US2042474A - Gas administering - Google Patents

Description

June 2, 1936. E. 1. M KESSON I GAS ADMINISTERING 6 Sheets-Sheet Filed/122mb 132 9.

14 7 a9 M5 4 j June 2, 1936.

E. l. M KEssoN' GAS ADMINISTERING June 2, 1936. I MCKESSQN 2,042,474

GAS ADMINISTERING Filed March 10, 1930 e sheets-sheet 5 June 2, 1936. E MCKESSON 2,042,474

GAS ADMINISTERING Filed March 10, 1930 e Sheets-Shet 4 June 2, 1936. E. MCKESSON' 2,042,474

GAS ADMIN I STEERING Fil ed March 10, 1950 6 Sheets-Shegd 5 June 1936- E. l. M KEssoN ,474

GAS ADMINISTERING Filed March 10, 1950 I 6 Sheets-Sheet 6 Patented June 2, 1936 UNlTED STATES PATENT OFFICE GAS ADM INISTERING son, Toledo, Ohio Application March 10, 1930, Serial No. 434,587

1 Claim. This invention relates to gas administering.

This invention has utility when incorporated v in apparatus for checking the condition of a patient and administering gas to the patient, more particularly in association with features for disclosing facts in regard to the patient and as to the gases.

Referring to the drawings:

Fig. 1 is a side elevation with parts broken away of an embodiment of the invention in a machine for cutting down high pressure gas supply and conducting such to a patient;

Fig. 2 is a detail view on an enlarged scale in plan of the relief valve at the mask;

Fig. '3 is a plan view of the apparatus of Fig. 1, parts being broken away;

Fig. 4 is a section on the line IV-IV, Fig. 2;

Fig. 5 is a front View of the apparatus of Fig. 1 from the left, with the delivery duct and vaporizer removed;

Fig. 6 is a section on the line VI-VI, Fig. 3;

Fig. 7 is a section on the line VII-VII, Fig. 3;

Fig. 8 is end view from the right of the section of Fig. 7, parts being broken away and the cover plate being removed;

Fig. 9 is a section on the line IX-IX, Fig. 6;

Fig. 10 is a section on the line XX, Fig. 3;

Fig. 11 is a partial section on the line X[ fl, Fig. 10;

Fig. 12 is a detail view from the inner side of the nitrous oxid chamber, with parts broken away;

Fig. 13 is a section on the line XIIIXIII, Fig. 12;

Fig. 14 is a section on the line XIV-XIV, Fig. 3; and

Fig. 15 is a section on the line XV-XV, Fig. 10.

Casters i are shown as mounting spider 2 carrying column 3 having bracket 4.

Nitrous arid-oxygen High compression gas supply tanks 5, 6, may be clamped by bolts '1 in heads 8 having valves 9 operated so that through coupling ID the high pressure gas may be stepped down by reducing valve or regulator M as adjusted by screw or bolt l2 and held by clamp bolt IS in arm M of the bracket 4 (Figs. 1, 5).

The column 3, extending above the bracket 4, mounts head I5 having arms l6, [1. The arm It has duct I? thereto from the regulator II as in communication with one of the nitrous oxid tanks 3 extending to fitting l8 (Figs. 3, 5). The regulators it, shown as provided with a pair of couplings it, permit simultaneous assembly of two tanks therewith so that as one tank is depleted the other tank may be cut in and the supply through the duct l1 not interrupted. The exhausted tank may be replaced and this accordingly provides operation facilities for the 5 region over an extended interval even with small tanks.

The fitting I8, for the'guidance of the operator, is shown as having notation l9 thereon. In the instance herein shown this is nitrous oxid as the 10 anaesthetizing gas. This fitting I8 is in communication with passage (Fig. 10) in the arm is. From this passage 20 extends duct 2| to gage 22 (Figs. 3, 5, 12) for disclosing the pressure of the gas delivery as cut down by the nitrous 15 oxid regulator l l which may be say to fifty or sixty pounds, while the pressure at the tank may have originally been a number of atmospheres, say 3000# per square inch. In lieu of the auxiliary, or duplication of the tanks at the valve or 20 regulator H, one of the couplings l0 may be connected to a high pressure gage 22 (Fig. 3) so that the amount in the supply tank may be checked, and when so checked as the supply becomes reduced, the auxiliary new tank supply attached, before the depression gets down below that at which it is desired to keep the pressure as indicated by the gage 22.

The passage 20 has branch-23 having terminal port 2t in proximity to flexible rubber diaphragm 25 (Figs. 1213) providing chamber 26 having outlet passage 27 therefrom to depending tube 28 spilling into distensible chamber 29 of disk form about the tube 28. This chamber 29 is thus provided with a pair of parallel distensible diaphragms 36, 3|. Housing plate 32 is protection and distension limit means for the diaphragm 3|, while opposing plate or housing section 33 is for the distensible diaphragm 30 of the chamber 29. w

Delivery pressure adjustment The diaphragm 30 is shown as having insert metal plate 34 as a bearing for nose 35 of bent lever 33 (Figs. 5, 13) protruding through opening 31 in the housing section 33. The lever 36 has fulcrum bearing 38 in the arm is with short arm 39 upward therefrom engaging reduced end 40 of plunger 4i directed by guide 42 against the diaphragm 25 as a holding means for causing the lever 35 on distension of the chamber 29 to cuted gas supply to the chamber 29 by way of the port 24.

From the reserve or pressure supply tank 5 as connected '(Figs. 1, 3, 5) through its reducing valve ll, supply of oxygen by way of duct 42 is the communication between the supply and the machine. This oxygen supply is effective through duct 20 in the arm I1 and discloses the oxygen pressure as passing the reducing valve at gage 44. The control of oxygen gas delivery at the reduced pressure to the oxygen chamber below the oxygen gage is analogous to that to the nitrous oxid chamber below the gage 22.

From the levers 36, as oppositely directed toward opposing diaphragms 39 is intermediate pair of links 45 having pivot pin connection 46 (Figs. 3, 5, 6). These links 45 thus provide a toggle from which there extends a yieldable resistance herein shown as comprising sleeve 41 having closure plug 49 as an abutment for compression helical spring 49 in the cylinder 41.

This spring 49 is oppositely held by pin 50 through stem 5I emerging past the plug 48 with clearance 52 for lateral play. This stem 5| extends through forwardly projecting arm 53 of the head I5. This arm 53 for this stem 5| has clearance way 54. The upper portion of this stem 5I has threaded portion 55, with which engages pinion nut 56 in mesh with pinion 51 on stem 58 fixed with knurled indicating disk 59 as disposed adjacent pointer 60 (Figs. 3, 6) on housing having hold-down portion 6| precluding axial shifting of the pinion 56. The knurled indicating disk 59 is shown as having notations 62. Accordingly, in rotating this disk 59 say for lifting the pin 51 by the operation of the nut 56 thereon, compression of the spring 49 is increased and there is accordingly a tendency to pull up the toggle pin 46 and resultantly increase the resistance to contraction which the lovers 36 might have.

There is thus a building up of the operating pressure in the chambers 29 as effective for gas supply, which is of a pre-determined indication disclosed at the notation 62 and this notation is to the extent of fully cutting off the supplies of the gases herein disclosed as nitrous oxid and oxygen in coming to the automatic delivery valves at the predetermined reduced pressure which may be the millimeters of mercury above atmosphere below the range which is that for rupturing the lungs, say up to forty millimeters of mercury.

Proportiom'ng From the chamber '29 and about the passage 20 is discharge port 63 (Fig. 13) to passage 64 (Figs. 10, 15) in the arm I6. This passage 64 extends to port 65 centrally of the head I5. Here is central seat 66 for hollow plug valve 61 having port 68 movable to variable register with port 65 thus providing communication with chamber 69 on one side of partition 10 in the plug valve. This plug valve is provided with ledge 1I flush with the top of the partition '10 providing a seat for check disk 12 by gravity normally providing a closure for the chamber 69. V

This plug valve above the disk 12 has chamber 13 in which. is mounted bushing 14 carrying transparency 15 held therein by gasket 16 and sleeve 11 depending into the chamber 13 as -a limit stop for the rise of the check disk 12.

The oxygen delivery from the oxygen chamber29 is to passage 18 in the arm I1 (Figs. 10, 15) with flow to port 19 oppositely from the port 65 as to partition 10 of the plug valve 61. This plug valve 61 has therein stepped or tapered port narrower at the lower proportions and widening up for greater width of port opening as the proportion increases for oxygen flowing through the ports 19 and ports 80 as brought into register in chamber 8| below the check disk 12 of the one-way gas flow valve.

From this chamber 13 are lateral ports 82 (Figs. 6, 11) to delivery passage 83 in the arm 53 of the head I5 for conducting the flow of gas from the two pressure sources of supply at the reduced pressure as separately coming to the valve 61 and together passing from up about the periphery of the valve 12 into the chamber 13.

The proportioning of these two different gases is effected by rotation of the plug valve 61 in its seat 66 in the head I5. This plug valve as protruding above the head I5 adjacent the bushing 14 has overhanging flange 84 (Figs. 1, 3, 6, 10) carrying scale 85 indicating percentage of oxygen as in position relatively to the pointer 60. The arm 53 has stop pin 86 with which pin 81 at the flange 84 coacts at the zero position of oxygen or 100% nitrous oxid, while the pin 86 coacts with pin 88 on the flange 84 as a stop at the 100% position of oxygen or zero nitrous oxid. As heretofore indicated, the zero oxygen and zero nitrous oxid is obtained by adjusting the dial 62 to on position at the pointer 60.

Micrometer operation or more delicate adjustment of the knurled flange 84 may occur in this proportioning, in lieu of handling this disk readings on the scale 85 as disclosed by the pointer there is proportional rotation of the plug valve 61 and nicety of proportioning to a minor percentage may be determined and this gas is accordingly, as definitely proportioned, free to pass from the chamber 13 (Fig. 10) by way of the passage 83- (Figs. 6, 11). Fitting 96 may provide the mounting connection for flexible duct 91, terminating in fitting 98 (Fig. 1) having rigid mask section 99 carrying flexible mask rim I00, as a delivery nozzle to the patient by placing such over a respiratory orifice, as the nose or nose and mouth, in order that upon inhalation there may be such drop in pressure that the check disk 12, as gravity seating, will be poised for supply of the nitrous oxid and oxygen gases in the predetermined proportion to the patient. Upon exhalation the check valve 1 seats and the gas supply is cut off.

Relief 7 In the mask fitting 98 (Figs. 1, 2, 4) is branch bushing IOI terminating in seat, I02 against which rests check disk I03 as held by compression helical spring I64. Threaded with the bush- I08, at protruding push button portion I I4 there- 75 of, materially increases "the resistance of the spring I04 and accordingly in practice is a normal closure for the check disk I03 against spilling of exhalation by the patient. In normal operation, the spill may be adjusted as to back pressure by rotating the shell IIZ which is provided with inwardly extending or thread means I I5 coacting with helical external groove II 6 on the extension sleeve I05 fixed by pin I05 with the fitting 98. By the rotation of the shell II2 relatively to the sleeve I05 the clearance between the collar I09 and the spider I06 is reduced and there isincreased compression of the spring I04. Calibration marker or pointer 'I I1 is provided on the housing 98 with scale II8 on the shell H2 say in steps of five millimeters of mercury up'to twenty, or other pressure as desired,thereby determining the exhalation pressure at which thevalve I03 may be unseated for spill of exhalation from the patient.

Rebreathing of the suppliedgases do not get into the lungs for taking up by the system of the patient and are exhaled uncontaminated. Other portion of the exhalation includes the gases given up by the patient, say carbondioxid as well as inert gases rejected. Importance attaches not only to conserving the supplied gases for anaesthesia and oxygen for maintaining life activities, but there is purpose in the carbon dioxid as an excitant to respiratory action. Herein measure is taken to effect return of exhalation gas in advanceof any re-supply of nitrous oxid, oxygen, or other gases, thereby insuring that the carbon dioxid of the previous exhalation may get to the patient for promoting a degree of lung action desired.

To this end the duct 83 is in direct communication through the ports 82 and chamber 13 with passage II9 (Fig. 6) in the arm 92. This passage II9 extends to gusseted chamber I as a rebreathing bag or reservoir in shield or housing having section I 2! toward the column 3 and fixed with the head I5 and additional section I22 on pivot bearing I23 adjacent the mounting of the flexible or distensible chamber I20 with the arm 92.

halation, cut off by check va1ve'12 from getting therebelow in the plug valve, flows through the passage II9 to inflate this chamber I20 and thus swingthe arm I22, as depending, outward on its fulcrum I23. This chamber I20 is accordingly collapsible and distensible over a range. This range in practice as adopted herein may be 1200 cc. or a range beyond the tidal volume usually experienced with patients. This chamber is thus responsive for filling, and upon inhalation, is responsive for emptying.

Hereunder, as an important feature of handling the patient, there may be attained effective emptying of the chamber I20 before the check valve 12 lifts for further supply of gases to the patient. This advance expulsion or emptying of thechamber I2 0 is effected by loading mechanism herein shown as involving cam I24 on the shield section I22. Roller I25 on depending arm I26 rides on this cam I24 to approximate uniform pressure as the shield I22 swings outward during the inflation of the chamber I 20. This 'arm. I25 is engaged by end I21 (Figs. 6, 9) of torsion spring I28 about'shaft I 29 which has fixed terminal connection I30 with collar I3! fast on this shaft I 29. This shaft I29 is under hood. or housing I 32 and terminally protrudes in shield I33 (Fig. 3) to house worm wheel I34 (Figs. 8, 9). Worm I35 is in mesh with this worm wheel I34 and may be operated by key I36. 5 The angle of friction is sufficient to hold the worm I35 in the adjusted position, while the operation of the key I36 is effective for increasing or decreasing the torsion action of the spring I28.

This means that this rebreathing chamber I20 may be adjusted to open at a pressure which in practice is desirably just below and effective in advance of unseating valve disk I03 at the mask. The shield I33 (Fig. 3) is provided with 15 pointer I31 fixed therewith in the vicinity of window I38; Fixed with the worm Wheel 5534 is scale I39 movable in the operation of the key I36 past the window I38for disclosure by the pointer I31 as the resistance, say in millimeters of mercury, against inflation of the chamber I23, which may thus be visibly checked with. the adjustment at the relief valve.

Rebreathing volume adjustment 25 side cheeks I41. Handle I48 may be grasped and 35 swung clear of the ratchet I for the attendant to locate the stop I4I in-desired positions for maximum inflation of the chamber I20.

Rebreathing volume disclosure The housing I32 above the shaft I29 carries bracket I49 (Figs. '7, 9) mounting shaft I50. Loosely mounted on this shaft I59 is arm I5I carrying scale I52 disclosed through window I53 (Fig. 3) of the housing I32. Additionally, also 45 loosely mounted on the shaft I50, is pointer I54 protruding through-the window I53 to disclose a reading on the scale I52. Compression helical spring I55 between these loose arms I5I and I 54 and about the shaft I50 interposes a frictional resistance for retaining location of this scale I52 as adjusted by handle I56 and for the pointer I54 disposed to be engaged by supplemental pointer I51.

The supplemental pointer I51 is also loosely mountedon the shaft I50 as an angle lever and carries short arm I58 (Fig. '1) connected by link I59 to bracket I60 mounted on the depending swinging shield section I22 aboutthe chamber I20 movable in response to inflation of such chamber. It thus follows that this inflation movement of thechamber I20 is transmitted to shift the pointer I51 along the scale I52 to pick up the pointer I54 at the maximum range of shifting during the inflation, and as the chamber I20 is emptied or deflated the pointer I51 recovers leaving the pointer I54 to show on the scale I52 the volume in 100 00., an instance herein disclosing rebreathing permitted say at the adjustment of the stop I40. I

i For checking full tidal volume of the patient, the head 'I I4 may be depressed to hold the relief valve from opening and the pawl I43 clear of the ratchet I45. Preferably this may occur with a minimum of pressure as'applied bythe key I36,

although it may be at the operating pressure as determined for the patient. At this aeidialation, the pointer I51 is effective say in shifting :irom zero on the scale I52 up to the .range of the :exhalation volume. This carries the pointer 154 so that it is not encumbent upon the operator to watch for the pointer 151, for the pointer I54 will rest at this tidal volume limit.

In the operations hereunder, the adjustment of the scale I52 by the handle I56 permits the location of the zero point on this scale at the deflation' or emptying position of the chamber I20 as the minimum before re-inflation.

Emergency oxygen Threaded on this bushing I63 is cap I61 hold- 7 ing the diaphragm. I66 in position, this cap having a central opening I68 therethrough. Push button I69 protrudes through this opening I68 and has within the cap I61 enlargement I10 bearing on the diaphragm I66 oppositely to the head- I65. Depression of this push button I69 is effective through stem I'1I to thrust fiber seat I12 away fromclosure position at the port at the lower end of the bushing I6I. This thrusting of the push button I69 as transmitted to this seat I12 .in collar I13 is resisted by compression spring I14 normally holding this port closed. It follows from this depression of the push button I69, unseating of the valve I12 allows the high pressure oxygen from the passage 26 to how past the bushing I6I about the stem I1 I into passage I15'to discharge by port I16 through ports 82 (Figs. 10, ii) in the plug valve for this high pressure oxygen supply, not only to pass above the disk 12, but flow directly through the passage 83 as a lung inflating spurt to the patient directly responsive to the pressure of the push button, with cut off at once the pressure is released at such push button I69.

Carbon diorid In lieu of rebreathing or as a definite supplemental supply for anaesthesia or excitant,carbon dioxid as an additional minorgas volume may be supplied say from pressure cylinder I11 past 'reducing valve or regulator I18 to flow throughduct I19 to fitting I80 (Figs. 1, 3, 10), provided with seepage port I8I at phenol condensation product seat and tapered valve I82 having scale notation I83 movable as to pointer I84. This scale as disclosed, say with the carbon diox'id pressure .at sixty pounds will give the direct reading of say 100 00.; 300 cc, and 500 cc. per minute spill past this seepage port I 8I, to flow from this fitting 180 by branch duct" I8 5 by-passing the oxygen emergency-for direct fiow into the passage 175 and thus for intermingling with the delivered or tenance of the accuracy for this minor volume supply as continuous and collateral which is spilled to the patient direct at the adjusted rate.

supplemental mthesiayns "In parallel with or in heu of nitrous oxid, ethylene may he used, and to this end adjacent the fitting I8 bearing the notation "I9, there is provided .fitting I8 bearing ethylene notation I86 as a supply to the passage 20 in parallel with or in lieu of the nitrous oxid supply from the duct I1. The ethylene supply to the fitting I8 may be from pressure tank source through reducing valve or regulatorand thence by flexible duct I81.

vaporizer Additional supplemental anesthesia promotion may be from a vaporizer liquid source as "ether. For such, there is shown herein introduced in the duct 83 'by coupling 188 head I89 '(Figs. 1, 3, 14) of vaporizer. This Thead I89 is provided with ether cup or chamber 190 which may have charge I9I of ether therein. The head I89 is provided with flange I92 carrying a pair of depending concentric'foraminmls cylinders I93, I94, as a housing for fiber J95 serving as a capillary attraction means for increasing the vaporizing surface of ether -I9I. The cylinder I93 is spaced inward from the outer portion of the cup .190 and the inner cylinder 19! leaves clearance for central chamber 196.

The head I89 .is provided with scale I9] adjacent slot 198 through which ,protrdues handle I99. This .handle as operating along this scale determines the ratio of .gasflow to be by-passed from the direct .flow between the passages and '61 into this ether cup. This .is efifected by sleeve 200 to which the .handle I99 is directly connected and through whichsleeve this handle extends to anchor partition 201. This sleeve as rockable in the head 189 has ,port 20-2 on the supply side for registering with port 203 of the head I89 .in communication above the flange I92 .forflow of gas .to pass .into the cup I through the outer foraminous cylinder I93 over the ether impregnated fibrous material. I95 thence out through the foraininous cylinder I94 .into cylinder I96. As thus charged with ether vapor it flows upward through duct 204 and port 205 into head I89 throughport 206 in the sleeve 200 on teh opposite side of the partition '20I from the port 202, as an ether pregnated charging portion of the anaesthetizing gas.

This head I99 at the 0d posit-ion has the port 202 clear the port 203 and in register with port v201 in the head 189 (Fig. 3) for by-passing the ether cup by way of passage 208 and port 209 in register with the sleeve port 296 of the sleeve 200. It accordingly follows from the intermediate positions as indicated by the handle I99 on the scale I91, the ports 202 and 2060f the sleeve 200 are in partial register for splitting the gas flow between the ports 203 and 201 for entering and between the ports 206 and 209 as passing on to the patient.

In operation, the patient .to be subjected to the anaesthesia has the mask I-00 applied after a supply tank for each of the :gases to be used is opened up and tested out through the machine, with .all foreign-gases thus removed and the.

' mask has been subjected to inhalations and exhalations to operate the various valves for delivery and exhaust or relief. The mask I00 is then applied to the patient.

practice it is usual to ailowinitialiy a few heavy or high percentage inhalations of the anaesthetizing gas, :say the nitrous 'oxid; Then the machine is adi-usted say by manipulating the disk 81 to that percentage which seems to be adequate to hold the patient in the desired condition of anaesthesia or analgesia. At each inhalation the check disk 12 is lifted after the rebreathing bag I20 has collapsed. On exhalation, the check disk 12 first is seated, the bag I20 is then distended to the desired quantity for rebreathing, and thereafter the relief valve disk I03 at the machine opens for exhaust.

The operation of the rebreathing bag in advance of the new gas supply has a tendency to keep the respiration excitant carbon dioxid in such volume in the circuit as to promote the respiration cycle. With the purpose of increasing progressively the accumulation of the carbon dioxid, the moments when respiration becomes to be progressively decreasing in volume, the carbon dioxid valve disk I83 may be operated for delivery directly into the machine in advance of the new gas supply and continuously at desired flow rate.

This carbon dioxid affords a stimulation means for keeping the respiration normal as to rate and o1 an efiicient depth in the lungs. As there is desired recovery, this supplemental gas supply of carbon dioxid may be cut out. Otherwise hereunder as the mask is removed from the patient there is not fresh gas delivery, only as there may be building up' of pressure through the manipulation of the disk 59.

What is claimed and it is desired to secure by 16 Letters Patent is:

A gas administering machine comprising an intermittently distensible rebreathing chamber providing a responsible replenishment device for the chamber, and means for adjustably establishing resistance to filling said chamber by said device embodying a plate member, pivotal mounting means for the member and adjustable loading means for the member rockable to and fro by the action of said member.

ELMER I. MCKESSON.

CERTIFICATE OF CORRECTION.

Patent No. 2,042,474. June 2, 1956.

ELMEE I MOKESSON.

It is hereby certified that error appears in the printed specification of the above numbered patent requiring correction as follows: Page 5, second column, line 14, in the claim, for the word "responsible" read responsive; and that the said Letters Patent should be read with this correction therein that the same may conform to the record of the case in the Patent Office Signed and sealed this 18th day of August, A. D. 1956.

Henry Van Arsdale (S l) Acting Commissioner of Patents

Images