US2637318A - Apparatus for inducing artificial respiration - Google Patents

Description

y 1953 J. H. EMERSON APPARATUS FOR INDUCING ARTIFICIAL RESPIRATION Filed Jan. 12. 1949 0 if J M w. 4 4 HHUWHH I Ma- W Pu DNNU I mj .3 l ln nnhm wn I U n! N J R Z A v j, 0 N M 1 1 4 4 A? M M WHHHHHWIHWWU Q 4 f 4 M fave 70507 Patented May 5, 1953 OFFICE APPARATUS FOR INDUCING ARTIFICIAL RESPIRATION John H. Emerson, Arlington, Mass.

Application January 12, 1949, Serial No. 70,573

i Claims. l

This invention relates to an improved apparatus for inducing artificial respiration in human beings.

In about 1903 the Schaefer prone pressure :method of inducing artificial respiration was in-. 'troduced and it has proved so adaptable to use by the general public and so effective in its re- :sults that it is now the most popular method of manual artificial respiration. Two objection- :able features are inherent in the Schaefer method; first it does not use as large a capacity of the lungs as is desirable (each inspiration and each expiration are of substantially less volume than in normal breathing) and second, when it is used for a prolonged period it is quite painful to the patient due to the intermittent pressure of the operators hands on the small of the patients back and the shifting of his organs which results therefrom.

The primary objects of the present invention are to provide an apparatus for use in artificial respiration the use of which will afiord a greater volume of lung ventilation during each inspiration and expiration than does the Schaefer method, which may be operated expeditiously by one operator, which is less painful to the patient, which causes close approximation of normal abdominal breathing, the use of which may be quickly and easily taught to the general public, and which is not readily susceptible to improper operation by an operator.

As will be more specifically described hereinafter, artificial respiration may be induced by placing the patient face down in a prone position on a support, for example the ground, a floor, or the bottom of a boat, and then alternately lifting the patients pelvic cage a few inches upwardly from the support and restoring it to the support. Raising of his pelvic cage slightly bows his spinal column downwardly from the pelvic cage along the back of his abdominal cavity, and concomitantly distends or lengthens the forward wall of his abdominal cavity be tween his crotch and his diaphragm (located between his abdominal cavity and his lung cavity) along the front of his abdominal cavity. This causes an accordion-like action which moves the patients diaphragm rearwardly or outwardly of his lung cavity, thereby increasing the volume of his lung cavity and causing an inspiration. Subsequent lowering of his pelvic cage restores the parts to their original prone position thus moving the patients diaphragm inwardly of his lung cavity, decreasing the volume of his lung cavity and causing an expiration. Repeated lifting and lowering of the'pelvic cage in approximately the rhythm of normal breathing (approximately sixteen times a minute) simulates normal respiration and causes each inspiration and each expiration to be of greater volume than in the Schaefer method. In one embodiment of the method no pressure is brought to bear on the patient except the slight pressure of the operators fingers beneath the hip bones during each lifting step.

If desired, in conjunction with the aforesaid raising and lowering steps, after each lowering step pressure may be applied by the operator to the small of the back in the vicinity of the patients lower ribs according to the Schaefer method by merely sliding the hands forwardly from the region of the pelvic cage and pushing downwardly and forwardly. By using this modification each inspiration and each expiration is of even greater volume.

While the method may be performed manually by the operator kneeling or standing astride the patient and lifting thepelvic cage by placing his fingers beneath the hip bones at opposite sides of the patients pelvic cage, or by a belt, towel or piece of clothing placed beneath the patient at his hip bone line, various forms of apparatus may be provided to facilitate practice of the method for prolonged periods and with less exertion by the operator. Two embodiments of such apparatus which embody my invention are illustrated and described in detail hereafter.

The invention will now be described in greater detail reference being made to the accompanying drawings wherein:

Fig. 1 is a plan view of a portable apparatus in the form of a table or stretcher;

Fig. 2 is a side elevation of the apparatus of Fig. 1; and

Fig. 3 is a side elevation partially in central longitudinal section of an alternative form of the apparatus of Figs. 1 and 2 wherein a motor is employed for imparting the necessary movement to the patient elevating means.

To perform the method manually the patient rests face down in a prone position on any suitable suriace, for example the ground, the floor or a table, stretched out as nearly straight as possible with hishead resting on one arm and the other arm extending forwardly and his tongue pulled forwardly in the mouth so as to prevent possible choking, all in accordance with the conventional Schaefer prone pressure method of resuscitation. The operator kneels astride the patient, just back of the buttocks, and in contrast to the Schaefer method with his fingers placed beneath the hip bones at opposite sides of the pelvic cage. Starting with this initial position the operator straightens up lifting the pelvic cage vertically from the supporting surface through a distance of approxh mately 6 to 12 inches. The lifting movement causes the patients spinal column to slightly increase its downward bow from the base of the spine at the pelvic cage to .the back .ed of the diaphragm (glocated betweentheilungrcavity and the abdominal cavity). At the same time the front abdominal wall is lengthened partly by the downward bowing of the spinal column which causes the pelvic cage .to .be ilocated a greater distance from the front edge of the:dia phragm, and partly by the sagging .,of the .internal organs within the abdominal cavity which push or bow the abdominal :vzall downwardly- This combined bowing of the spinal column and extension or lengthening of the abdominal wall produces an accordion-like rearward or outward movement of the diaphragm. The diaphragm extends transversely of the body and normally occupies a forward dome-line position --wherein it extends a substantial distance into the lung cavity. The foregoing accordion-like action which elfects movement of the diaphragm rearwardly or outwardly of thelung cavity increases its volume and hence induces inspiration. Upon restoring the pelvic cage to its original prone position the spinal column is straightened, the abdominal wall is pushed back into its normal prone position and the diaphragm is '-re-- turned to its forward or inward position in the lung cavity, decreasing its volume and hence producing an expiration. Repeated lifting and lowering of the pelviccavity at intervals in the rhythm-of normal'breathing of the patient causes artificial respiration.

In the Schaefer method, pressure is brought to bear upon the lung. cavity by applying the hands in the small of the patients back near the border of his lower-ribs' and'pressing in an oblique direction toward the patients head. Thus'the abdominalcavity is compressed, forcing the organs, intestines and stomach up against the diaphragmand .causingthe lungs to be deflated inducing an expiration. Upon releasing this pressure said organs-return to their original position causing the lungs toexpand and inducing an inspiration. It is thus apparent that the actual change in volume of the lung cavity in the method of the present invention is greater than that of the Schaefer method due to the accordion-like outward and inward movement of the patients diaphragm and that no additional pressure is brought to bear upon the patients abdominal parts thus both increasing the depth of the artificial respiration and reducing the pain' to the patient.

As the pelvic cage is restored to the support to cause an expiration the operator's hands may be shifted from the patientship bones to the small of his back andpressure exerted obliquely toward his head in the precise manner of the Schaefer method. This additional step during each expiration adds to the depth of each expiration and produces a greater ventilation of the lungs. This step however is optional and if it is used the same danger of excessive pain to the patient is present as in the Schaefer method but it is an improvement thereon because of the greater volume of ventilation.

If desired, the operator may carry out the aforesaid method by placing ,a flexible member or ex mple a b lt, owel or. rti le. f cl n beneath the patient so as to span his pelvic cage at the hip bones, and While standing astride the patient, lift the pelvic cage vertically and then restore it to the supporting surface. For heavy patients and where the method must be carried out for extended periods, this is a less tiring operation for the operator.

In ,conjunction with practicing the method of this invention a simple apparatus, preferably of a portable type, may be useful and desirable.

The apparatus shown in Figs. 1 and 2 is suitable for use by fire departments and ambulance corps. shown, .this apparatus is in the form (of a portable table or rigid patient supporting member Mi having a surface of sufficient length and width to receive a person or" normal stature and'supporting :legs 4 which are relatively short so that the device will be close to the ground and-may be manipulated like a stretcher. Casters or wheels 55 are rotatably mounted in the lower ends of the legs. Amovablepatierit contactingmember as extends :irom one end of the table top to a line which substantially :un'derlies the location of the crotch or hip joint of a person lying in prone position on the table with his abdomen, chest and head located on the portion d6 of the table top. The patient con- 'tacting member 418 is hingedat atone end of the table 46 and at its other end terminates short of the adjacent :endof the portion 56 in a position to engage the patient s body approxh mately on a line with the hip joints. In use the patient should be placed on the table top in such a manner that the'member '42} does not interfere with the sagging of the abdominal wall when the movable member is rotated to the dotdash position of Fig. 2. A pair of operating members 5! are secured to the cross bar 53 which is mounted for rotation in suitable bearings in the table extension member We. Handles 52' are secured to theoperating members El. Thus an operator may grasp one handle and by pulling it rearwardly rotate the cross bar 53 and the attached operating members El. Since the members 151 underlie and engage the movable member 23, such movement causes it to tilt upwardly about its pivot 53' to the dotdash position shown in Fig. 2. From the foregoing it will be apparent how this apparatus is used to raise and lower the patients pelvic cage and to cause his body to alternately assume the positions described above thereby to induce artificial respiration.

If desired, the apparatus of Figs. 1 and 2 may be further mechanized as illustrated in Fig. 3. In this embodiment a motor M is mounted on the under side of the table as, an eccentric 55 is fastened to the driven shaft 55, a lever 56 is pivot ed at 58 to the strap 57 and at one end engages the eccentric 54 and at its opposite end is pivotally connected to a rod 81), the rod 60 being pivotally connected at its upper end to the movable patient contacting member 45 in the centrally located slot 6!. The motor M is provided with a reduction unit (not shown) to provide a normal speed of about sixteen revolutions per minute for the driven shaft 55 and a speed regulator R is provided to vary the speed of the driven shaft as desired. The lever 55, strap 5i and rod 60 are located substantially below the longitudinal center line of the table 40.

In use the patient is placed in prone position on the top of the table with the free end of the movable member 48 located beneath the line of his hip joints and his legs extending along the surface of the movable member. The motor is then started during each revolution of the driven shaft 55 the eccentric at depresses the adjacent end of the lever 56 thereby elevating the opposite end of the lever and the rod til. Elevation of the rod 6% causes upward movement of the movable member it about its pivot to the position shown in dot-dash in 3. This elevates the patients pelvic cage from its prone position to an elevated position and thereby causes an inspiration. During the second. half of each cycle the member it is lowered to its original substantially horizontal. position, the weight of the patients buttocks causing the lever 56 to follow the eccentric a l until the lever has also been returned to the substantially horizontal position of Fig. 3. This lowers the patients pelvic cage to its original prone position and thereby causes an expiration.

The apparatus of this embodiment can only be used where a convenient source of current is available for energizing the motor.

It should be understood that the present disclosure is for the purpose of illustration only and that this invention includes all modifications and equivalents which fall within the scope of the appended claims.

I claim:

1. Apparatus for use in artificial respiration comprising a support upon which the patient may be supported in a prone position face downward, a movable section pivotally connected to the support adjacent to the foot end thereof and nor-- mally situated substantially in the plane of the support with the end remote from pivotal 0 comprising a support upon which the patient may be placed in a prone position face downward, a movable section on the support normally situated in the plane thereof and above one end of which the pelvic cage of the patient may be placed, a pivotal connection between the other end of the section and the support adjacent to the foot end of the support. means for raising and lowering said movable section about said pivotal connection, thereby to raise and lower the patients pel vic cage and to create an inspiration and expiration respectively and means for controlling the duration of each upward movement of the mov able section.

3. Apparatus for inducing artificial respiration in a patient who is supported in a prone position face downward comprising a patient contacting member adapted to be positioned beneath the patient with its forward edge substantially underlying the line between the patients hip joints, the patient contacting member extending thence toward the patients feet, elevating means attached to said patient contacting member, a support for said elevating means and a pivotal connection between said support and said elevating means, said pivotal connection being spaced 1ongitudinally of the patient from said line between the patients hip joints, whereby upon movement of said elevating means about said pivotal connection the patients pelvic cage may be periodically elevated and lowered with respect to his lung cavity without corresponding elevation and lowering of his feet.

4. Apparatus for use in artificial respiration comprising a substantially horizontal patient support for supporting a patient in a prone position face downward, a hip elevating member mounted on said patient support and extending transversely of the patient support with its forward edge substantially underlying the line assumed by the patients hip joints when he reclines in said position on said patient support, said elevating member ext-ending thence towards the foot end of the patient support and means for periodically moving the forward edge of said hip elevating member from the surface of said patient support upwardly a few inches and then downwardly substantially to said surface without movement of the surface of the patient support which underlies that portion of the patient which extends from the line assumed by his hip joints to his head, whereby the patients pelvic cage may be periodically elevated and lowered while his lung cavity remains substantially stationary.

JOHN H. EMERSON.

References Cited in the file of this patent UNITED STATES PATENTS Useful for the Paralyzed Patient, Journal of American Medical Association, vol. 104, No. 4, January 26, 1935, pp. 307-308.

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