an air-impervious casing, which casing is formed as a unitary member prior to assembly with the foam rubber insert, the structure of the invention providing for the assembly of the foam rufbber insert into the unitary casing by special compression of the foam rubber casing and distention of a relatively small aperture provided in the casing for the accommodation of valving, etc.
Another object of the invention is the provision of an air-oxygen intake which provides for the inflow of air and oxygen as needed but which prevents undesired inflow of oxygen, even though the oxygen be supplied to the unit under `considerable pressure.
Yet another object of the invention is the provision of safety means for minimizing the possibility of the projection of particles of foam rubber into the lungs of a patient, the invention providing not only for the guarding of exposed edges of apertures in the foam rubber bulb, but also for a filtering screen interposed in the system between the foam rubber bulb and the passage through which air is delivered to the patient.
Yet another object of the invention is the provision of specially configured nozzles for the outfiow of air exhausted from a patient and for the accommodation of a breathing mask having an air flow passage therein, which nozzles prevent the operator from misassembling the device with the breathing mask over the exhaust nozzle. Other objects and advantages of the invention will be clear from the following description taken together with the accompanying drawings, in which:
FIGURE 1 is a longitudinal section with part of the breathing mask in full view and with the inner parts of the valve at the left of the figure elevation;
FIGURE 2 is a separated section of the two halves of the inner bulb member, this view being on a reduced scale as compared to FIGURE l;
FIGURE 3 is a separated sectional view similar to FIGURE 2 and further showing sleeve members mounted in position in the two halves of the bulb;
FIGURE 4 is an elevational view, partly broken away, showing the two halves of the inner bulb member, shown in FIGURES 2 and 3, in assembled relation, and showing the assembly inside of the exterior casing;
FIGURE 5 is a longitudinal section on an enlarged scale as compared with FIGURE 1 of the inlet valve shown toward the left in FIGURE 1, FIGURE 5 being generally along the line 5-5 of FIGURE 6;
FIGURE 6 is an end view of FIGURE 5 looking toward the left; and
FIGURE 7 is a cross section on the line 7 7 of FIG- URE 5.
In general, the main parts of the invention are the fiexible hand bulb B, the breathing mask M, the non-rebreathing valve V, the air intake A and the oxygen intake O.
The bulb B is composed of an interior member 8 constructed of a soft, resilient and elastic material, such as foam rubber. The interior member 8 is stiffened somewhat by means of ribs 9 and portions of increased wall thickness such as 10 and 11.
Since materials, such as foam rubber, which are suitable for use for the interior member 8 are generally porous and, therefore, not air impervious, and since such materials are rather readily sllject to mechanical erosion, a protection exterior casing 12 is provided which entirely encloses the member 8. The casing 12 is preferably made of thin sheet material which is flexible, limp, elastic and air impervious. Latex rubber is a material suitable for the outer casing 12.
As seen in FIGURE 2, the interior member 8 is conveniently constructed in the form of two half members 13 and 14 which are just alike and which are assembled together by applying cement around the opposing rims 15 and 16, and then bringing the opposing rims into contact. The assembled interior member 8 (as seen in FIGURES 1 and 4) is generally ellipsoidal in exterior shape.
Accommodation of air flow passage and valve means is provided for through apertures 17 and 18 in opposite ends of the ellipsoidal assembly. The edge surfaces 19 and 20 of the apertures 17 and 18 present special problems because of the tendency for such foam rubber edges to erode in use :and release small .particles of foam rubber. As an aid in protecting or guarding the edge surfaces 19 and 20 from such erosion, sleeve members 21 and 22, see FIGURE 3, are provided. The sleeve members 21 and 22 are preferably made of a resilient elastic material, such as latex rubber. Conveniently, the sleeve members 21 and 22 are made of the same material as the exterior casing 12.
Sleeve members 21 and 22 include outwardly flared flanges 23 and 24 which are adapted to fit inside of and seat against the interior member 8 in the region of the end apertures. The flanges 23 and 24 include conical portions 25, 26 and 27, 28. As best seen in FIGURE 1, the conical portions 25 to 28 provide small annular pockets 29 and 30 which facilitate the cementing of the fianges 23, 24 to the interior surface of the member 8.
The sleeve portions of the sleeve members 21 and 22 protrude through the apertures 17 and 18. Conveniently, outwardly projecting flanges 31 and 32 are provided on the free ends of the sleeve members 21 and 22, and serve to reinforce the mouths of the sleeve members.
When the sleeve members 21 and 22 have been assembled with their bulb halves 13 and 14, as shown in FIG- URE 3, cement may be applied as above described to the surfaces 15 and 16 and then the halves 13 and 14 are brought axially together so as to form an integral interior member 8.
The exterior casing 12 includes neck extensions 33 and 34 protruding from opposite ends thereof around apertures 35 and 36 in the casing. The neck extensions 33 and 34 of the exterior casing and the sleeve members 21 and 22 of the interior member are sized and positioned so as to cooperate with each other in forming an access port at each end of the assembly.
The exterior casing 12 may be built up from a plurality of cut pieces of latex rubber sheet, in the manner generally used in prior devices, the pieces being vulcanized to form a unitary casing completely enclosed except for the apertures 35 and 36, prior to the assembly of the exterior casing with the foam rubber insent. However, because of the special assembly method of the invention, it is possible to form the exterior casing as a completely unitary structure by la formation process involving the dipping of a core or form into a latex rubber solution. Such a formation process is of advantage in that it rninimizes the risk of the existence of minute holes through the casing.
The interior member 8 is inserted into the exterior casing by collapsing or compressing the interior member, expanding or distending one of the apertures and neck extensions thereof, such as the aperture 35 and neck extension 33 and then axially telescoping the compressed interior member into the exterior casing through the distended aperture. After the interior member is inside of the exterior casing, the interior member is released from compression and the exterior member is released from distention. There results an assembly of porous interior member and air impervious exterior casing without the necessity for the vulcanization in situ of any seams or large openings in the exterior casing.
As seen in FIGURE 4, the end 37 of the neck extension 34 of the exterior casing may be folded back so that cement may be applied between the exterior surface of the sleeve member and the interior surface of the neck extension. Thereafter the rolled-over edge 37 is uncurled so that the neck extension becomes firmly bonded to t'ne sleeve member. A similar cementing operation is effected at the opposite end of the bulb.
Attention is now difnected lto the non-rebreathing valve V as seen in FIGURE 1. A valve block 38 includes a cylindrical fitting 39 which may be forced into one of the access ports in the bulb. A bore 40 extends through the valve block 38. The fitting 39 is threaded and screwed into corresponding threads in the bore 40. The bore 4l in fitting 39 is in communication with the bore 40 of the valve block, An exhaust nozzle 42 extends out of the valve block 38 from the end of the bore opposite to fitting 39 and is maintained in place by means of a threaded sleeve extension 43 which is screwed into corresponding threads within the end of the bore 40.
An air delivery nozzle 44 protrudes from the valve block and provides communication between the bore 40 and the breathing mask M, via the aperture 45 in the mask. The mask M is adapted to cover the nose and mouth of a patient and has a soft, hollow rubber face engaging lip 46 for this purpose. The access nipple 47 having a cap 48 provides for access to the interior of the lip 46 if it is desired to increase or decrease the quantity of air within the lip.
The end 49 of the nozzle 44 is threaded `and cooperates with corresponding threads in the bore 50 in the valve "block 38. The bore 50 intersects the bore 40 at right angles thereto.
The inner end 51 of the fitting 39 comprises .an annular valve seat. Valve disk 52 is mounted for axial movement on the valve stem 53, which stem is retained concentric with the bore il by means of the mounting spiders 54 and `55. The valve disk 52 is urged toward the left as seen in FIGURE 1 against the seat 51 by means of the helical spring 56.
A third spider member 57, similar to the spiders 54 and 55, serves to guard the valve mechanism from tampering or accidental damage by preventing the access of a finger to the valve member through the exhaust flow passage 58 communicating with the bore 4t) through exhaust nozzle 42.
The inner end 59 of the exhaust nozzle fitting is configured to form an annular valve seat similar to the valve seat Eil so that the valve disk 52, when forced toward the right as viewed in FIGURE l against the coil spring S6, will seat against valve seat 59 and occlude the exhaust passage 58. A lter screen 60 is interposed in the airflow passage between the foam rubber 8 and the breathing mask M. This filter screen serves an important function in arresting the travel of any minute particles of foam rubber which may become dislodged Vfrom foam rubber member 8 and preventing such particles from passing through the air delivery nozzle 44.
Attention is now directed to the opposite end of the bulb and to the valve mechanism there shown, as best seen in FIGURES 5 to 7.
In many rescue operations it is sufficient to effect artificial respiration using air alone. However, in some cases it is necessary or desirable to supplement the oxygen content of the air by adding pure oxygen from a supply of oxygen under pressure, such as an ordinary oxygen tank. At such instances it is important to mix the oxygen with `air and deliver the mixture to the patient so as to avoid delivering an excess of oxygen.
The inlet valve mechanism includes an outer conduit 61 and an inner conduit 62 concentrically mounted within the outer conduit 61. The outside diameter of the inner conduit 62 is substantially less than the inside diameter of the outer conduit 61 to provide a substantial space 63 for the flow of air within the outer conduit 61 but outside of the inner conduit 62. The inner conduit 62 is maintained in position by support member 64 which occludes the space 63.
Inner conduit 62 includes a tapered portion 65 leading to a nipple 66 of conventional type which is adapted to cooperate with the end of a rubber or plastic tube leading to the source of oxygen.
Apertures 67 are provided through the wall of the inner conudit 62 so that flow may take place between the inside of the inner conduit and the outer conduit. At the inner end, the right-hand end as seen in FIGURE 5, the inlet structure includes a valve seat 68 and a retaining ring 69. The valve disk 70' is adapted to seat against valve seat 68 and occlude flow through the inner conduit 62. Motion of the valve disk 70 off of the seat 68 is limited by retainer disk 71 held in position by four L-shaped legs 72 extending into the end of the conduit 61 and terminating at the inner end in a cylindrical ring member 73 having a plurality of raised bumps 74 around the inside thereof, which bumps are adapted to snap over the retaining ring 69 and thus maintain the ring 73, legs 72 and retainer 71 in position.
The operation of the device is as follows. When a patients breathing is interrupted for any reason, such as electric shock or near drowning, the breathing mask M is placed over the nose and mouth of the patient, and the patients head is tilted so as to facilitate the opening of the air passages at the back of the throat. The operator can hold the mask over the patients face with one hand and grip the bulb B with the other hand. Manual squeezing of the bulb B builds up the pressure of the air inside of the bulb. The valve disk travels toward the left as seen in FIGURE 1 and seats in position to occlude all inflow of oxygen and air and to occlude all outflow through conduit 62. The valve disk S2 in the non-breathing valve V travels toward the right and seats in position to occlude the exit passage 58. The air within the bulb B is therefore forced out of the air delivery passage in the delivery nozzle 44, through the mask M and into the patient.
When the bag is fully depressed, the operator releases the bag and the resilient foam rubber Walls tend to expand to their former position. During the expansion motion the valve 52 returns to its seat 5=1 under the action of the spring 56 so that the air exhausting from the patient travels outwardly out of the exit nozzle 58 and into the atmosphere. At the same time the valve disk 70 in the inlet mechanism leaves its seat and permits the inflow of air into the interior of the bulb. If a source of oxygen is fastened to the nipple 56 as mixture of air and oxygen will be taken into the bulb.
Rythmic compression and release of the bulb B therefore provides for the periodic injection of fresh air into the patient and forthe periodic discharge of air from the patient to the atmosphere.
The exhaust nozzle 42 is exteriorly tapered as shown at 75 for a special purpose. The breathing mask M is of standard construction having aperture 45 of standard acceptable size. The nozzle` 44 is sized to accommodate such a mask. By properly tapering and sizing the exit nozzle 42, it is possible to provide an exterior surface thereon which will not fit into the aperture 45. A saftey feature is thus accomplished in that the operator cannot by mistake misassemble the mask onto the exit nozzle instead of onto the delivery nozzle.
The coaxial delivery of oxygen 4and air through a common valve performs a significant safety function. If the oxygen supply were provided, in the usual way according to the prior art, through a separate intake stem and valve member, the oxygen could continue to ow into the unit even after the bulb was compressed. If the operator inadvertently held the bulb depressed an unusually long period of time, a positive pressure Would build up within the bulb because of the continued flow of oxygen. Such positive pressure would serve to hold the air intake valve in closed position and to hold the nonrebreathing valve member in position to occlude the exit or exhaust passage.
The result would be a substantial increase of oxygen concentration within the bulb and `a build up of pressure which would not be relieved on the discharge stroke. The patients lungs would be subjected to positive pressure without being given sufficient opportunity to exhale. By the oxygen and air ow passage and valve means according to the invention, this danger is eliminated. If the bulb is held in depressed condition, the valve 70 remains on its seat and the oxygen flowing through nipple 66 flows outwardly through aperture 67 and into the atmosphere.
The air delivery nozzle 44 is specially sized to perform several different functions as may be desired. In the rst place, as mentioned, the exterior sizeV of the nozzle 44 is such as to provide a snug fit in mask M having a' standard aperture 45. In the second place, the exterior surface 76 is cylindrical near the free end `and then tapers very slightly outwardly to provide a gradually enlarged portion. This surface configuration follows exactly the well-recognized standard established for intratracheal ac- 7 cessories. In other words, there are standard intratracheal accessories available having fittings which will press tightly onto the exterior surface ofthe nozzle 44.
Similarly, the bore 77 through nozzle 44 -is straight and cylindrical and of a size to meet standard requirements. As a result, various intratracheal accessories will exactly fit within the bore 77.
Thus, by properly constructing the nozzle 44, it will interlit neatly and snugly with not only mask M, but also various intratracheal accessories having apertures or projecting connectors.
The method of assembly of the `foam rubber interior member with the air impervious exterior casing attains a number tof important advantages over prior structures.
As discussed above, it is no longer necessary to vulcanze a seam of the exterior casing after the foam rubber insert is in place. On the contrary, the exterior casing is completely formed as a unitary member prior to the insertion of the foam rubber insert.
Further, the edges of the apertures in the foam 4rubber piece are shielded from erosion by means of the special sleeve members secured within the foam rubber in- 'sert and protruding through the apertures.
Since the sleeve members, after being `cemented inside the foam rubber bulb, are, in eifect, integral exten.
sions of the bulb, they serve to positively orient the bulb within the exterior casing throughout the life of the unit.
In contrast, when the prior method of assembly is followed, positioning of the foam rubber insert within the casing depends on the accuracy and permanence of the cement or glue tack spots utilized. It sometimes happens upon prolonged use of the unit that such tacks became loosened and the foam rubber insert can then become disoriented so that the apertures therethrough do not line up with the apertures in the exterior casing. If this occurs, the functioning of the unit is severely impaired and there is no way to get inside of the unit to repair the damage.
The parts and assembly method of the invention guard against the diiculties discussed land provide for a quick, sure and permanent orientation lof the foam rubber member within the casing, and, further minimize exposure of the foam rubber edges to mechanical erosion.
The shoulder 78 ron the delivery nozzle 44 limits the' travel of the threaded end 49 into the bore 50 and thereby avoids excessive compression of the screen 60 against the bottom of the bore 50.
The screen 60, in addition to preventing foam rubber particles from passing into the lung of a patient, also prevents the passage of foreign matter, such as vomit,
from the patient upwardly into the mechanism of the nonrebreathing valve V..
An artificial respiration device comprising a hand bulb, a breathing mask, and air ow passage and valve means providing for the forcible injection of fresh air into a patient during a compression stroke of the bulb, and upon release of the bulb, for discharge of air from the patient to the atmosphere during expansion motion of the bulb, the hand bulb comprising a hollow interior `member and an exterior casing, the interior member being of a soft elastic -and porous material and the exterior casing being formed of a flexible elastic and air-imperivous material, the exterior casing and interior member each having a pair of apertures therethrough, the apertures in the interior member being aligned with the apertures in the exterior casing to provide two access ports, the air How passage and valve means comprising air intake passage means communicating with the interior of the interior member, through one of said access ports, oxygen intake passage means communicating with the air ow passage means, whereby supplementary oxygen may be mixed with the air taken into the device, a valve in the air intake passage means, said valve being adapted to permit flow into the interior member during the expansion motion of the bulb and to occlude ow of air and oxygen in'either direction during the compression stroke of the bulb,.thc air intake passage means :comprising a first tubular conduit member, and the oxygen intake passage means comprising a second tubular conduit member of outside diameter substantially smaller than the inside diameter of the first conduit member, the construction further including mounting means mounting the second conduit member within the first conduit member and occluding the space around the second conduit member within the rst conduit member, the wall of the second conduit member being -apertured to permit interflow between the outer conduit member and the inner conduit member, and a valve disk positioned to seat against the inner end of the inner conduit member and thus 'occlude flow therethrough.
References Cited by the Examiner UNITED STATES PATENTS '723,042 3/1903 Schwerin 230-169 3,009,459 11/1961 Ruben 128-29 Y FOREIGN PATENTS 1,183,803 2/195'9 France.
RICHARD A. GAUDET, Primary Examiner.
C. F. ROSENBAUM, Assistant Examiner.