US2192429A - Gas administration - Google Patents

Description

March 1940- J. 1.. BLOOMHEART 2,192,429

GAS ADMINISTRATION Filed Nov. 3, 1957 KSheets-Sheet 1 grwonlo n .1. L. BLOOMHEART GAS ADMINISTRATION Filed Nov. s. 1957 March 5,

5 Sheets-Sheet 2 v J. L. BLOOMHEART 2,192,429

GAS ADMINISTRATION Filed Nov; 3, 1957 3 Sheets-Sheet 5 Patented Mar. 5, 1940 UNITED STATES PATENT OFFICE 2,192,429 GAS ADMINISTRATION Application November 3, 1937, Serial No. 172,500

17 Claims.

This invention relates to prescribing and controlling gases for a patient.

This invention has utility for resuscitation, anaesthesia, and analgesia. The latter may be effective under the control of the patient to modify the functioning of the apparatus.

Referring to the drawings:

Fig. 1 is a side elevation, with.parts broken away, of an embodiment of the invention, more particularly as adapted for patient control in analgesia administration;

Fig. 2 is a fragmentary view looking into a form of mask from the back in which the spill port is open constantly to the atmosphere;

Fig. 31s a section on the line IIIIII, Fig. 2, showing the port of the mask;

Fig. 4 is a plan view of the head of the gas administering machine of Fig. 1, parts being broken away;

Fig. 5 is a view of the gas supply fitting to the head on the line V-V, Fig. 4;

Fig. 6 is a view of the head from the front or right of Fig. 1, parts being broken away;

Fig. 7 is a view of the lever control for the gas supply to the head on the line VII-VII, Fig. 4;

Fig. 8 is a diagram in plan of ducts to and at the head, showing the gas flow passages from the support to and past the proportioning valve;

Fig. 9 is a section through the head on the line IXIX, Fig. 4;

Fig. 10 is a view of the proportioning valve and patient control relief features on the line XX, Fig. 9;

Fig. 11 is a detail view of the proportioning valve plug;

Fig. 12 is a plan view of the plug valve of Fig. 11 with the cover plate removed;

Fig. 13 is a section through the proportioning valve on the line XIIIXIII, Fig. 10, showing the gas flow ports therefrom;

Fig. 14 is a section on the line XIV-XIV, Fig. 10, showing the supply ports to the proportioning valve;

Fig. 15 is aview similar to Fig. 3 of a mask having an automatically variable spill or intake port; and

Fig. 16 is a view looking into the mask port of Fig. 15.

Rollers i (Fig. 1) on casters 2 at base 3 mount standard 4 as a tube carrying clamp bracket sleeve portion 5 mounting on opposite sides of the support tube 4 reducing valves 6 having oppositely extending yokes or arms 7 provided with clamping screws 8 mounting valve heads 9 of fluid supply cylinders I0, which may in practice hereunder be nitrous oxid cylinders in showing at the left side of the machine as in Fig. 1, while at the opposite side of the machine as facing to the right of Fig. 1 may be disposed the oxygen supply cylinders. These pressure gases may be under 5 pressure of a plurality of atmospheres.

From the reducing valve 3 duct ll rises to fitting l2 at elbow l3 entering head piece I4 (Fig. 9). This elbow l3 in head piece It is in communication with passage l5 having ported plug l6 therein 10 normally thrust by gas pressure against flexible diaphragm H as a closed valve. At the opening of this valve, fiow of the supply gas is into chamber It in the head with bypass therefrom through port l9 into flat disk-like rubber bag 20 in disk 16 chamber providing housing 2|. This rubber bag 20 has seat 22 thereon in position to be contacted by projection 23 through port 24 in the housing 2 i. This projection 23 is offset from lever arm 25 having fulcrum 26 and short arm 21 acting on so plunger 28 to be thrust against thediaphragm l1 and hold such in closure position against the plug it as the bag 20 is expanded by gas supply therein.

From this chamber l8 in the head ll the supply 35 gas past the valve I! normally flows by way of passage 29 (Figs. 8, 14) to port 30 at one side of the partition 3| in taper plug valve 32 of the proportioning valve. This plug valve 32 is tubular or has chamber 33 (Fig. 10). This chamber adja- 30 cent the top of the partition 3! has annular ledge 34 therein clear of the inner Walls of the chamber. Resting on this ledge is valve disk 35 having selectively attachable weight or load 36 thereon, thereby adjustable as to its mass for holding this disk 35 or check valve normally in closure position against flow of gas from the supply port 30 over the partition 3| or out from under the valve disk 35. However, as the unbalanced pressure lifts this valve disk, whether suction in the chamber 33 below closure cap 31 as mounted thereon by screws 38 or whether it be pressure from the supply lifting such valve disk 35, there is flow of this supply gas herein, thus far taken as nitrous oxid, not only into this chamber portion of the tubular plug valve 32 but therefrom by way of port or ports 39 thereabout into passage 40 to which is connected delivery duct 4i (Fig. 1), herein shown as extending to rebreathing bag or flexible reservoir 42, from which extends a pair of 5 flexible ducts 43 to fittings M on opposite sides of nozzle or mask 45 say as adapted to fit over the nose of the patient. This mask 45 is shown 'as having soft flexible rim 46 (Fig. 3) engaging the flesh of the patients face surrounding the nose.

.trol especially adaptable in analgesia.

From this flexible portion 46 there is conformable body portion 41 rising therefrom. say of heavier rubber.

Centrally. this mask or nozzle has port 48 normally at all times communicable with the atmosphere. In normal practice, this port may be say inch in diameter. There is importance in certain ranges of operation hereunder that this port be protected against casual closure. say by a physician or patient getting the hand or some object thereagainst. tending to throttle this port supplied past ported plug I6 to flexible diaphragm H for spill into chamber I8 and a bypass by port Hi to the lever control device as to the valve I1. This supply gas from fitting |3 in advance of the ported plug I6 may pass by duct 5| (Figs. 4, 8, 9) to fitting 52, thence by U-duct 53 (Figs. 4, 10) to fitting 54 in which is located check valve 55, which may be unseated by pressure at button 58 to allow this pressure gas flow from this minor supply duct 53 by way of duct 56' not only into the chamber 33 of the plug valve above the check disk 35, but by way of ports 39 therefrom and passage 40 into supply duct 4| as emergency oxygen delivery controllable by the anaesthetist, attendant, or physician directly to the mask or nozzle as a resuscitating' supply for the patient. Pulsing of this plunger 56 is effected by successive depressions timed for promoting inhalation. To this end there may be intermittent closure of the port 48 at the mask. This is a desirable factor for supplying oxygen-enriched respiration gas to the patient. The attendant may shut off the plunger 56 at the time of exhalation and remove the digit from closing the port 48. This practice permits I exhalation'gas to spill to the atmosphere.

When efiecting anaesthesia for the patient, the control may be by the plug valve 32. The extent or ratio of the gases in proportion may be indicated by locating graduation 58 (Fig. 4) as to the pointer 59, which scale may be for the per cent of oxygen. With the nitrous oxid reduced or eliminated by the shifting of the port 30 out of register with the duct 29, there is greater exposure to oxygen supply passage 60 (Figs. 8, 14) for oxygen gas supply by way of port 8| into the plug valve 32 on the opposite side of the partition 3| from the port 30. This oxygen supply as in-flow gas lifts the check valve disk 35, enters the chamber 33 and passes therefrom through the passage 40 and duct 4|. This is a gas to dilute the anaesthetizing gas to the mask. In this control there may be manipulation of the port 48 in the event the rebreathing bag 42 be not of sufficient lung capacity desired for the patient in economical gas functioning of the machine. ,This exhalation gas may have its back pressure at exhalation built up as the check disk 35 is seated to distend the bags 20 and thereby be effective through the levers to close the respective supply valves l1.

Hereunder there. is supplemental patient con- To this end, the hand of the patient may grip bulb 62 (Fig. 1). This bulb 62 is provided with check valve 63 for free entrance of air thereinto as this bulb 62 expands upon release. As this bulb 62 movement of the flexible disk 69.

is compressed by grip oi the patient, the valve 4 63 closcs and check valve 84 from this bulb 82 is with chamber 68 (Fig. 9) herein shown as having opposing side walls 69'0! flexible disks and each directly acting upon plunger 10.

This plunger I0 as protruding has forked end 1| embracing lever arm 25. Surrounding this plug 10 is a sleeve forming an adjustable stop 12 threaded into this housing for the chamber 88. Adjustment of this stop 12 is effective to vary the clearance for movement of the plug 10 as to the sleeve 12. This means a positive limit for At the adjusted position for throw flexing of this diaphragm 69, this plug 12 is a stop and as such is determined from rotation of knurled disk 13 such disk may be engaged by set screw 14 in bar '15 assembled by screws 76 with the housings 2| and screw 11 withthe housing for the chamber 88. It is thus seen that as the patient grips the bulb 62 the diaphragm 69 responds to throw the plungers 10 and thereby rock the lever arms 25 against whatever pressure may be in the bag 20 and thereby pneumatically effect, as patient controlled independent of respiration of the patient. an opening of the valve I! for supply gas.

Were this set up gas tight, the check valve 64 might tend to hold the gas supply as a continuous flow during a period of respiration of the patient, whether or not there were subsequent gripping action. However, in the control herein, it is contemplated that the patient may manipulate for pain release. While the patient is conscious the patient may exert suflicient effort to promote anaesthesia gas flow in lieu of suffering pain from dental operation or in connection with labor.

To determine the interval which may be gaged for an inhalation or several inhalations, there is from the chamber 68 port 18 in which is located needle valve 19, which as clearing the port allows spill by port 80 to the atmosphere. This needle valve is adjusted-by manipulating cap 8| (Figs. 4,

= scale 83. This adjustment may be in practice say at the reading flight at the right at the number 1 to a quantity as say 200 cc. of anaesthesia gas, say straight nitrous oxid as against say 1000 cc, of straight nitrous oxid gas at the left or "heavy and proportionate inhalation as may be in order to exhaust such flow from the supply duct 4| as normally free and flowing into the mask 45 to be more readily inhaled through the nostrils than as spilled through the port 48 as open to the atmosphere. Spring 84 at this needle valve device adjacent the cap 8|. ofiers frictional means against ready disturbance of this proportioning as determined by the attendant or anaesthetist independent of the patient.

Should the patient respond to an acute pain by several successive squeezes of the bulb 82 as in quick succession, the result is not one materially to disturb the control adjustment as set by the physician or attendant in the control at the gage 83, for this chamber 68 has therefrom port 85 (Fig. 10) controlled by relief valve 86 having its spring 81 adjusted by ported nut 88. In practice, it is desirable to adjust this relief valve so that there is less than two capacities of the 'bulb 62 in the chamber 69 at any time. This bulb 82 would only carry on slightly beyond the inhalation supply of anaestbetizing gas for which the administration is set. Should the patient be sufllciently conscious to grip as the pressure in the chamber 64 has approached the condition for the valve disk l1 approximately in closing, then there is an elongation of the period for supply. This character of control is to be effective for the patient when conscious. Accordingly, as the conscious condition of the patient departs, the valve should be free for closing to cut of! anaesthesia gas supply. In the event the patient may have maintained grip, the relief valve coacts so there may not be a continuation of the supply.

Under the disclosure herein there is a simplified mechanical set-up for wide range of gas administration as anaesthetist, physician, or attendant controlled, whether for resuscitation, for anaesthesia administration, for analgesia by physician. anaesthetist. or attendant, or as to the analgesia as patient controlled. The patient control is subordinate to the proportioning spill to limit patient control and the manipulations incident thereto. Accordingly, there is reliability in this set-up acceptable to meet wide ranges of operatir'ig conditions, not only in the dental field but in physicians and surgical fields as well.

The proportioning valve plug 32 is not displaced to disturb its port relation axially, for screw extension 99 (Fig. 10) is through port to carry disk 9i mounted thereon by screw 92. The plug 32 is accordingly locked against removal upwardly without taking oil the support tube 4.

Disk 13 may be set for predetermined flow rate control of the respective valves H.

In practice there may be satisfactory operation hereunder with the single reservoir or expansible rebreathing bag 42. Factors toward disturbance may arise when the patient takes a deep quick heavy breath to inhale, deliberately takes a long inhalation, or when breathing may be quick and shallow or deep and variable. With the mask port 48 of Fig. 3 there may be depletion of the bag 42 r filling thereof with the spill-and intake at port 48 of such extent that the patient so reduces the control of the anaesthetic as to detract from the efllciency-of the functionings hereunder.

To ofiset these factors there may be instead of the single reservoir 42 an intermediate reservoir 93 in the line 4| connected to the reservoir 42 by duct 94 with check valve 94' effective to hold the contents of the bag 93 against exhalation contamination. Under this mode of control, say with the bag or reservoir 93 of 1,000 cc. capacity for the nitrous oxid, oxygen, or other anaesthetizing gas, its composition as determined by the valve 32 is against disturbance. The exhalation after the bag 42 has been collapsed may be to distend such back, say for 200 cc. capacity, thereby having the carbon dioxid therein to promote respiration of the patient at the next inhalation.

The course taken to insure that this reservoir 42 has the rebreathing capacity charge thereinto is effected by providing in the mask 45 a spider 95 centrally carrying a stem 96 mounting a flexible disk 91 as anchored by screw 98. This disk 91 is normally close to closure position in its coaction with the mask 45. Its degree of flexibility say as a rubber or like flexible disk is such that exhalation when rapid or quick may tend first to inflate the reservoir or bag 42 and then spill by flexing the disk 91 outwardlywith the response such that no labor is upon the breathing of the patient. At once this exhalation is discontinued,

the disk 91 resumes normal position against spill I of these supplies, the disk 91 will flex toward the spider 95 and thereby avoid distress to-the patient by insuring full gas supply by intake supplement from the atmosphere. The proportioning may be so nicely controlled that there is conserving of the anesthetic gas with retention of its properties for eflicient conducting 01 the functioning of the machine hereunder. These features of mechanical control are thus in a range undisturbed by the patient control factors hereunder. The mask 45 is thus equipped with a reversibly operable automatically variable eiIec-, tive areaflow port.

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

1.'A gas administering machine embodying a support, a supply tank mounted on the support, a chambered head, a reducing valve between the support and head, flexible diaphragm valve means at the head controlling flow of supply gas from the reducing valve into the head, flow means to v the patient including a mask having a port normally constantly communicablewith the atmosphere, and patient control means for the valve means at the head and operable independently of the port at the mask and independently of respirationgas flow. I

2. A gas administering machine embodying a head, supply means to the head, a proportioning valve in the head operable to vary the relation between the supplies as flowing from the head, through flow means to the patient from the head including a mask having a normally constantly open spill port to the atmosphere respiration by the patient through the mask tending to effect intermittent gas flow past the proportioning valve, and patient control pneumatic means connected to said supply means for there disturbing said respiration gas intermittent flow.

3. A gas administering machine embodying a support, a supply tank mounted on the support, a chambered head, a reducing valve between the support and head, flexible diaphragm valve means at the head controlling flow of supply gas from the reducing valve into the head, and flow means to the patient including a mask having a port normally constantly communicable with the atmosphere, there being lugs about said mask port exteriorly of the flow means to the patient shielding the port against casual closure.

4. A gas administeringmachine embodying a support, a supply tank mounted on the support, a chambered head, a reducing valve between the support and head, flexible diaphragm valvemeans at the head controlling flow of supply gas from the reducing valve into the head, flow means to the patient including a mask having a flow responsive intake and spill port to the atmosphere, there being a control lever for the diaphragm valve means, and an adjustable abutment shiftable against the lever for varying the control operation of the valve means. I

5. A gas administering machine embodying a support, a supply tank mounted on the support, a chambered head, a reducing valve between the support and head, flexible diaphragm valve means at the head controlling flow of supply gas from the reducing'valve into the head, flow means to the patient including a mask, patient control 1 matic device from the patient to the chamber for eflecting functioning of said plunger. 6. A gas administering machine embodying a support, a supply tank mounted on the support,

achambered head, a reducing valve between the support and head, flexible diaphragm valve means at the head controlling flow of supply gas from the reducing valve into the head, flow means to the patient including a mask having a normally constantly open spill port to the atmosphere, patient control means independent of respiration gas flow for valve means control, and a pre- .determined-influence adjustable control extent for said patient control.

7. A gas administering machine embodying a support, a supply tank mounted on the support, a chambered head, a reducing valve between the support and head, flexible diaphragm valve means at the head controlling flow of supply gas from the reducing valve into the head, flow means to thepatient including a mask having a. variably open spill port to the atmosphere, respiration by the patient through the mask tending to efi'ect intermittent gas flow at the valve means, and patient control means disturbing said respiration intermittent gas flow embodying a manually operable bulb for a pneumatic control of said dia' phragm means.

8. A gas administering machine embodying a support, a supply tank mounted on the support,

the reducing valve into the head, flow meansto the patient including a mask having a reversibly open flow portto the atmosphere, respiration by the patient through the mask tending to eifect intermittent gas flow at thev valve means, and patient control means disturbing said respiration intermittent gas flow embodying a manually operable valve bulb for a pneumatic control of said diaphragm means. I

9. A gas administering machine embodying a support, a supply tank mounted on the support, a chambered head, a reducing valve between the support and head, flexible diaphragm valve means at the head controlling flow of supply gas from the reducing valve into the head, flow means to the patient including a mask having an automatically responsive flow port to the atmosphere, respiration by the patient through the mask tending to efl'ect intermittent gas flow at the valve means, patient control means disturbing said respiration intermittent gas flow, embodying a manually operable bulb, a duct therefrom, and diaphragm control means for the valve means operable from said bulb.

10. A gas administering machine embodying a support, a supply tank mounted on the support, a chambered head, a reducing valve between the support and head, valve means at the head controlling flow of supply gas from the reducing valve into the head, flow means to the patient including a mask having an automatically reversible port to the atmosphere, respiration by the patient through the mask tending to effect intermittent gas flow at the valve means, patient control means disturbing said respiration intermittent gas flow, embodying a manually operable bulb, a duct therefrom, diaphragm control means for the valve means operable from said bulb including a chamber, and an adjustable spill from said chamber. I

11. A gas administering machine embodying a support, a supply tank'mounted-on the support, a chambered head, a reducing valve between the support and head, valve means at the head controlling flow of supply gas from the reducing valve into the head, flow means to the patient including a mask having an automatically variable means operable from said bulb including a chamber, and an adjustable stop for varying the control of the means.

12. A gas administering machine embodyinga support, a supply tank mounted on the support, a chambered head, a reducing valve between the support and head, valve means at the headcon-' trolling flow of supply gas from the reducing valve into the head, flow means to the patient including a mask having a reversible automatically variable port to the atmosphere, respiration by the patient through the mask tending to efiect intermittent gas flow at the valve means, patient control means disturbing said respiration intermittent gas flow, embodying a manually opera ble bulb, a duct therefrom, diaphragm control means for the valve means operable from said bulb; including a chamber, and a relief valve Y from the chamber.

13. A gas administering machine embodying a support, a supply tank mounted on the support,

a chambered head, a reducing valve between the support and head, flexible diaphragm valve means at. the head controlling flow of supply gas from the reducing valve into the head, flow means to the patient including a mask having a port to the atmosphere, and av flexible disk' having clearance of said port at all times and shiftable as disturbed by pressure in the mask for spill or intake response increasedclearance at said port.

I 14. A gas administering machine embodying a support, a supply tank mounted on the support, a chambered head, a reducing valve between the support and head, movable means at the head controlling how of supply gas from the reducing valve in the head, flow means to the patient including a reservoir, and a mask, and patient control means for the movable means at the head including a bulb to be grasped by the patient and a tube in communication from said bulb to the movable means having a port to the atmosphere, and a fiexible disk having clearance of said port at all times and shiftable as disturbed by pressure in the mask for spill or intake response increased clearance at said port subordinate to said reservoir. v

'15. A gas'administering machine embodying a support, a supply tank mounted on the support, a chambered head, a reducing valve between the support and head, flexible diaphragm valve means at the head controlling flow of supply gas from the reducing valve into the head, flow means to the patient including a primary gas reservoir, a-

secondary rebreathing gas reservoir, a valve precluding flow from the secondary reservoir to the primary reservoir, a mask in communication with the secondary reservoir, said mask having a port to the atmosphere, and a flexible disk having clearance at said port at all times and shiitable as disturbed by pressure in the mask to increase said clearance for spill subordinate to said secondary reservoir or for intake subordinate to said secondary and primary reservoirs.

16. A gas administering machine embodying a support, a supply tank mounted on the support, a chambered head, a reducing valve between the support and head, flexible diaphragm valve means at the head controlling flow of supply gas from the reducing valve into the head, flow means to the patient including a mask having an automatically responsive flow port to thaatmosphere. said valve being adapted to eflect intermittent gas flow upon respiration by the patient through the mask, patient control means disturbing "said respiration intermittent gas flow, embodying a manually operable bulb, a duct therefrom, and diaphragm control means for the valve means operable from said bulb.

17. A gas administering machine embodying a support, a supply tank mounted on the support, a chambered head, a reducing valve between the support and head, flow means to the patient including a mask having an automatically responsive flow port to the atmosphere flexible diaphragm, valve mechanism tending to effect intermittent gas flow upon respiration by the patient through the mask, patient control means disturbing said respiration intermittent gas flow embodying a manually operable bulb, a duct therefrom, and diaphragm control means for the valve mechanism operable from said bulb.

JOHN L. BIOOMHEART.

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