US 3476113 A
Description (OCR text may contain errors)
United States Patent iitice 3,476,113 Patented Nov. 4, 1969 TLS. Cl. 12S- 305 8 Claims ABSTRACT OF THE DISCLOSURE A needle-knife assembly for forming an emergency breathing opening in the crico-thyroid membrane of the neck of a patient is releasably attached to one end of a common, plastic hollow squeeze tube syringe handle containing a supply of anesthesia in solution with a vasoa constrictor. This needle-knife assembly includes a knife blade bisected by a hollow hypodermic needle that communicates with the interior of the syringe handle and is initially used to inject the solution of anethesia and vasoconstrictor contained therein into the tissues of the neck. With the needle portion retained in position, the knife blade is subsequently guided to make a correctly oriented incision at the etico-thyroid membrane to thereby form the emergency breathing opening.
A throat-button having an airway improved to provide increased air flow therethrough and being removably attached to the opposite end of the common syringe handle is inserted in the emergency opening formed by the needle-knife assembly to thereby ensure sustained emergency breathing of the patient.
BACKGROUND OF THE INVENTION This invention relates generally to the eld of ernergency crico-thyrotomy devices and, in particular, to a combined crico-thyrotomy kit providing both anesthesia, vaso-constriction, sterility, and improved means for ensuring relatively sustained breathing all contained within a small, pocket-sized, unitary device.
In previously developed emergency life-saving kits for use when upper respiratory obstruction has occurred in a patient, the technique known as the tracheotomy (cutting a hole into the trachea-windpipe) has long been established as a method of providing emergency breathing and, therefore, preserving human life. However, except for surgeons, this is a rather diicult and dangerous procedure and thus one that should not normally be practiced by the unskilled layman. Therefore, during the past twenty years, much interest has centered on the development of a newer and less dangerous emergency life-saving technique known as the crico-thyrotomy. This techniques consists of cutting an emergency opening through the thin membrane that lies between the thyroid and cricoid cartiiages. This procedure is considered less dangerous and constitutes a considerable improvement, since there are no important nerves, arteries, veins, or other structures lying over this membrane that might be damaged during the formation of the opening. Moreover, it is rather easily located and lies close to the surface of the skin.
A number of methods and devices have been previously developed to exploit the use of the crico-thyroid membrane as a route for establishing the requisite emergency opening. These have included, in the simplest form, a hollow needle which, however, has the disadvantage of being effective only when connected to a supply of 100% oxygen and, moreover, is inherently dangerous unless held carefully in place by someone other than the patient at all times. Other methods have included use of special scissors, tissue spreaders and knives, together with various pipe-like devices (canulae). Although these methods work well, they are usually relatively expensive, and are bulky to carry as an emergency kit. Moreover, they are not usually readily available in an emergency situation. Furthermore, asepsis, hemostasis and local anesthesia are usually ignored in most of these devices, because of the urgency of immediately securing the emergency opening. In this connection, the emergency crico-thyrotomy kit design of the present invention offers significant improvements and advantages over the above-noted previously developed methods, in that it is a simple, small, pocketsized emergency kit that provides improved means both for ensuring a properly cut emergency breathing opening and for facilitating relatively sustained, painless and blood-free emergency breathing, as will become readily apparent hereinafter from the following summary and detailed description.
Summary of the invention It is a principal object of the present invention, therefore, to provide an emergency crico-thyrotomy kit improved in that it incorporates a unique needle-knife assembly facilitating the cutting of the correctly oriented emergency breathing opening in the crico-thyroid membrane, combined with a novel syringe squeeze handle that is joined with the needle-knife assembly and is adapted to inject a solution of anesthesia and vaso-constrictor into the appropriate neck tissues just prior to the formation of the emergency opening.
A further object of the invention resides in the provision of an emergency crico-thyrotomy device that incorporates a novel design throat-button specifically adapted to the anatomy of the human neck when tted into the emergency breathing opening cut therein and having a unique airway designed to provide increased air ow therethrough to thereby assure sustained emergency breathing.
A still further object of the invention is in the development of an improved emergency life-saving kit consisting of a crico-thyrotomy set having a novel needleknife assembly incorporating an improved hollow needle portion for guiding the knife portion in correctly cutting an emergency breathing opening into the crico-thyroid membrane, coupled with an improved throat-button adapted for insertion into the opening with both mounted on a unique and common syringe squeeze handle containing a solution of anesthesia and vaso-constrictor adapted for injection into an initial opening formed in the crico-thyroid membrane by the hollow-needle portion.
Other objects and advantages of the invention will become apparent from the following detailed description, taken in connection with the accompanying drawings, in which:
Summary of the drawings FIG. 1 represents an assembled view of the cricothyrotomy set of the present invention shown in position and sealed in a clear plastic pocket-sized and sterile carrying and storing case;
FIG. 2 is a disassembled view of the crico-thyrotomy set of FIG. 1, shown removed from its carrying case, and illustrating certain details of the throat-button and needleknife assembly components utilized therewith;
FIG. 3 is a front view of the needle-knife unit shown in the disassembled view of FIG. 2, illustrating certain details of the supporting relationship between the knife blade and hollow needle portions thereof;
FIG. 4 is a view in side elevation, illustrating additional details of the throat button unit depicted in FIG. 2 when correctly oriented for insertion in the emergency breathing opening cut in the crico-thyroid membrane by the invention knife-needle unit; y
FIG. 5 is another view of the throat-button unit of FIG. 4 looking in the direction of, and illustrating the improved streamlined and funnel-shaped configuration of' the rear air opening incorporated therein; and
FIG. 6 is a lateral view schematically illustrating the throat-button of the present invention in correctly inserted position, as oriented in FIG. 4, within the emergency breathing opening formed in crico-thyroid membrane.
Description of the preferred embodiment The emergency crico-thyrotomy life-saving set of the present invention is seen in the assembled view of FIG. 1 of the drawings as generally including an overall assembly consisting of a main hollow tube syringe handle 1 open at one end and closed at the opposite end thereof and containing a supply of anesthesia in solution with a vasoconstrictor; a needle-knife unit 2; and a throat button unit 3. Units 2 and 3 are respectively releasably positioned on opposite ends of handle 1 as shown, and the entire assembly is normally carried and/or stored within a sealable, sterilizable and clear plastic case depicted generally at 4. The latter includes a relatively elongated portion 4a, in which is positioned the needle-knife unit 2, and a relatively enlarged and shortened portion 4b for supporting therewithin the throat-button unit 3. Due to the difference in dimension between the respective inside diameters of case portions 4a, 4b, an inside diameter fiange is inherently formed at 4c in the relatively enlarged and shortened case portion 4b. In this regard, throatbutton unit 3 incorporates an exteriorly disposed rear flange portion that is both sized and shaped to closely conform with, and, therefore, fit in snugly-supporting relation on the inside diameter flange 4c. In this manner, the needle-knife unit 2 is supported within the relatively elongated case portion 4a free of contact with the bottom of carrying case 4. The carrying case 4 and its contents are maintained in a sterile condition as by means of a top cover element at 4d which may be spot thermal-sealed to the body portion of the aforesaid case 4.
Referring particularly to FIG. 2 of the drawings, the present crico-thyrotomy set is shown removed from its protective case 4 with its principal components further detailed for the sake of clarity. The needle-knife unit 2 is illustrated as including a knife portion 5 that consists of a surgically sharp, stainless steel knife blade or scalpel 6 that is silver-soldered to the previously referred to knife hilt 7, and a knife stem 8 that incorporates a circumferentially disposed outer bead element 8a. The latter element 8a is specifically configured to engage with and thereby frictionally retain the aforesaid knife stem 8 within a similarily shaped, interiorily-disposed circumferential slot formed within the inside diameter surface of the squeeze handle 1 adjacent to the open end thereof, as illustrated at 1a in FIG. 2. Throat-button unit 3 is removably positioned on the opposite, closed end of handle 1 by means of a friction grip. A hypodermic-type hollow needle indicated at 9 is positioned in supporting and bisecting relation on aforesaid knife blade 6. In this connection, the knife blade 6 is grooved, as indicated at 6a in FIG. 3 of the drawings, to a radius equal to that of the hollow needle 9 and is silver-soldered thereto to provide proper support therefor. Needle 9 is made hollow in form and incorporates an open end in communication with the interior of the previously-noted hollow tube squeeze syringe handle 1 adjacent the open end thereof, and is therefore specifically adapted to inject the supply of anesthesia and vaso-constrictor contained within said handle 1 on manipulation of the latter during the initial preparation stage prior to the use of the inventive instrument in forming the requisite emergency opening. Note also that the pointed end of the needle 9 extends in overlapping relation forward of the front edge of knife blade 6 a predetermined distance which, in an actual example, was made equal to 0.062 inch.
As seen particularly in FIG. 4 of the drawings, the aforesaid throat-button unit 3 of the present invention consists of a relatively pointed and downwardly-curved nose portion 12, which is directed towards the patients lungs, when in properly oriented position; an interconnecting and integrally-joined duct portion 11, and the previously mentioned rear fiange portion 10. A key feature of the latter element 10 is that it is specifically designed in a collar-button shaped configuration for a specific purpose to be discussed in more detail hereinafter. Throat-button unit 3 further incorporates an airway passage, indicated generally at 13, as including a relatively straight passage portion 13a extending rearwardly from a front opening at 10a to an arcuate portion 13b that substantially conforms with the configuration of the aforesaid nose portion 12 in that it terminates in a downwardly curved rear end opening at 13C that is directed towards the patients lungs when properly inserted in the emergency breathing opening formed therefor.
With specific reference to FIGS. 4 and 5 of the drawings, the previously noted airway passage 13 and in particular front and rear openings 10a and 13e` are clearly depicted as being uniquely designed with streamlined and funnel shaped configurations. In this manner, the inventive throat-button unit 3 has the important advantage of inherently eliminating or, at least, significantly reducing the approximately energy loss known to be suffered by the use of a plain suction end of a round, square, or rectangular duct used alone and which is reduced to about a 50% energy loss when a fiange is added at the end of the duct and which is still further reduced to a loss of less than 3% when a bell-shaped transformation piece is used to form a contracting nozzle of a radius of curvature of not less than one duct diameter. Thus, the streamlined and funnel-shaped design of the airway passage 13 and openings 10a, 13C of the present invention scientifically promotes more efficient and increased air fiow, by eliminating any abrupt changes in velocity, or the direction of the air fiow, insofar as is possible and still perform the assigned function. In FIG. 5, it is also seen that both the airway passage 13 and the body of throat-button unit 3 itself are made oval shaped in cross section. This oval shaped design is specifically incorporated in the present device to accommodate the crisco-thyroid space which is of similar shape; furthermore, the original cut made by the previously described needle-knife unit 2 is made horizontal in orientation and therefore will more easily line up with the long axis of the oval configuration and thus permit easier entry. Finally, the oval shape configuration assists in maintaining the original position of the throatbutton, and, additionally, allows the largest cross sectional area for a given size wound.
In using the present invention, the instrument is first removed from its carrying/storing case 4, and the hollow needle 9 is then inserted into the skin of the neck over the crico-thyroid membrane. The plastic handle 1 is then squeezed to inject the solution of local anesthetic and vasoconstrictor contained therewithin into the appropriate neck tissues by way of said needle. This action, which last only a few seconds, will anesthetize the area involved and also prevent excess bleeding. Next, without removing the needle 9 from the skin, a horizontal incision cut is made by thrusting the knife blade or scalpel 6 directly into the neck. During this step, the needle 9 acts as a guide for the blade 6. The latter must, of course, be held in the horizontal position. During this cutting movement, the knife hilt 7 acts as a stop means to prevent over insertion of the blade 6 into the wound, thus protecting the deeper structures of the neck from injury. At this point, the throat-button unit 3 is ready for insertion. This unit is oriented as shown in FIG. 4 with front opening 13C of airway passage 13 directed downward towards the patients lungs. Now, as depicted particularly in FIG. 6 of the drawings, throat-button unit 3 (shown disassembled from its connection with handle 1) is inserted into the horizontal wound or cut previously made by needle-knife unit 2 into the crico-thyroid membrane. The plastic handle 1 would then ybe twisted off, leaving the aforesaid throat-button unit 3 inserted in its proper breathing position as shown. As noted hereinbefore, the unit 3 is made oval-shaped both to prevent its rotation to a position away from the direction of the patients lungs for obvious reasons, and in addition, to promote the maximum entrance of air therethrough. The previously noted streamlined and funnel-shaped configuration of airway passage 13 also greatly assists in the further promotion of optimum air flow into the emergency breathing opening.
Moreover, the collar-button shape of the unit 3 forms a ared out configuration, as clearly visible in FIG. 6, to thereby ensure to a high degree the natural retention of the unit within the crico-thyroid membrane opening provided therefor. Furthermore, the curved nature of the flange 10, which is specifically designed to adapt closely to, or accommodate the anatomy of the neck further assists in retention of the throat-button unit 3 in correctly inserted position in the neck opening provided therefor. Thus, better breathing is assured by the elimination of possible leakage around the outer edges of the flange itself, which leakage could divert normal air ow into the front opening a of airway passage 13. Although the inherent configuration of the inventive throat-button unit 3 is specifically designed to promote its natural retention in position in the emergency breathing opening provided therefor; nevertheless, a pair of slots may be utilized, as shown at 14 in FIG. 5, to thereby provide for the use of tie-down tapes, if additional retention should be desired.
While a preferred embodiment of the invention has been shown and described for purposes of exemplification, it is apparent that many modifications and changes may be made without departing from the true spirit or scope of the invention, as defined hereinafter in the accompanying claims.
1. In a small, pocket-sized life-saving kit adapted to establish emergency breathing in a patient experiencing upper respiratory obstruction; an integrated crico-thyrotomy instrument having first, combined means adapted t0 anesthetize and cut an emergency breathing opening in the crico-thyroid membrane, said cutting means including a surgical knife means, in combination with a second, self-contained breathing tube means adapted to fit the emergency opening formed in the crico-thyroid membrane and incorporating an airway shaped to provide sustained respiration in the patient; said first, combined means and said breathing tube means being oppositely mounted on a common, hollow tube, syringe squeeze handle containing a supply of anesthesia in solution with a vaso-constrictor, and said combined means further including a hollow hypodermic needle in open communication with said solution for initially injecting said solution into the tissues of the neck, on manipulation of said syringe handle prior to the actual cutting of the emergency opening in the crico-thyroid membrane by said surgical knife means, to thereby anesthetize and inhibit bleeding of the wound created by the subsequent formation of the emergency breathing opening.
2. In a small, pocket-sized life-saving kit as in claim 1, said hollow hypodermic needle bisecting said surgical knife means and incorporating a pointed end solutioninjecting portion overlapping the blade portion of said knife and, after injecting said solution into the neck tissues, being retained in its solution-injection position to thereby act as a guide for the subsequent cutting operation of said knife.
3. In a small, pocket-size life-saving kit as in claim 1, said breathing tube means having an entrance air opening exposed to the atmosphere and incorporating an outer, curved flanged surface sealed against the circumference of said opening and adapted to accommodate the anatomy of the neck to thereby assist in its natural retention in position within the emergency opening cut in said cricothyroid membrane.
4. In a small, pocket-sized life-saving kit as in claim 3, said entrance air opening being made funnel-shaped to promote the admittance of optimum air fiow therethrough, and said breathing tube means further incorporating an interconnecting airway passage of streamlined shape t0 further promote optimum air flow therethrough and further having a ared configuration to further assist in its natural retention in its breathing position.
S. In a small, pocket-sized, life-saving kit as in claim 1, said breathing tube means comprising a collar-button shaped throat -button equipped with an oval cross-section to thereby facilitate its adaptation to the similarly shaped crico-thyroid space and thereby ensure the maintenance of said throat-button in its original breathing-promoting position.
6. In a small pocket-sized, life-saving kit as in claim 1, said breathing tube means comprising a throat-button incorporating an outwardly-flared, hood portion to ensure its retention in its inserted position in the emergency breathing opening and terminating in a curved flanged portion adapted to the anatomy of the neck.
7. In a small, pocket-sized, life-saving kit as in claim 6, said throat-button further incorporating an airway passage of less air-resistant, oval-shaped cross-section to ensure maximum air fiow therethrough, said airway passage terminating at opposite ends thereof in streamlined openings further assisting in assuring maximum air flow therethrough into the patients lungs.
8. In a small, pocket-sized, life-saving kit as in claim 1, said breathing tube means comprising a collar-button shaped air valve of oval-shaped configuration incorporating a first, streamlined and funnel-shaped entrance air opening exposed to the atmosphere and having a streamlined and flare-out shape designed both to increase the air ow therethrough and simultaneously promote its retention in position, and terminating in an outer, curved flanged surface sealed against the circumferential edge of said emergency breathing opening cut therein by said combined means, said curved fiange surface ybeing further adapted to accommodate the anatomy of the neck t0 thereby further promote the retention of said breathing tube means in its inserted position; an interconnecting airway passage shaped into an oval cross-section to facilitate optimum air fiow therethrough; and a second, exit air opening of streamlined configuration and integrally formed with said interconnecting airway passage and disposed in a downwardly curved direction oriented towards the patients lungs and naturally held in said oriented position by the oval-shaped cross-sectional area configuration of said air valve.
References Cited UNITED STATES PATENTS 2,258,863 10/1941 Reynolds 128-188 X 2,687,727 8/1954 Lawshe 128-216 3,307,551 3/1967 Violet 12S- 305 3,415,250 12/1968 Peterson 128-305 FOREIGN PATENTS 14,727 1894 Great Britain.
ANTON O. OECHSLE, Primary Examiner R. I. APLEY, Assistant Examiner U.S. Cl. X.R. 128--215, 347, 351