RU2732009C1 - Emergency device for valve pneumothorax - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medical equipment, namely to an emergency device for valve pneumothorax. Device comprises a tube with an obliquely cut pointed end in the working part, a collar on the other end of the tube with a side channel in it, which is interconnected with a longitudinal channel in the tube. In the device above the side channel there is a check valve element, a mandrel with a head and a rod with an obliquely cut and sharpened end with the possibility of its removal from the tube. Device includes sealed package with sterile working part of device and detachable plug. Restrictor roller is arranged on working part tube. Check valve element is made of a resiliently elastic material with circular coverage of the tube between the bead and the roller, to the upper surface of which an elastic plate holder is attached to its upper part, the inner surface of which has adhesive edges to attach the holder to human skin. On the mandrel and plug necks the external thread is made, and under it the internal thread is formed in the tube rim channel. On the side surface of the bead there is an indicative notch is applied in the projection of the tip of the working end of the tube. On upper side surface of mandrel head is indicative mark-notch in projection of tip of end of mandrel rod.

EFFECT: technical result consists in improving the quality of emergency care in valve pneumothorax outside the medical institution and preventing infectious complications.

3 cl, 11 dwg

Description

The invention relates to medical equipment for providing emergency care for valve pneumothorax at the site of its occurrence and at further stages of medical evacuation and in a hospital.

In case of chest injuries, air can enter the pleural cavity from the surrounding atmosphere through the wound of the chest wall into the pleural cavity without leaving it, leading to the development of external valvular pneumothorax. When gas enters from a damaged bronchus or lung, an internal valve pneumothorax occurs [Kolesov V.I. In the book. "Multivolume Guide to Surgery. Volume 5. State publishing house of medical literature. M. - L .: Medgiz. 1960. C - 378, 393]. The continuing accumulation of air in the closed pleural cavity leads to the development of a tense pneumothorax. With it, the pressure in the pleural cavity increases, exceeding atmospheric, and is accompanied by a displacement towards the trachea and heart [Encyclopedic Dictionary of Medical Terms. First edition. Chief editor B.V. Petrovsky. Volume 2. p. 341. Moscow, Ed. 2. "Soviet Encyclopedia". 1983] with life-threatening circulatory disorders. If you do not provide urgent assistance, death occurs in the next few hours [Great Medical Encyclopedia. Ch. ed. A.N. Bakulev. Tom. 25. Second edition. State Scientific Publishing House "Soviet Encyclopedia". M. 1962. C - 312]. In case of man-made and natural disasters, road traffic accidents, falls from a height, at construction sites, far from a medical institution, chest injuries often occur with the development of valvular pneumothorax. In such cases, it is necessary to carry out emergency medical care by puncturing the chest wall and pleura with the removal of air from the pleural cavity. However, sterile devices are often absent at the scene of the incident, therefore, a pleural puncture is forced to be performed with a non-sterile hollow needle. Pleural puncture is an invasive manipulation with penetration into the body cavity, and requires sterility to prevent infection with the development of soft tissue inflammation, serous or even purulent pleurisy [http.//airfrost-ufa.ru/lechenie-plevritov/oslozhneniya-posle-punkcii- pri-plevrite]. Striving for

improving the provision of emergency medical care to the victim at the site of the occurrence of valvular or tension pneumothorax and at further stages of evacuation, prompted us to develop a special portable sterile device that reduces the danger to human life and the occurrence of complications.

We know our device for puncture of cavities according to patent No. 2157120, which includes a pointed needle with a cannula, a fixator, a mandrel containing a groove for the fixator. An element of the device - a needle, can release air from the pleural cavity and reduce the pressure in it in case of tension pneumothorax.

The disadvantage of this device is that, with internal valve pneumothorax, it does not provide complete release of the pleural cavity from gas due to its further flow from the damaged lung or bronchus. There are no signs of a more reliable retention of the needle in the pleural cavity, preventing the entry of atmospheric air through it into the pleural cavity. At the stage of providing first aid outside the medical facility, it is difficult to ensure its sterility to prevent infectious complications.

Known needle for spinal puncture, according to the design features similar to the features of the claimed device. It contains an obliquely sharpened tube, which is equipped with a mandrel, which has a head with a retainer that allows you to place the cut of the mandrel rod coinciding with the plane of the cut of the needle. In this case, there is a lateral protrusion on the cannula of the needle, and a longitudinal slot with a turn to the side on the mandrel retainer [Pozdnyakov S.S. Medical equipment. Medgiz. M. 1957, p. 143]. Such a needle can be used for tension pneumothorax to reduce the pressure in the pleural cavity.

The disadvantage of this needle is that with internal valve pneumothorax, it does not provide complete release of the pleural cavity from gas due to its further flow from the damaged lung or bronchus. It does not show signs of a more reliable retention of the needle in the pleural cavity, prevention of atmospheric air entering it through the lumen of the hollow needle, and prevention of infectious complications in the context of emergency care outside a medical institution.

Known for patent No. 2158553 a device for the treatment of pneumothorax, containing a puncture needle with a valve. The valve is made of metal in the form of a truncated cone, inside which a ball is installed. On a wide base, the cone has stops that prevent the ball from falling out. The narrow base of the truncated cone is made to connect to the pavilion of the puncture needle. As a result, the tightness of the pleural cavity is ensured.

The disadvantage of this device is the complexity of manufacturing a truncated cone from metal with stops for the ball to fall out of the cone. Such a design cannot always perform the function of a check valve efficiently when the cone is tilted, due to spontaneous movement of the ball along the inclined wall of the cone. The device lacks signs of reliable retention of the needle end in the pleural cavity. There are no signs of sterility of the portable device at the point of care outside the medical facility, which does not reduce the risk of infectious complications from pleural puncture with valve pneumothorax.

The closest in terms of the achieved result to the proposed technical solution is the device according to the patent of the Russian Federation No. 2158553, which we take as a prototype, and its disadvantages are stated above.

The technical result of the invention is to improve the quality of emergency care for valvular pneumothorax outside a medical institution and to prevent infectious complications, by providing portability to a sterile device for pleural puncture, more reliable retention of the piercing element in the pleural cavity with the possibility of removing gas from the pleural cavity and preventing entry into less than atmospheric air.

The technical result is achieved in that the device for emergency care in valve pneumothorax contains a sealed package with a sterile working part of the device and a removable stopper placed with it. A limiting roller is made on the tube of the working part, the check valve element is formed from an elastic material with a circular coverage of the tube between the bead and the roller. An elastic plate holder is attached to the upper surface of the roller with its central part, in which the edges of the inner surface are made adhesive so that the holder can be attached to human skin. In this case, an external thread is made on the necks of the mandrel and the plug, and an internal thread is formed under it in the channel of the tube flange. On the side surface of the rim, an approximate mark is applied - a notch in the projection of the tip of the working end of the tube. On the upper lateral surface of the mandrel head, an indicative mark is a notch in the projection of the tip of the mandrel rod end.

In a preferred embodiment of the device, handles with holes are provided at opposite ends of the holder.

In another preferred embodiment of the device, marks of the intended rupture of its shell are made on the package from two opposite edges and at different levels.

Brief description of graphic images. FIG. 1 shows in general view an assembled device including a sealed package and a sterile working part of the device and a stopper placed in its cavity. FIG. 2 - the same, side view. FIG. 3 - the same, bottom view. FIG. 4 - the working part of the device removed from the package, containing a tube with a mandrel inserted into it, and a holder. FIG. 5 is the same, deployed for intended use. FIG. 6 - detail of the device - tube holder in a straightened state, view from the side of the working end of the tube. FIG. 7 - detail of the device - mandrel, side view. FIG. 8 - the same, view from the sharp end of the mandrel rod. FIG. 9 - stopper to the channel in the bead at the outer end of the tube 4, side view. FIG. 10 - the same, bottom view. FIG. 11 - device in use: the working end of the tube is inserted into the pleural cavity, and the holder is glued to the skin of the chest.

In Figs 1-11 are indicated: 1 - a dense upper part of the package with bonded surfaces, sealing its cavity; 2 - contour line of demarcation of the dense part 1 of the package from its cavity; 3 - left mark for breaking the edge of the package; 4 - right mark for breaking the opposite edge of the package; 5 - front surface of the package; 6 - hole at the top edge of the package outside its cavity; 7 - the first part of the holder; 8 - elongated handle of the first part 7 of the holder; 9 - hole in the handle 8; 10 - handle of the second part of the holder; 11 - hole in the handle 10; 12 - the space between the folded in the package parts of the holder for the piercing part of the tube 14; 13 - the second part of the holder; 14 - device tube; 15 - tip of the working end of the tube; 16 - oblique cut of the working end of the tube; 17 - limiting roller on the tube; 18 - lateral outlet in the tube; 19 - an elastic circular element of the check valve; 20 - tube bead with an approximate notch mark on the side surface and with an internal thread in its channel; 21 - mandrel head with an approximate notch mark on its upper lateral surface in the projection of the tip of the rod end 25; 22 - plug to the side 20; 13 - contour of the boundary between the adhesive outer edges of the inner surface of the holder and its central part without an adhesive surface; 24 - mandrel neck with external thread for internal thread in the side 20; 25 - mandrel rod; 26 - oblique cut at the working end of the mandrel rod; 27 - neck of a plug with an external thread for an internal thread in the rim 20; 28 - the skin of the chest; 29 - soft tissues of the chest wall; 30 - pleura; 31 - pleural cavity.

A concrete example of the operation of the device with an open chest injury with valvular pneumothorax, which developed from a fall from a height in a remote garden area. Gardeners - paramedics sealed the chest wound with tape. When signs of development of internal valvular pneumothorax were detected, it was decided to carry out unloading pleural puncture. The site of the intended puncture is treated twice with iodonate and alcohol and local anesthesia with novocaine is performed. A developed sterile device with elastic packaging is used. First, along the mark 3 with scissors, cut the left edge of the package beyond its middle, then towards the opposite level at the mark 4, cut the right edge of the package beyond its middle and tear off the dense 1 upper part of the package. The cavity of the package is opened. For both handles 8 and 10 of the holder, a sterile working part with a pointed tube 14 and two parts 7 and 13 of the holder are removed from the packaging cavity, which are diluted. Check for the coincidence of the notch on the mandrel head 21 with a notch mark on the side surface of the side 20, which indicates the alignment of the oblique cut 26 of the mandrel rod 25 with the oblique cut 16 of the working end of the tube 14. Puncture of the pleural cavity is performed by the developed device. To do this, in the third intercostal space along the anterior axillary line along the upper edge of the inferior rib, the sharp end 15 of the tube 14 pierce the skin with soft tissues 29 of the chest wall. After puncturing the pleural membrane 30, the mandrel is removed by pulling on its head 21. The appearance of air bubbles from the outer lumen of the tube 14, with a closed injury, indicates the presence of an internal valve pneumothorax. A sterile plug is removed from the package and its neck 27 is inserted into the longitudinal channel in the side 20 and fixed there. Parts 7 and 13 of the holder are spread apart and attached with an adhesive surface to the breast skin with slight tension. Through the lateral opening 18 in the tube 14 from under the elastic element 19 of the check valve, air begins to leave the pleural cavity. By the arrived ambulance car the victim is transported to a specialized hospital.

The second specific example of the possible use of the developed device for a closed chest injury that occurred in a road traffic accident. The passing driver, a paramedic, saw a severe unconsciousness of the victim with a sunken part of the ribs, shortness of breath, cyanosis and increasing breathing disorders. When tapped on an intact rib, I detected the sound of an "empty box". Tense internal valvular pneumothorax threatened the victim's life. At mark 3 on the package, he tore its left edge farther than the middle, then at mark 4 on another level he also tore the right edge, and tore off the dense upper part of the package 1, easily and quickly opening the package cavity. From its cavity, using both handles 8 and 10, he removed a sterile working part. I treated the skin with iodine solution and alcohol. Along the middle axillary line above the upper edge of the fourth rib, a sterile sharp end 15 of tube 14 with a mandrel rod 25 located in it was inserted into the soft tissues of the chest wall into the soft tissues of the chest wall and, with a feeling of falling through, pierced the pleural membrane. Parts 7 and 13 of the holder spread in opposite directions and attached them with an adhesive surface to the skin of the chest wall with tension. The mandrel rod 25 was removed from the tube 14. From the side outlet 18 of the kagala in the rim 20, air began to escape under a pronounced internal pressure, which indicated an excess of pressure in the pleural cavity over atmospheric pressure. Suddenly, the air flow stopped. Suspecting a blockage of the longitudinal canal in the tube 14 with a blood clot or a piece of tissue, he again inserted the mandrel rod 25 into it and then removed it. Air began to come out of the tube again. When the air outflow weakened, the channel in the bead 20 was plugged with a stopper by screwing the thread of the neck 27 of the plug into the thread of the channel of the bead 20. The air from the pleural cavity during exhalation began to leave through the side opening 18 in the tube 14 from under the element 19 of the check valve, which does not allow the atmospheric air into the pleural cavity. The victim was transported by car to an emergency hospital.

The essential differences of the claimed device are as follows. The presence of a sealed package in the device with a sterile working part and a removable stopper placed in it provides the device with portability and compactness. The sealed package, impermeable to gas and liquid, makes it possible to preserve the sterility of the working part of the device in it during storage, transportation and carrying out a pleural puncture at the location of the victim at the rupture during the stages of evacuation. The removable stopper makes it possible to seal the channel in the side of the tube after removing the mandrel rod from the longitudinal channel in the tube, which prevents the entry of atmospheric air into the pleural cavity. The formation of the check valve element from an elastically elastic material (for example, from thin rubber) with a circular coverage of the tube between the bead and the bead, ensures the reliability of the placement and functioning of the easily performed and replaceable check valve element. The presence in the device of an elastic plate holder with attachment of its central part to the upper surface of the roller, provides accurate positioning of the holder on the tube of the piercing element and more reliable retention of the working end of the tube in the pleural cavity. Making the edge of the inner surface of the holder adhesive allows you to easily and quickly, quickly and reliably attach the holder to the skin of a person, which increases the reliability of holding the inserted tube in the pleural cavity. The execution on the necks of the mandrel and plug of the external thread, and under it in the channel of the bead of the internal thread, ensures reliable fixation of the mandrel rod in the longitudinal canal of the tube, and after its removal, the hermetic closure of the channel in the bead of the tube with a stopper, which helps to prevent the entry of atmospheric air into the pleural cavity and prevents the occurrence of complications. In the claimed device, the application of an approximate notch mark on the lateral surface of the bead in the projection of the tip of the end of the tube allows one to represent by the notch on the bead where the tip of the tube is located in the tissues and pleural cavity. The notch on the upper-lateral surface of the mandrel head in the projection of the tip of the end of its rod inserted into the longitudinal channel of the tube, when coinciding with the notch on the side, indicates the alignment of the tip of the mandrel rod with the tip of the tube. The combination of these features of the device when performing a puncture, according to the mutual position of the marks - notches on the surface of the mandrel head and on the lateral surface of the side, allows obtaining information about the mutual position of the sharp ends of the tube and the mandrel rod in the depth of body tissues inaccessible for direct visual control. It was found that the lateral divergence of the tip of the obliquely cut end of the mandrel rod with the tip of the obliquely cut end of the tube during puncture leads to ruptures of the soft tissues of the chest wall and pleural membrane. Therefore, their exact alignment is necessary. Turning the mandrel head until its mark coincides with the mark on the side, allows you to quickly and accurately align the sharp ends of the mandrel rod and the tube, which in case of a pleural puncture minimizes damage to the skin, soft tissues and pleural membrane and improves the quality of the procedure. The design of the handles with holes at the opposite ends of the holder allows you to grip them to remove the sterile tube from the package without touching it, which preserves the sterility of the tube being introduced into the body tissues and reduces the likelihood of developing infectious complications. The presence of holes on the handles of the holder makes it possible, if necessary, to pass additional clips through them for storage and transportation. Execution on the package from two opposite edges and at an equal level of marks of the intended rupture of the shell, facilitates the capture and dilution of the edges of the shells at the rupture, accelerates access to its cavity and the removal of the sterile working part of the device from the package.

Thus, the claimed device, developed to be portable and sterile, makes it possible to use it by various rescuers when providing emergency assistance to victims with valvular pneumothorax outside a medical institution. The device reduces the trauma of the procedure, more reliably holds the piercing tube in the pleural cavity, ensures the removal of gas from the pleural cavity and prevents the entry of atmospheric air into it, improves the quality of emergency care and helps prevent infectious complications. The developed device, when used, creates the possibility of achieving social and economic benefits.

The created device for providing emergency care for valve pneumothorax to an injured person outside a medical institution can be used by employees of ambulance brigades, the Ministry of Internal Affairs, the Ministry of Emergencies, the traffic police and other rescuers. The device can also be used in military field conditions and in veterinary medicine.

Claims (3)

1. A device for emergency care for valve pneumothorax, containing in the working part a tube with an obliquely cut pointed end, a bead on the other end of the tube with a lateral channel in it communicating with a longitudinal channel in the tube, a check valve element above the lateral channel, a mandrel with a head and a rod with an obliquely cut and pointed end with the possibility of removing it from the tube, characterized in that it contains a sealed package with a sterile working part of the device and a removable stopper placed in it, while a limiting roller is made on the tube of the working part, the check valve element is formed of an elastic elastic material with circular coverage of the tube between the bead and the roller, to the upper surface of which an elastic plate holder is attached with its central part, in which the edges of the inner surface are made adhesive with the possibility of attaching the holder to the human skin, while on the necks of the mandrel and the plug there is an external thread, and under it VK An internal thread is formed on the side of the tube flange, on the side surface of the flange there is an approximate notch mark in the projection of the tip of the working end of the tube, and on the upper-side surface of the mandrel head there is an indicative notch mark in the projection of the tip of the mandrel rod end. 2. The device according to claim 1, characterized in that handles with holes are made at opposite ends of the holder. 3. The device according to claim 1, characterized in that marks of the intended rupture of its shell are made on the package from two opposite edges and at different levels.

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