MXPA06003724A - Mask seal trainer - Google Patents

Abstract

A device for practicing mask ventilation, comprising a first passage and a second passage. The first passage is designed to provide communication between a source of air and the interior of a patient mask. The patient mask is designed for placement over a person's mouth and/or nose. The second passage is designed to provide communication between the air source and a back pressure means. The back pressure means is adapted to simulate the resistance of a human airway. The device can also comprise a third passage designed to provide communication between a breathing person and the surroundings. The passages may be formed in one integrated adapter to be placed between a patient valve and the mask.

Description

SEALED TRAINING MASK Field of the Invention The present invention relates to a means for practicing mask ventilation, comprising a first passage and a second passage, said first passage being designed to provide communication between an air source and the interior of a mask for a patient, said mask being designed for a patient to be placed on the nose and / or mouth of a person. BACKGROUND OF THE INVENTION Currently, the practice of mask ventilation takes place mainly through the use of a manikin. These dummies are excellent for providing basic training to train personnel, since they allow to blow or otherwise force air into the "lungs" of the manikin, eg, through the use of mouth-to-mouth resuscitation or through the use of mask ventilation of stock Generally, the mannequins are strong and will resist any error made in the treatment. However, these mannequins suffer from a common problem; They are not human with the natural variations in the shape of the face, hair growth and distinctive features that occur in humans. The chin, cheekbones and skin of humans can vary greatly. Also, the mannequins will be static, while Humans can exhibit a variable degree of mobility of the head, smoothness of facial features, type of skin, layer of fat, etc. After completing the hospital training program using mannequins, the inexperienced rescuer will be sent to the field and / or allowed to practice in hospitals. There, he or she will be allowed to spend some time observing experienced rescuers at work. After completing this phase as well, he or she will be thrown into the deep end of the difficult job of saving lives. Having practiced on mannequins, the rescuer will now join to try to save the life of a real person. This person will not behave in the same way as a mannequin. One of the biggest problems is the fact that the person can have a facial configuration or facial hair that makes it difficult to make a good seal between the patient mask (respirator) and the face. The patient may have a denture that has fallen or must be removed, and that makes the area around the mouth less firm and hinders the seal against it. The result of a poor mask seal is a reduced air supply to the patient. Therefore, the chances of a successful resuscitation diminish. Several studies have been carried out that deal with the training of rescuers. The next appears in the text "Fundamental of BLS for Healthcare Providers," American Heart Association, published as recently as in 2001: "Various studies have shown that rescuers in training frequently adapt rescue breaths to mannequins because they are not skilled at using them. A rescue worker alone may have difficulty obtaining a tight seal on the face while pressing the bag and maintaining an open airway.The text "Basic Trauma Life Support", Brady 2000, states the following: "The leak in the mask it is a serious problem, decreasing the volume delivered to the oropharynx sometimes by 40% or more. "Several other series of texts deal with the same problem, usually describing the difficulties in obtaining sufficient practice in psychomotor skills, especially since there is a limit on how much can be practiced on real people.It is also possible to directly ventilate volunteers who must Then try not to use your respiratory muscles during training and instead let the air from the bag flow into your lungs. This is an unpleasant situation for the volunteer. In addition, the bag will be contaminated unless the bag fits with filters. GB 2339392 describes a mask for resuscitation. This has an outlet tube that contains a sphere. The movement of the sphere can be monitored to verify the gas supply to the patient or the expiration of the patient. This mask is not suitable for training. The sphere provides a small resistance to air flow, but this resistance must be as small as possible in order to let the air pass with as little obstruction as possible. Consequently, the sphere does not provide a resistance that simulates the resistance of a human lung, and therefore this mask is not suitable for training purposes. The resistance will be too low to accumulate enough pressure inside the mask and there may be an insufficient air seal between the mask and the patient without the rescuer noticing. The present invention proposes to remedy the above deficiency in the rescuer training program by practicing the sealing of the mask on healthy living persons. As an example, this may imply that a volunteer holds the breath for a period while the rescuer practices the realization of a good seal of the mask. This is done by a device of the invention, wherein said second passage is designed to provide communication between the air source and a back pressure means, said back pressure means simulating the resistance of a human airway.

Since the volunteer must hold their breath during practice (in order to prevent air from the reservoir being forced into their lungs), somehow the period of such training is reduced. Therefore, a preferred embodiment of the present invention is aimed at providing equipment that will make it possible to practice on live people while allowing the volunteer to breathe as required without interrupting the training. This is done by providing a communication between the person who breathes and the environment. This provides a satisfactory training situation for the rescuer who is able to force air from the reservoir into the mask through the first passage, thereby being able to verify the seal of the mask against the area around the nose and / or mouth of the patient, and the discomfort experienced by the volunteer is reduced, since he is allowed to breathe through the second passage independently of the inflations through the first passage. Preferably, the device has a indicating means that indicates the flow of air through said first passage to facilitate control of the air flow. Preferably, the indicator is a regulator inclined in a transverse position in said first passage, which facilitates visual control and is convenient to implement. In a preferred embodiment, the back pressure means is an artificial lung, which upon filling will indicate the volume supplied from said air source. This allows the use of a conventional test lung. In an alternative embodiment, the back pressure means is a restriction. This is a means of low cost back pressure and in many cases enough. In a preferred embodiment, the first, second and third passage is formed in an integrated adapter designed to be placed between the patient valve and the mask. This allows the use of a conventional mask and a conventional patient valve. In an alternative embodiment, the first and second passage is formed in an integrated adapter, and said third passage is formed in a separate unit. This facilitates the construction of a training device for children. In a further alternative embodiment, the third passage extends through the wall of the mask at a distance from the connection of the mask to said first passage. This allows conventional resuscitation equipment to be used directly in a special mask for training. Preferably, the third passage communicates as much with the mouth as with the nose of the person who breathes.

This avoids the need to close the person's nose before training. Preferably, the resistance provided by the back pressure medium is between 5 and 40 cm H20 / l / s, e.g., approximately 20 H20 / l / s, which distends well with the resistance of the human airways. Preferably, the counter-pressure medium has a compliance that simulates the compliance of a human airway with the compliance being between O.OOal and 0. 151 / cm H20, e.g., approximately 0.02 1 / cm H20, which distends well with the resistance of the human airways. It should be emphasized that in the above and the following, an air source refers to any source capable of supplying the pressure required to test the seal of the mask. The air source can be a bag (sometimes called an AMBU bag) that sucks in air from the environment or the reservoir, or it can be a pressure tank, the rescuer's own lungs or other suitable source. Now the invention will be explained in more detail through examples of modalities also illustrated in the accompanying drawings in which: Figure 1 is a section of an arrangement of training equipment according to the present invention for the practice of facilitation of breathing in people who breathe; Figure 2 shows a detail of Figure 1; Figure 3 shows a section through an adapter according to the invention; Figures 4a and 4b are perspective views of how the adapter of Figure 3 works in cases of good and bad mask seals, respectively; Figure 5 illustrates an alternative embodiment of the invention; and Figures 6a, 6b and 6c show characteristic waveforms for controlled volume ventilation of an adult human being. Figure 1 is a sectioned drawing of an equipment arrangement used when practicing on a person breathing. A volunteer 1 recumbent is shown. A mask for patient 2 having a standard connection of an internal diameter of 22 mm is arranged over the mouth and nose of the volunteer. This mask can be any type of commercially available mask, eg, one manufactured and marketed by Laerdal Medical AS under article number 860220 or 870220. An adapter 3 according to the invention is connected to the mask for patient 2, whose adapter 3 will be explained in detail below. The adapter 3 is also connected to a valve patient 4. This may be of the type manufactured and marketed by Laerdal Medical AS under article number 951300, 851200 or 560200, or an equivalent patient valve from another manufacturer, with a nozzle with a standard connection with an external diameter of 22 mm . Since the construction and operation of such a valve will be well known to the person skilled in the art, the patient valve will not be explained in greater detail herein. What is important for the present invention is that the patient valve is designed to admit air in the patient's direction, and let the patient's air escape to the environment. In addition, a bag 5 is connected to the patient valve. This bag 5 can be of the type manufactured and marketed by Laerdal Medical AS under article number 870100, 860100 or 850100, or it can be an equivalent bag from another manufacturer. Alternatively, pumps such as those described in e.g. US 5217006 may also be used. It is also possible to use a gas-operated regulator or, in special cases, a pressurized gas cylinder or an electric pump. However, the use of a hand pump will maximize the benefit gained from the training. At the opposite end of the bag 5 is an absorption valve 6. This can be of the type described in NO 2002 3404 or an equivalent valve. The only important feature for the present invention is that the absorption valve 6 must be designed to admit air into the bag 5 and prevent air from flowing in the opposite direction. An artificial lung 8 is also connected to the adapter 3, through a hose 7. The artificial lung can be of the same type found in mannequins, or it can be a simple bag. Reference is made to Figure 3 which shows a section through the adapter 3. The adapter 3 has five connection tubes. The first connection 9 is designed to be connected to the patient valve 4. The second connection 10 is designed to be connected to the patient mask 2. It is practical that the second connection 10 is disposed opposite the first connection 9. The third connection 11 it is designed for its connection to the hose 7 that leads to the artificial lung 8. The fourth connection 12 leads to the environment. The fifth connection 13 is disposed within the connection 10 and is designed to be connected to a hose 20 (see Figure 2). The third and fifth connections 11, 13 communicate freely with each other. However, there is no communication between these two connections 11, 13 and the rest of the connections. The first connection 9 communicates with the fourth connection 12 and also with the second connection 10. A regulator 14 is It is arranged between the first and second connections 9, 10. The regulator 14 is designed to be inclined around a first joint 15, between a position in which the communication between the first and second connections 9, 10, and a position is blocked. at an angle thereto (see Figure 4), where there is open communication between the first and second connections 9, 10. The regulator 14 has a first part 16, on the other side of the joint 15, outside the elbow 17. first part 16 of the regulator 14 is heavier than the second part of the regulator 14, giving it a neutral position as shown in Figure 3. A half wall 19 covers that part of the orifice of the fourth connection 12 located low (in accordance with the orientation of Figure 3) the regulator 14 in its neutral position, preventing the flowing air from passing the regulator 14 through the fourth connection 12. Accordingly, a first passage is formed between the first connection 9 and the second connection 10, a second passage between the first connection 9 and the fourth connection 12, and a third passage between the third connection 11 and the fifth connection 13. Reference is now made to the detailed section in the Figure 2. As shown, there is a hose 20 running from the mouth of volunteer 1 to the fifth connection 13, allowing the volunteer to breathe through the mouth and exchange air with the environment through the hose 20 and the third passage in the adapter 3, as indicated by the double arrow 21. When the rescuer presses the bag 5 the air is forced through the patient valve 4, through the second passage of the adapter 3, outwardly into the hose 7 and into the artificial lung 8, as indicated by the arrow 22. The artificial lung 8 is constructed In order to ensure that the introduction of air results in a visible elevation of the lung 8. In addition, the lung provides a certain degree of resistance, providing an imitation of the sensation of ventilating a human lung. The returned air from the lung flows back through the same route and out into the environment through a patient valve gate. Lung 8 provides an indication of how good the mask seal is, and also how low the bagged volume is. In the course of this operation, excess pressure will accumulate inside the patient's mask 2. In order to prevent air from being forced down through the volunteer's respiratory passage through the nose, a Nose clip 23 to the volunteer. If the seal on the mask is poor, the excess pressure inside the patient mask 2 will escape between the mask and the face of the volunteer. Some of the air flowing through the first connection 9 in the adapter 3 will then flow through the first passage into the interior of the mask. This leakage will result in the artificial lung 8 not rising sufficiently, and the resistance felt by the rescuer during the compression of the bag 5 to be less. The purpose of the regulator 14 is to act as an additional leakage indicator, and it does not have a functional significance beyond this. Figures 4a and 4b illustrate this function. Preferably, the adapter 3 is made of a transparent material, making the regulator 14 visible. If the air flows only through the third passage and outward into the lung 8, the regulator will be horizontal (ie, protruding at the elbow 17), as shown in Figure 4a. If the seal of the mask deteriorates, allowing some air to flow through the first passage, the regulator will tilt in the air flow, to a position as shown in Figure 4b, thus allowing the user to quickly notice the leakage of flow through the first passage. Instead of an artificial lung, it is also possible to arrange a restriction on the fourth connection 12 to offer a certain degree of resistance in order to create an illusion of resistance and back pressure in a lung human . The above illustrates in fact that, to a large extent, it is possible to use existing components. The patient's mask, the patient valve, the bag and the absorption valve can be the same components used in a real treatment of the patient. The hoses 7 and 20 can be made from standard hose materials, and the lung 8 can be one of several used in mannequins today. Therefore, only the adapter 3 is specially developed for this training purpose. In addition, it is possible to convert the equipment into an ordinary treatment to the patient only by removing the adapter 3 with the hoses 7 and 20, and connecting the patient valve 4 directly to the mask for patient 2. When using the training equipment shown in FIG. Figure 1, only hose 7 and adapter 3 will be contaminated. For this reason, these components can be disposable or constructed in some way that allows them to be cleaned after use. The remaining components will not require cleaning prior to being used in the next volunteer. It is also possible to introduce an air filter into the system in order to reduce the number of components exposed to contamination. It is also possible, even, to contemplate that the adapter is built as an integral part of the mask for patient and / or patient valve. The adapter 3 and the hose 20 can also be manufactured in one piece. In a further alternative embodiment, the connection tubes forming the third passage and the hose can be constructed as a first unit (snorkel), and the connection tubes forming the second passage can be constructed as a second unit. These two units can be assembled to act as the adapter 3. The advantage of this is that only the first unit will be contaminated after use. This unit is somehow simpler than the adapter 3 and can therefore be slightly cheaper. The disadvantage is that the arrangement becomes a bit more complex. In a simple embodiment of the invention, it is also possible to use only the first unit (the snorkel), since the forced air in the mask has no outlet. This will work well to test the seal of the mask but will not allow any verification of the supplied volume. Instead of a lung 8, a volume indicator, e.g., an electronic volume indicator may be used. In a simplified embodiment of the present invention, a snorkel is provided that extends through the mask to the mouth and / or nose of the volunteer. The snorkel can be a hose that goes through a orifice in the mask, or it can be an integral part of the mask. A conceivable alternative would be to make a special mask for training, as illustrated in Figure 5, the mask comprising a communication with an artificial lung. Therefore, in practice, the artificial lung, which is the same as a back pressure device, is located in an extension of the passage from the air source to the facial mask. This obviates the need for a connection link between the patient valve in the bag and the patient mask; instead, a mask is used for separate training. This training mask can also have a separate step to allow the volunteer to freely breathe into the environment, either through a connection through the side wall of the mask or by separate communication up through the tube connecting the mask. mask. Figures 6a, 6b and 6c show characteristic waveforms for controlled volume ventilation of an adult human being. Figure 6a shows the transrespiratory pressure in cm H20 for a period of time in seconds. As the graph shows, during the inspiration phase, which lasts approximately one second, the pressure increases from zero to approximately 36 centimeters H20, after from which the pressure is released immediately to allow the lungs to expire. Figure 6b shows the volume administered in milliliters. During the inspiration phase the volume increases from zero to about 700 ml during the same period of one second, after which the pressure is released and the volume expires for a period of about 3 seconds. Figure 6c shows the flow in and out of the lungs in liters per minute. The flow increases from zero to approximately 65 1 / min for a period of approximately 0.5 seconds and then decreases to zero again for the next 0.5 seconds. When the pressure is released the flow increases again, but in the opposite direction and abruptly to a maximum of approximately 100 1 / min until gradually decreasing to zero during the following 3 seconds. The volume and flow are controlled by the rescuer, e.g., by the pressure of the bag in his hand. If the rescuer is able to empty the bag sufficiently, he will have administered approximately 700 to 1000 ml of air (in the case of an adult bag without additional oxygen supply). In the case of an additional supply of oxygen, the total volume administered is limited to approximately 400 to 600 ml. The administration of this air / oxygen should take approximately 1 second.

With a back pressure device according to the present invention, the pressure must increase while the air / oxygen is being administered, to create a near-reality experience for the rescuer. The resistance must be within the range of 5-40 cm H20 / liters / second. A typical healthy airway of an adult person has a resistance of approximately 20 cm H20 / liters / second. Consequently, the back pressure device must be calibrated at approximately this resistance. However, the back pressure device may preferably have the option of adjusting resistance, e.g., to simulate asthma, which results in greater strength than in a healthy lung. The adjustable back pressure device can be realized, e.g., by an adjustable restriction. The means to provide it are readily available to the skilled person. A lung of a human being typically also has a compliance of approximately 0.02 liters / cm H20. The compliance can be adjustable within the range of 0.01 to 0.15 liters / cm H20. This provides a simulation of e.g., COAD (chronic obstructive air disease), which results in very rigid lungs. Adjustable compliance can be realized, e.g., by a test lung having elastic means that can vary in length or in number. These means are readily available to an expert person.

Claims (16)

1. CLAIMS 1. A device for practg mask ventilation comprising a first passage and a second passage, said first passage being designed to provide communication between an air source and the inside of a patient mask, said mask being designed for patient to be placed on the nose and / or mouth of a person, wherein said second passage is designed to provide communication between the air source and a back pressure means, said back pressure means simulating the resistance of a human airway. A device according to claim 1, wherein it further comprises a third passage designed to provide communication between a person breathing and the environment. A device according to claim 1 or 2, wherein said first passage includes indicating means that indicate the flow of air through said first passage. 4. A device according to claim 3, wherein said indicator is a regulator inclined in a transverse position in said first passage. A device according to one of the preceding claims, wherein said backpressure means is an artifl lung, which upon filling will indicate the volume supplied from said air source. 6. A device according to claim 1, 2, 3 or 4, wherein said counter-pressure means is a restriction. A device according to one of the preceding claims, wherein said first, second and third passages are formed in an integrated adapter designed to be placed between a patient valve and the mask. A device according to one of the claims 1-6, wherein said first and second passages are formed in an integrated adapter, and said third passage is formed in a separate unit. A device according to claim 8, wherein said third passage extends through the wall of the mask at a distance from the connection of the mask to said first passage. A device according to one of claims 2-9, wherein said third passage communicates both with the mouth and with the nose of the person breathing. A device according to claim 1, wherein said second passage extends from said patient mask to the back pressure device. 12. A device according to one of the preceding claims, wherein the resistance provided by the backpressure means is between 5 and 40 cm H20 / l / s. A device according to one of the preceding claims, wherein the resistance provided by the back pressure means is approximately 20 cm H20 / l / s. 14. A device according to one of the preceding claims, wherein said counter-pressure means has a distensibility that simulates the compliance of a human airway. 15. A device according to one of the preceding claims, wherein the counter-pressure medium has a compliance of between 0.01 and 0.15 1 / cm H20. 16. A device according to one of the preceding claims, wherein the counter-pressure medium has a compliance of approximately 0.02 1 / cm H20.