FR2906149A1 - Mobile device for non-invasive determination of carbon monoxide in e.g. emergency truck, has measurement apparatus, measuring carbon monoxide concentration of blood, coupled to LED and light sensor, and including display system - Google Patents

Abstract

The device has a respiratory aid apparatus (4) arranged on an emergency support plate (1) and connected to a patient side interface e.g. tube. A compressed gas cylinder supplies oxygen to the apparatus. A measurement apparatus (3) is arranged on the plate for non-invasive measurement of carbon monoxide concentration of blood, and is coupled to a light source e.g. LED, and a light sensor, where the apparatus (3) is provided with a display system. The measurement and respiratory apparatuses are operationally connected to each other. An independent claim is also included for a mobile oxygen supply system for supplying oxygen to blood of the patient.

Description

Mobile device for the treatment of a patient The invention relates to

  a mobile device for the treatment of a patient who has a respiratory support system which, arranged on a support, can be connected to a patient-side interface and in which an oxygen supply of said respiratory assistance system is performed under the shape of a bottle of compressed gas. The invention also relates, in particular, to a portable device for the rapid, noninvasive determination of the concentration of carbon monoxide in a patient's blood, and an oxygen supply system for directly feeding patients with oxygen. when it is found that the concentration of carbon monoxide in the blood is raised. Direct oxygen treatment is in particular carried out via a patient-side interface. An oxygen supply can also be provided by means of rescue breathing apparatus. The respiratory assistance system may alternatively be in the form of an oxygen cylinder or a breathing balloon. In comparison with oxygen, carbon monoxide has a binding capacity to red blood cells, which transport oxygen, up to 300 times higher. When carbon monoxide expels oxygen from the red blood cells, there is a lack of oxygen in the body. It manifests itself first in the brain. Symptoms range from headache and dizziness to hallucinations, confusion, loss of consciousness, or stopping breathing. To make a diagnosis according to usual diagnostic procedures, a blood test is performed and the carbon monoxide value is determined in just 5 minutes by means of a special measuring device.

  In critical cases, in which an exact determination and a control of the evolution are necessary, the blood test is given to a laboratory where it is examined with the greatest precision. The means chosen for the treatment of carbon monoxide poisoning is so-called oxygen therapy. Here, the patient is treated for several hours in a row with pure oxygen. Depending on the severity of the intoxication, the patient must be mechanically ventilated. This can take several days.

  Sequelae are possible and usually affect the heart and the nervous system. They manifest as headache, dizziness, and nausea. But it can also occur disorders of concentration or memory and even diseases, similar to Parkinson's disease, or psychoses. The health disorders that occur depend on the concentration of carbon monoxide in the blood as well as the duration of the disorders. With regard to the concentration of carbon monoxide in the blood, the following areas are distinguished. > 10% Headache, fatigue, dizziness, nausea, ECG: CO-Hb depression ST> 20% Disturbance of perception, CO-Hb visual field shrinkage of> 30% onset of unconsciousness, reduction of CO-Hb depth of the breathing> 40% Possible circulatory collapse CO-Hb> 60% Muscle spasm, coma, cessation of CO-Hb respiration, death So far, for patients with symptoms of carbon monoxide poisoning, an analysis of blood in the laboratory is necessary. For this purpose, the patient's blood must be collected and analyzed in a complex and expensive way.

Standard therapy for carbon monoxide poisoning is immediate and long-term patient ventilation with concentration. high oxygen. Often at the scene of the accident, for example during a fire or an underground accident, the technical possibilities for an invasive blood test are not available. Patients must first be transported to a hospital, resulting in a waste of valuable time for immediate treatment. Oxygen ventilation can only take place after blood analysis. In the state of the art, there are known respiratory gas supply systems which are completely installed in a container, respectively on a portable transport plate. There, all necessary components, such as, for example, a compressed gas cylinder with oxygen, a pressure reducer, a compressed gas backup respirator, and a patient-side interface are present to be transported to the place of delivery. Implementation. The object of the present invention is to construct a device of the kind mentioned at the beginning so that, when ascertaining an elevation of the concentration of carbon monoxide in the blood of a patient, a sufficient supply of oxygen can be made available without significant loss of time. The solution to this problem of the invention lies in the fact that, in order to non-invasively measure the carbon monoxide content of the patient's blood, is additionally installed on the support a measurement system which is coupled to at least one light source and at least one light sensor and which is provided with a display system.

A further object of the invention is to provide a mobile container for immediately treating the patient with medical oxygen when an elevation of the carbon monoxide concentration in the blood has been noted.

Another object of the invention is to provide a portable device, in the field of which at least one oxygen source may be arranged with a patient-side interface for ventilating a patient with oxygen to a patient. concentration of 80 and a device for the noninvasive determination of the blood carbon monoxide content and / or blood hemoglobin concentration, in less than 60 seconds after the application of the detector, with a precision of +/- 15 in a saturation measurement range of 0.5 to 90 respectively from 4 g / dl to 40 g / dl. The drawings show exemplary embodiments of the invention. They show: Fig. 1 a side view of an emergency case with a measurement system for the non-invasive determination of the amount of carbon monoxide contained in the blood, as well as a respiratory assistance system, FIG. 2 a partial representation of a support plate arranged by means of a wall attachment, FIG. 3 an assembly according to Figure 2 after latching a locking pin, FIG. 4 the arrangement according to FIGS. 2 and 3 during a manual removal after an unlocking, FIG. A diagrammatic representation of a vertical section of the movable support system, showing several reference planes The mobile gas supply system according to the invention has, according to FIG. 1, a transport container, respectively a transport case, for example an aluminum case, or a transport plate (1) which contains all the essential components for the mobile treatment of patients with oxygen supply. The essential component of the gas supply system according to the invention is an oxygen cylinder (7) which is installed on the support plate (1). This oxygen bottle allows for continuous ventilation of the patients. A pressure reducer (6) reduces the pressure of the bottle to the pressure necessary to ventilate the patient. The application is made by means of a mask or a tube. The construction according to the invention gives the support plates (1) greater functionality in 5 emergency cases by monitoring vital parameters. To ensure the possibility of a modular combination on the support plates (7), it is envisaged to make a SaCO measurement module or cHb measurement of a size and a volume comparable to those of a respirator. relief, such as the WEINMANN Medumat, Hamburg. On the support plate (1) is arranged a measuring device (3) for carrying out the measurement of concentration of carbon monoxide in the blood. An accessory bag (5) simplifies the final arrangement of accessory elements. The oxygen cylinder (7) supplies a breathing apparatus (4) which can be connected to the patient via a patient interface, not shown. For ease of handling, the support plate (1) is provided with a handle (2). The total system, including oxygen supply, suction, breathing apparatus (4) and SaCO measurement with support plate monitoring (1), offers a unique kind of application benefit through the realization as a portable global system unit. The following advantages can be achieved: Flexible, customer-specific supply advantages 30 Further equipment, possible at all times Conversion benefits via standardized / already existing vehicle-side and load interfaces (support plate system ) 2906149 7 Logistical and cost benefits through one-stop service and removal of multiple maintenance periods for individual components.

The emergency support plates (1) according to the invention are equipped with accessory pouches (5) for use equipment, such as catheters, tubes, respiratory masks or inhalation masks.

The emergency support plates (1) according to the invention have a protective bag which, if necessary, can accommodate the use material. In emergency cars, for example on the walls or on the ceiling, a fixing device (8) for the emergency support plates (1) according to the invention can be additionally mounted. Unlocking one hand to quickly detach the emergency support plates (1) from the wall mount (8) helps to ensure easy and extremely safe operation. Figure 2 shows the support plate (1) before hanging from the fastening device (8). During a first step, the support plate (1) is put into place in a lower receiving rail (9) of the wall-mounting device. As shown in FIG. 2, the support plates (1) are then rotated towards a wall to which the wall-mounting device (8) is mounted. The pivoting takes place until a locking pin 30 (10) is snapped into the support plates (1). To remove the support plate (1) from the wall-mounting device (8), the handle (2) is gripped by hand and the attachment lever (10) is pulled upwards for unlocking. The support plate (1) is then slightly tilted forward and can thus be withdrawn upwards from the lower receiving rail (9). SaCO measuring device, the oxygen source and / or the apparatus Emergency breathing are mounted, in the form of portable assembly, on the support plate (1) while etanu: individually removable. The following properties can be obtained in particular: The total weight of the portable assembly, comprising the support plate, the oxygen source, the pressure reducer and the emergency breathing apparatus, is less than 20 kg, preferably less than 12 kg.

The dimensions of the support plate are preferably less than 1 x h × p, 80 cm × 60 cm × 35 cm. The support plate and mounted modules support loads> 3 g, preferably> 6 g. The portable assembly, comprising the support plate and the modules, can be releasably connected to a securing device in emergency vehicles, a rescue car, a rescue aircraft, a rescue helicopter, a rescue boat, rescue. In the emergency vehicles, the fastening device 25 with connected support plate supports loads> 3 g, preferably> 6 g. The support plate can be removed from the fixation device by means of a release mechanism, preferably a handle.

The modules mounted on the support plate preferably have an accumulator for the power supply for possible electronic functions.

The charging process of the power supply system of the modules mounted on the support plate is carried out via a connection system between the support plate and the fixing device 5 in the emergency vehicle, preferably by a plug contact. Via a connection system between the support plate and the securing device in the rescue vehicle there is also a transmission of data between the modules and connectable evaluation units. Optional, with modules for patient monitoring, eg for: SpO2, CO2, ECG, EEC, Optional, with patient interface (mask, tube) 15 for ventilation. Optional, with a module for aspiration. With regard to the SaCO measurement, the following essential functions and properties are available: Control and% or display of SaCO. The SaCO apparatus and / or the respiratory assistance apparatus informs the user optically, for example by lamps according to the signaling light principle, and / or acoustically, for example by means of a signal lamp. voice instruction, functional states and / or patient status. The SaCO device has a display screen for the representation of vital parameters: pulse, SaCO, optionally SpO2, CO2, cHb. The SaCO apparatus and / or the respirator have a wireless communication interface for data transmission (eg SaCO, SpO2, NIBP, implementation data, service data) and for the remote control. The SaCO apparatus and / or the ventilator have a data memory and provide a possibility of fast data transmission. Accessories for the SaCO device are stored in a protective bag and carrying a capacity to accommodate the necessary accessory equipment (cables, electrodes, SpO2 sensor). The bag can be adapted to the support plate. The power supply of the SaCO apparatus and / or the respirator on the support plate is effected by means of an accumulator which is charged via a charging interface of the support plate as soon as the support plate is installed in the attachment device in the emergency vehicle. Alternatively, batteries can be used. In a configuration mode of the SaCO device and the respirator, it is possible to set the language of the country and deactivate the voice information. The functional cooperation of the measuring apparatus (3) and the breathing apparatus (4) can take place in different ways. According to an alternative embodiment, the measuring apparatus (3) generates an alarm signal, for example optical or acoustic, when a critical concentration value of carbon monoxide in the sana is reached, and incites the user to supply the patient with oxygen.

According to another embodiment, it is also intended to provide communication between the measuring apparatus (3) and the breathing apparatus (4). This can take place, for example, so that / or / and / or the measuring device (3) automatically proceeds, depending on the concentration of carbon monoxide respectively seized in the blood, to an increase in the dose of oxygen or at a suitable dosage.

Typically, the mobile system comprises an autonomous power supply system, for example a battery or an accumulator. When using an accumulator, it is particularly envisaged to couple it to a charging device to charge the mobile system via the on-board network during transport with a suitable motor vehicle. In all, four fractions of hemoglobin can be distinguished, namely: deoxygenated hemoglobin, oxygenated hemoglobin, as well as hemoglobin carbon monoxide and methemoglobin. To do this, up to ten wavelengths are required for their common determination. According to the invention, the different fractions are also seized separately. The device according to the invention is also used for the non-invasive determination of blood parameters such as, for example, blood saturation with SaCO carbon monoxide, cHb hemoglobin concentration, other physiological or pathophysiological blood parameters or substances of non-physiological markers. The device according to the invention comprises at least one light source which emits a beam of at least two different wavelengths, which are selected in the range of 280 nm to 3500 nm, preferably of the 300 nm group. %, 350 nm 15%, 400 nm 15%, 460 nm 15%, 480 nm 15%, 520 nm 15%, 550 nm 15%, 560 nm 15%, 606 nm 15%, 617 nm 15%, 620 nm 12%, 630 nm 15%, 650 nm 15%, 660 nm 15%, 705 nm 15%, 710 nm 15%, 720 nm 15%, 805 nm 15%, 810 nm 15%, 880 nm 15%, 905 nm up to 15%, 910 nm 15%, 950 nm 15%, 980 nm 15%, 1050 nm 15%, 1200 nm 15%, 1310 nm 15%, 1380 nm 15%, 1450 nm 15%, 1600 nm 15%, 1800 nm 15%, 2500 nm 15%. Here, the light source is arranged so that the light beam is directed at a vascularized tissue and the ray reflected and / or transmitted by the tissue encounters at least one photodetector (PD) which converts radiation energy. in an electrical value. The output of the PD is connected to an evaluation unit which evaluates the PD signals and determines for the blood parameters current measurement values which can be visualized in the region of a display system. The measurement method uses for the calibration the (virtual) extinction coefficients. Virtual extinctions are actual lumen reduction values, measurable in the biological tissue, which come mainly from the photonic absorption and scattering photon processes. The fact that certain fractions of hemoglobin exist physiologically only as small values and move especially at low percentages of saturation makes, in most applications, the measurement of these hemoglobin fractions more difficult. as the determination of Hb-02 saturation. It starts at just under 100% and is also still present with significant amounts of hemoglobin in pathological cases. Small SaCO fractions result in a steep calibration curve. The resulting calibration surface establishes a connection between the resulting measurement value and establishes a connection between the SaCO measurement value and so-called variable variables of measurement, named S2 23 and S2 24. In the context of pulse spectroscopy, the calculation of relative concentrations of substances is performed by the formation of measurement variables. A measurement variable S2 is a derived quantity, which is each time formed from the plethysmogram of two emission wavelengths, and we have: n1 / J (t2) ln [l + dl (At) L. t ] t] ln PPA / 141 At v 1 (t2) Al, (At) ln. [1 + PP1V.ty (At)] ln [r] ln [1 + I t] v (t1)]) Here 15 Iy (tX) ... is the plethysmographic signal intensity of the wavelength y at time t>. shot t2 are the moments t1 and t2 serving as a basis for calculating omega. At = t2 - basic to the calculation .. is the difference of the moments serving 2906149 14 AIy Iy (t2) 1 y (t1). . . is the change of the plethysmographic signal intensity of the wavelength between moments t2 and tl.

5 PPM y (At). . . is the pulse modulation of the wavelength y versus Delta T. In pulse spectroscopy, the omega calculation is based on the assumption that the transmitted wavelengths accurately traverse the same optical path in the biological tissue. The light that passes through the biological tissue undergoes several times all the elementary optical processes: absorption, reflection and refraction. Many of the elementary photonic interactions result in scattered light that exhibits a characteristic angular dependence (anisotropy coefficient). In general, the structure of the biological tissue is inhomogeneous. At the boundaries of macroscopic structures, there are differences in optical refraction and, in priority, the appearance of reflections. In the context of pulse spectroscopy, the wavelength radius necessary for calculating the measurement variables must pass sequentially through the same area of biological tissue. On the basis of the pulsed cyclic change of the arterial and post-capillary vessels, one can then draw conclusions as to the concentrations of substances in these. The pulse spectroscopy used is preferably emission spectroscopy. This means that the spectroscopic limitation of wavelengths is not performed on the detector side by means of a filter (in the case of white light) but that the emission sources themselves are limited in lengths. wave. Each wavelength has specific optical properties which, when passed through biological tissues of different kinds, yield to the detector the resulting radiant energy. The calibration of the 10 pulso-spectroscopic measurement systems requires the consideration of optical properties at the same measurement location. Because emission spectroscopy is preferably performed by different radiation sources (eg, laser and LED), however, these are at different locations on the side of the radiation emission. Therefore, the paths of the light beams can not be exactly the same. The greater the distance of the discrete radiation sources, the higher the difference between the optical paths, respectively taken by the radiations. In different optical paths, however, two effects are to be considered: On the one hand, an optical path length inequality is possible. As a result, the wavelength along a longer optical path experiences higher absorption and scattering of radiation. On the other hand, optical paths can be biologically inhomogeneous. This means, for example, that the degree of density of the capillaries could be different between the optical paths. This also results in an incidental and additional difference in absorption / scattering between the two optical paths. In summary, it emerges that the measurement variables, which occur in the case of spatially separated optical paths, are no longer defined. But measurement variables are the basis for calculating substance concentrations. Thus, the calibration of pulso-spectroscopic measurement systems can not be executed without more in case of long distances between the emitters.

According to an exemplary embodiment, at least two LEDs which emit light of at least 8 different wavelengths are used. The signals received by the detector are smoothed, for example by a bandpass filter. The present invention makes it possible in the first place to have a movable support plate on which at least one measuring device and a respiratory assistance device are mounted, which plate is made in the form of a compact and portable unit of which the maximum dimensions, width x depth x height, 20 are of the order of 480 x 210 x 340 mm and whose weight is at most 17 kg. When performing the support plate without an oxygen bottle, it is possible to ventilate the patient using only the respiratory assistance device and a breathing mask. When performing forced ventilation, it is also possible to obtain effective ventilation without oxygen supply. For emergency cases, it is particularly important that the emergency personnel be able to quickly transport a portable unit to the patient including all medical devices, and that all necessary medical devices are present in a compact package. To do this, the dimensions and weight of the medical devices required must be adapted to the requirements of portability. According to the invention, there is therefore a movable support plate on which are mounted at least one measuring device and a respiratory assistance device, the entire mobile support plate, with defibrillator and respirator, not exceeding a weight of 17 kg and preferably not exceeding a weight of 13 kg, and preferably not exceeding, in particular, a weight of 11 kg. The support plate has, preferably in the field of a base plate, fasteners and / or receptacles for fasteners 15 for removably mounting at least two modules on a support plate. The securing devices are executed so that the fixation of the device for the non-invasive determination of blood parameters and the respiratory assistance device on the support plate withstands shocks and loads up to a force of> 3. g, and preferably> 6 g, and in particular preferably> 10 g. The display screen and the control elements of the measuring device, and the display screen and the control elements of the respirator are protected by a raised edge of the support plate. The region of the rim is furthermore, for example, from the housing structure, at least in sections, above the plane of the display screen and the control elements of the measuring apparatus and respirator. Preferably, the region of the edge is arranged in twinning and executed in the form of two convex pieces. The edge area is not more than 200 mm, preferably not more than 170 mm, and in particular not more than 140 mm above the base surface of the support plate. This corresponds to a depth of the support plate of at most 220 mm, preferably at most 190 mm and in particular at most 160 mm at most. Thus, the support plate has a depth such that it can easily be carried with one hand in case of emergency and that, mounted on the basic structure in the rescue vehicles, it does not protrude too deeply. inside the emergency car. FIG. 5 shows a movable support system (1) having a first plane (11), in the region of which at least two modules, in particular a respiratory assistance system and a measurement system for the noninvasive determination of a blood parameter are removably attached, at least one lateral structure (12) extending from the first plane (11) substantially perpendicular to the first plane, the lateral structure having a marginal area (13); ) which defines a second plane (14) which extends substantially parallel to the first plane, and a third plane (15) being provided which is formed by the maximum height of the modules and which extends above the foreground and below the second plane.

Claims (17)

claims   Mobile device for the treatment of a patient who has a respiratory assistance system which, arranged on a support (1), can be connected to a patient-side interface and in which an oxygen supply of said respiratory assistance system (4) consists of a bottle (7) of compressed gas, characterized in that, on the support (1), is additionally arranged for the non-invasive measurement of a blood carbon monoxide content, a system measuring device (3) which is coupled to at least one light source and at least one light sensor, and which is provided with a display system.   2. Device according to claim 1, characterized in that the device for the non-invasive determination of the SaCO carbon monoxide saturation comprises means for signaling in less than one minute, after the introduction of the sensor, the current SaCO measurement value via the output system.   Device according to claim 1 or 2, characterized in that a display screen is used as the output system.   4. Device according to one of claims 1 to 3, characterized in that it comprises, in the region of the output system, means for generating information which is able to indicate whether the SaCO measurement value is representative for a physical state defined as being critical or non-critical.   5. Device according to one of claims 1 to 4, characterized in that it comprises, in the region of the output system, a means for generating an acoustic signal when the SaCO measurement value is greater than one. defined threshold value.   6. Device according to one of claims 1 to 5, characterized in that it comprises, in the region of the output system, means for generating an optical signal when the SaCO measurement value is greater than a value of defined threshold.   7. Device according to one of claims 1 to 6, characterized in that one uses as oxygen source 10 a bottle (7) of compressed gas to which can be connected a pressure reducer.   8. Device according to one of claims 1 to 7, characterized in that a flow selector switch is connected or can be connected to the oxygen source. 15   9. Device according to one of claims 1 to 8, characterized in that the device for the non-invasive determination of blood saturation carbon monoxide has a power supply independent of a cable. 20   10. Device according to one of claims 1 to 9, characterized in that the device for the non-invasive determination of blood saturation carbon monoxide has a power supply by means of a battery. 25   11. Device according to one of claims 1 to 9, characterized in that the device for the non-invasive determination of the saturation of the carbon monoxide blood remains, for the charging of the accumulator, on a power supply installation. mobile oxygen., and that it is adapted therewith to a holding device.   12. Device according to one of claims 1 to 11, characterized in that the measuring apparatus (3) and the processing apparatus (4) are operably coupled to each other.   13. Device according to claim 12, characterized in that a dosing system of the respiratory apparatus (4) is coupled with an evaluation system of the measuring apparatus (3).   14. Device according to claim 13, characterized in that the dosing system is designed for the predetermination of a concentration of oxygen in the respiratory gas.   15. A mobile oxygen supply system for supplying oxygen to a patient in whose blood a high saturation of carbon monoxide (SaCO) has been determined, which system has a transport container in which an oxygen source is arranged. which can be connected to a patient-side interface via a connecting line, characterized in that a device for the non-invasive determination of the blood saturation in the container is releasably secured in the container. SaCO carbon monoxide which is composed of at least one light source which emits light radiation of at least two different wavelengths selected from the group of 400 nm 15%, 460 nm 15%, 480 nm 15% 520 nm 15%, 550 nm 15%, 560 nm 15%, 606 nm 15%, 617 nm 15%, 620 nm 15%, 630 nm 15%, 650 nm 15%, 660 nm 15%, 705 nm %, 710 nm 15%, 720 nm 15%, 805 nm 15%, 810 nm 15%, 880 nm 15%, 905 nm 15%, 910 nm 15%, 950 nm 15%, 980 nm 15%, 1050 nm 15%, 1200 nm 15%, 1310 nm 15%, 1380 nm 15%, 1450 nm 15% , 1600 nm 15%, 1800 nm 15%, the light sources being arranged so that the light beam, emitted by them, penetrates a vascularized tissue of the body of the patient, at least one photodetector (PD) which is arranged so that it detects the light emitted by the light sources and having passed through the tissue, and / or the backscattered light, the light source and the photodetector (PD) being connected in a sensory unit. an evaluation system that determines the saturation of the SaCO carbon monoxide blood and transmits it to an output device, and that the mobile oxygen supply system, comprising at least the transport, the patient-side interface and a device for the non-invasive determination of the saturation u Saco carbon monoxide blood, is portable and weighs less than 20 kg. 15   16. Device for the mobile treatment of a patient who has a respiratory assistance system which, attached to a support plate, can be connected to a patient-side interface, characterized in that on the support plate (1) in addition, a measuring system (3) is provided for the non-invasive determination of a blood-related parameter, such as, for example, the saturation of the blood in SaCO carbon monoxide or the concentration of hemoglobin cHb or other pathological physiological or physiological parameters or non-physiological marker substances of the patient, said system being coupled to at least one light source and at least one light sensor and provided with a display system.   17. Device according to the preceding claim, characterized in that the support plate has fixing devices and / or receptacles for fastening devices for the removable mounting of at least two modules, in particular a system 23. 2906149 for respiratory assistance and a measuring device for the non-invasive determination of a blood parameter, and in that the securing devices are constructed so that the modules disposed on the support plate resist shocks. and at loads of a force> 3 g.