US2206687A - Pleural diagnosis and treatment - Google Patents

Description

M2 2, 1940. .1. 1.. BLOOMHEART 9 7 PLEURAL DIAGNOSIS AND TREATMENT Filed Nov. 29, 1957 2 Sheets-Sheet l July 2, 194w, J. L. BLOOMHEART PLEURAL DIAGNOSIS AND TREATMENT Filed Nov. 29, 1937 2 Sheets-Sheet 2 Patented July 2, 1940 UNITED STATES PATENT OFFICE PLEURAL DIAGNOSIS AND TREATMENT 4 John L. Bloomheart, Toledo, Ohio, assignor to Martha F. McKesson, Toledo, Ohio Application November 29, 1937, Serial No." 177,001

2 Claims.

respiration.

This invention has utility in establishing a duct, U passage or way into the thorax, exterior of the lung-encompassing envelopaand there establishing achamber to be definitely controlled as to capacity in the introduction of gas, as air, for effecting collapsing of alung portion or portions. This control is even to the extent of plus ,orminus gas flow for removing from aswell as delivering fluid or gas to this chamber for definite control thereof as to capacity and pressure therein.

Referring to the drawings; i Fig. l is a front elevation of the cabinet, open, and with parts broken away, as extending to a patient to be treated;

Fig. 2 is a view looking into the back of the casing or cabinet of Fig. 1. parts being broken away;

Fig. 3 is a section through the cabinet on the line III-4H, Fig. 2, looking in the direction of the arrow at the liquid or water pressure manometer; it Fig. 4 is a section on the line IV-IV, Fig.2, looking in the direction of the arrow at the mercury or gas volume manometer;-

Fig. 5 is a diagrammatic view of the tem in the device; i

Fig. 6 is a section on the line VI-VI, Fig. 2. looking down on the reservoir or main chamber and manometers; and

Fig. 7 is a partial diagram of the system of Fig. 5. adapted for minusfinstead of plus operation with the patient.- and accordingly effectiveto exhaust or remove air from the cavity as about the lung envelope. i

Bosses I of rubber may provide a soft support for casing having bottom 2, sides 3, 4, risin therefrom to top 5 as arectangular or oblong frame. may receive screws 1 in mounting back panel 8 to close the rear of this casing or cabinet. The side 4 carries hinge sections 9 with eye adapted to receive hinge section pins H) fixed with panel M (Fig. 1) as a cover equipped with boss portions l2 in registry with boss portions l3 on theside 3, which portionsl3 have hinge bails M to swing over the boss portions I2 in detachably holding the cover panel II in closed position. Arch brackets l5 on top side 5 mount links Hi for swingably carrying handle I1, and thereby completing a portable housing for this pneumothorax device as a self-contained unit.

Bolts IB (Fig. 4) mount brackets I9 carrying bolts assembling intermediate partition or dial is duct sys- This invention relates to handling gas to and i 1 from a patient, especially apart from normal Holes 6 (Fig. 2) in the back of this frame rectangular frame of the casing. This partition 2| has medial concavity 22 in which is located phragm 2| between the side walls 3, 4, in the reservoir or chamber 23 as held by straps 24 (Fig. 2) anchored by bolts 25 with this partition 2|. This chamber 23 rests on the bottom 2 at one side thereof. Anchored by bolt 26 with the bottom 2 is U-block 21 engaging duct 28 between mercuryv chamber 29 on one side of the partition 2| and minor foot chamber 30 on the other side thereof, from which rises mercury manometer tube 3| connected by block 32 having fiber filling 33 to port 34 to the atmosphere. The mercury chamber 29 has connection by duct 35 to fitting 36 with the chamber 23, thereby providing direct chamber 23. This duct 39 extends to fitting 40 through the partition 2| and may there have slip communication with duct 4| past check valve 42 (Figs. 1,. 3, 5) to compressible rubber bulb or pump 43. In compressing this bulb 43 it may act as a pump. in drawing air past entrancecheck valve 44 at nipple 45 and expelling such air past the check valve 42 for flow by the duct 4| in the chamber orreservoir 23 and thereby build up pressure in the mercury manometer. On this partition 2 i, adjacent the riser duct 3| of themercury manometer, are graduations 46, herein shown in cubic centimeters toindicate the volume of gas as air pumped into this chamber 23 on the basis of atmospheric pressure. For the purposes of this device, the zero on this scale is at the: charged pressure for this reservoir or chamber 23, and as such pressure drops from the zero it indicates the amount of gas at atmospheric pressure delivered from this chamber 23.

The chamber 23 has at its top three-way valve fitting 4! operable by hand wheel 48 on the side of the partition away-from the chamber 23 and on I opposite side of the partition 2| from the duct 50 and base fitting 5|, At such position forward of the partition 2|, thisbase fitting 155 carries riser manometer tube 56 parallel to the mercury man- This duct 52 is in comsired appurtenances in connection with this a-p paratus. In this holder is slender rod 63 having eye or handle M. Upon opening the valve 59, in the event the colored water or liquid in the tube 56 has air bubbles therein, insertion of this red 53 through the opening atth e cut-oi? valve 59 will serve to clear the air and thus allow the-gage liquid to form as a body from the base fitting 5.5 in its rise along graduation plate '55 having elongated slots 66 engaged by screws 6'7 extending through the partition 2i and carrying thereon springs 68 as compressed by nuts 69. There .is, accordingly, a frictional holding of this gage strip '55 permitting shifting of such to bring the zero point on this gage stripwith'its pointer it! at the atmospheric liquid levelin this gage tube 56. There is thus ready adjustment for evaporation or other loss of this liquid; Inpractice, when the'apparatus is out of use, the valve 59 may be closed to minimize the evaporation loss.

Pointer l! at'thehand wheel '68, when at ofi' position, shuts oif communication between the reservoir 23 and the duct isto the manometer. In shifting this pointer from off position It to pleural pressure position E3, the duct A9 to the manometer is connected to duct "M extending back of the partition 2! to fitting l as through the partition, with which fitting if: there is sliprltof duct "it having therein filter'l'l, say of impregnated fiber as cotton, thence by duct section'lt'to'fitting '29 carrying tubular needle 8!! "adapted for insertion in patient Bl, say into the thorax to an extent to enter about or outside the envelope for the lung but interior of the chest cavity. The readily collapsing condition of the'lung tissue as exposed to atmospheric pressure exterior of the lung cavity or envelope tends to collapse. This exposure to the needle with communication to the'pressure or liquid'manom- "tion may be determined. For instance, should the investigation reveal a disturbed or diseased condition, say local to certain portions of the lung, the collapse may be effectedby allowing gas ,as air to enter through this tube l8 and needle fill to a desired degree of collapse,-which asmain- .tained ,for a period provides aperiod of rest for such tissue with improved chance for recovery;

.and as such ,rest period is determined .of sunl- .cient extent the collapse condition may be removed. In practice, .itis not usual to maintain .the needle communication but .efiect-such intermittently in checking the condition of the pa tient. [In this connecting up as herein, the con- -ditionhas been for ascertaining thepleural pres- :sure .at the point 13 for the hand wheel .48.

With the condition that it maybe desired to introduce pressure or gas into this cavity ex- .terior of the lung envelopeas having access thereto by the needle Bil, the attending physician may l,being to the slightly open, 2 and 3" to the more open, and 4 to the fully open position, for communication of this needle 80 as on tube or duct 18, past this three-way valve to be connected by the fitting 41 with duct 83 to the reservoir or chamber 23. This allows the pressure air in this chamber to flow at a desired or elected rate for entrance into this cavity about the lungenvelope to effect collapsing of the lung. This flow of air from this chamber 23 reacts for volume on the position of the column of mercury in the manometer tube 3|, and such is disclosed by the graduations 36. The cubic centimeter extent of this flow is definitely determined. As such extent of collapse is effected, the hand wheel 4t may be operated to shut ofi this gas supply by bringing the pointer ll to ofi position 12. It is to be noted that this hand wheel is a'single 'means for operation which will connect up the needle 80 for pressure disclosure as to the manometer, the liquid manometer scale 65, or independently thereof aflow of gas to the patient for disclosing such flow on the,

graduations M at the mercury manometer 3!. This precludes an alternative operation or gas pressure flow into the liquid manometer tube 56.

In the event the pleural pressure after the treatment be excessive in the patient or there be purpose to exhaust such cavity, the duct 16, instead of being connected at fitting i5, is connected at nipple 45 adjacent the bulb or pump ll-3 and outside the intake check valve 44. As thus connected up, operation of the pump '43 effects exhausting in the duct 73 and accordingly withdrawal of liquid or gas by way of the tubular needle 36 from the patient, and this may be to a measure or extent desired, for in this operation the hand wheel 58 may have its pointer H to communicate with the graduation 12 and flow past on valve 38 into the chamber 23. Should there be purpose in determining the drop inpressnre effected in this cavity, the hand wheel 48 is adjusted to have its pointer H at pleural press,ure point position l3, thereby enabling the attending physician to take the reading on the graduation 65 at a sub-atmospheric pressurathat a;

is, below the point 10 or above.

'Withthis set-up: of equipment, the tubing'may be left connected with the fittings or merely hung" in the cabinet, say about the mounting for the hand wheel 18. It iswell in handling to have the valve 59 closed as well as the valve 38 at off position and likewise the valve wheel 48. This .device in its set-up is compact, with range of operation .for gas delivery to or from a patient, and especallyv adaptable in pulmonary cases, with ready adaptability for .control'in .diagnosis' as well as for maintenance of a treatment condition during an interval as desired for lung rest and extent found acceptable therefor.

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

'i. Pneumothorax apparatus embodying a mercury manometergraduated for gas volume, a liquid manometer graduated for gas pressure, said :manomet-erseach having upward from the graduations thereon an. atmospheric pressure responsive port open in normal operation hereunder. a reservoir, independent ducts from the reservoirto the manometers, the ductto the mercury manometer being from the top of the reservoir, valve means .in theduct between the liquid manometer and the reservoir, a tube adapted for communication with the reservoir, 2. needle connected to the tube and insertable .in the patient to be treated, a bulb pump having assembly means adapted selectively to connect the pump to charge the reservoir for gas flow to or from the patient, each of said manometers having its atmospheric opening independent of said valve means, tube and pump, and a casing from which the tube extends to the needle and in which casing the apparatus is housed with the manometers disposed parallel to each other, said casing having a cover section at closed position to house the pump and duct with the needle terminus.

2. Pneumothorax apparatus embodying a mercury manometer graduated for gas volume, a liquid manometer graduated for gas pressure, said manometers each having an atmospheric pressure responsive port open in normal operation hereunder, a reservoir therebetween, valve means between the latter manometer and the reservoir, a tube adapted for communication with thereservoir, a needle connected to the tube and insertablein the patient to be treated, a bulb 1y to connect the pump to charge the reservoir for gas flow to or from the patient, each of said manometers having its atmospheric opening independent of said valve means, tube and pump, a casing from which the tube extends to the needle and in Which casing the apparatus is housed with the manometers disposed parallel to each other, said casinghaving a cover section at closed position to house the pump and duct with the needle terminus, said tube from the needle at one position of the valve means being in communication with one of said manometers, at a second position of the valve means being entirely disconnected from gas flow relatively thereto, and at a third adjusted position of the valve means adapted to connect the reservoir for selected rate of flow of gas to the needle, said valve means in said operation providing a control precluding gas flow into the liquid manometer.

i JOHN L. BLOOMHEART.

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