GB2626910A

GB2626910A - A thoracotomy training model

Info

Publication number: GB2626910A
Application number: GB2218495.6A
Authority: GB
Inventors: Yanny Irini
Original assignee: Individual
Current assignee: Individual
Priority date: 2022-12-08
Filing date: 2022-12-08
Publication date: 2024-08-14
Also published as: GB202218495D0; WO2024121573A1

Abstract

A medical training model (1) comprising an enclosure defining a thoracic cavity (4), a rib cage within the thoracic cavity formed of a plurality of resilient members (6), a pair of inflatable lungs (2) located in the enclosure and within the rib cage; a model heart (3) located between the lungs (2). The model (1) also comprises a Y-shaped tubing (16) comprising two lateral branches (16a, 16b) connected to a supply line (16c) at a proximal end and sealed at a distal end, the Y-shaped tubing located anterior to the rib cage and within or adjacent to the thoracic cavity (4) and a fluid supply attached to the supply line (16c) such that the Y-shaped tubing (16) contains pressurized fluid. The model may also comprise an artificial aorta (17), wherein the artificial aorta (17) includes a fluid filled tube located adjacent to the model heart (3).In preferred embodiments, a backboard may define the posterior side of the enclosure and the resilient members may be hingedly attached to the backboard.

Description

A Thoracotomy Training Model

Field of the Invention

The present invention relates to the training of medics and provides a model for assisting in that training. The model can be used for training medics in clamshell thoracotomies in particular.

Background to the Invention

An emergency thoracotomy is a procedure that can be performed in an attempt to resuscitate a patient who has suffered severe trauma and is in cardiac arrest. The procedure involves directly accessing the thoracic cavity to repair heart injuries and/or to perform direct cardiac massage or defibrillation. The procedure is relatively rare and only usually indicated in the case of major trauma. This means that emergency medical practitioners rarely experience emergency thoracotomies during the usual practice. Further they are time-critical procedures that are required to be carried out in a short time-period.

In light of the above, there is a need for an improved method of, and apparatus for, training medics in emergency thoractomies. Expensive anatomically correct mannequins are available. These are generally made from high grade silicones, with accurate weight distributions, and with anatomically correct organs located within a chest cavity. However, these mannequins are extremely expensive, costing upwards of £50,000 to buy and, whilst superficially lifelike, don't replicate the bleeding, blood pressure, cardiac activity and respiration of real patients.

An alternative to the use of mannequins is the use of animal carcasses. However, as for the mannequins, whilst animal carcasses have the correct anatomy the animals are deceased and so not bleed or respirate in the same manner as a living patient.

As a result, several people have attempted to make low cost models that can be used to train medics in emergency thoracotomies. These models are typically quite basic containing structural elements that generally correlate with the anatomical features of the chest cavity but without any particular or relevant functionality. For example, simple models of lungs, blood vessels, and the heart may be positioned within a thoracic cavity defined by a plurality of ribs, possibly with an external membrane acting as skin. However, the models of the lungs, blood vessels, and heart are generally functionless and do not act in the same manner as those of a live patient.

In light of the above, there is a need for an improved model for training medics in emergency thoracotomies. Any such model should provide improved functionality and preferably be capable of construction at relatively low cost.

Summary of the Invention

The present invention provides a medical training model comprising: an enclosure defining a thoracic cavity; a rib cage within the thoracic cavity formed of a plurality of resilient members; a pair of inflatable lungs located in the enclosure and within the rib cage; a model heart located between the lungs; wherein the model further comprises: i) Y-shaped tubing comprising two lateral branches connected to a supply line at a proximal end and sealed at a distal end, the Y-shaped tubing located anterior to the rib cage and within or adjacent to the thoracic cavity and a fluid supply attached to the supply line such that the Y-shaped tubing contains fluid; and/or ii) an artificial aorta, wherein the artificial aorta comprises a fluid filled tube located adjacent to the model heart.

The present invention is advantageous in that it provides a simple and low-cost model for training medics in clamshell thoracotomies. The model is also advantageous in that it provides structures that are capable of mimicking the bleeding of the mammary arteries and/or the aorta.

This allows the use of the model to better replicate real-life conditions. Specifically, the Y-shaped tubing may be formed and positioned to mimic the mammary arteries of a patient's thorax and/or the artificial aorta may be formed and positioned to mimic a patient's aorta. By providing the Y-shaped tubing and/or the aorta with fluid they will mimic bleeding of the mammary arteries and/or the aorta if they are punctured. In embodiments of the invention only the Y-shaped tubing may be provided and not the artificial aorta. In other embodiments of the invention only the artificial aorta may be provided and not the Y-shaped tubing. Advantageously, in embodiments of the invention both the Y-shaped tubing and the artificial aorta will be provided.

The Y-shaped tubing may be positioned and shaped to mimic the mammary arteries of a patient and be positioned relevant to the resilient members, any sternum, and the model heart appropriately. In embodiments of the invention, the Y-shaped tubing may be located anterior to the rib cage and laterally adjacent to a sternum.

The fluid within the Y-shaped tubing may be pressurized or may the tubing may simply be filled with fluid without pressurization. Similarly, the artificial aorta may either be pressurized or may be filled with fluid without pressurization.

The artificial aorta may be attached to the model heart or may simply be located adjacent to the model heart in an appropriate position, preferably the position in which the aorta is found within the human body.

The thoracic cavity is formed by a plurality of resilient members. The resilient members may be formed and shaped in any appropriate manner. Preferably, the resilient members will be formed and shaped to replicate the shape and size of a typical rib cage. For example each resilient member may be formed to be the size and shape of an individual rib. Alternatively, one or more resilient members may be formed to be the size and shape of two or more ribs.

The lungs of the present invention are inflatable. That is the model comprises a pair of lungs that are each inflatable and deflatable such that they can mimic pneumothorax when in use. The lungs may be formed and may be inflatable in any manner apparent to the person skilled in the art. In embodiments of the invention the model may further comprise pumps used to inflate the lungs. Any such pumps may be manual or mechanical. Pumps may be internal within the model or may be external and connected to the lungs via tubing. A separate pump may be provided for each lung or a single pump may operate both lungs. If the pumps are connected to the lungs via tubing it may be advantageous that the tubing is formed and located in a manner analogous with the size, shape and positioning of the bronchi of the human body. Additionally or alternatively the model may be provided with a suitably formed and located bronchi and trachea extending from the pair of lungs.

For simplicity it may be preferable that the model comprises a backboard defining a posterior side of the enclosure and the resilient members are mounted at a lateral side to the backboard. That is, the model may be provided with a ribcage extending outward in an anterior direction from. The backboard may, for example, be a flat board formed from wood, plastic, or any other suitable material. A flat backboard may be preferable as it makes the construction of the model simpler and allows the model to be securely positioned on a table or other similar surface.

If the model comprises a backboard, in order to replicate the clamshell opening of an emergency thoracotomy it may be advantageous that one or more of the resilient members are attached to the backboard by means of a hinge. The hinge may be formed in any appropriate manner. Preferably the or each hinge is formed such that the relevant resilient member(s) can be opened outwards in the same manner a ribcage would be separated in a clamshell fo thoracotomy. In particular, the or each resilient member may be able to be pivoted laterally outwards from an initial position to an open position.

In order to better replicate a human ribcage the model may further comprise a rigid breakable sternum located anterior to the rib cage. If the model comprises Y-shaped tubing as discussed above, then it is advantageous that the rigid breakable sternum is located between the lateral branches of the Y-shaped tubing. A sternum may be made of any suitable material that mimics a human sternum in that it is rigid but breakable with suitable surgical tools. In embodiments of the invention the sternum may be formed of plaster of paris or any other similar material. Advantageously, the sternum is sized and shaped to be the same size and shape as a typical adult human sternum.

In order to better replicate the pericardium and tamponade it may be advantageous that the model heart is located within a sealed fluid-filled bag. For example, the model heart may be located within a sealed plastic bag or a bag of any other suitable flexible material that mimics the pericardium. The fluid within the bag may be water or any other suitable fluid. The fluid may be coloured to mimic blood, for example the fluid may contain water that is dyed red or it may contain a blood substitute.

In order to replicate phrenic nerves on the pericardium a fluid-filled bag, a discussed immediately above, may comprise one or more filaments mounted thereon and extending at least partially around the bag. The filaments may be formed in any suitable manner and may be adhered to the bag in any suitable manner. In embodiments of the invention the filaments are formed of plastic string. Any filament may be taped, glued, or attached to the bag in any other manner. The filaments may be appropriately coloured to imitate nerves. For example, it may be advantageous that the filaments are yellow coloured to better imitate the phrenic nerves. Any filament may be shaped and located to imitate a phrenic nerve.

A medical training model according to the present invention may further comprise an adhesive wrapping providing over the rib cage. If the model comprises Y-shaped tubing the adhesive wrapping may be positioned beneath the Y-shaped tubing. The adhesive wrapping may be formed of any suitable adhesive material and may extend completely over and arogund the rib cage. Any adhesive material may be intended to replicate the intercostal musculature and, as such, is bound to and around the rib cage.

A medical training model according to the present invention may further comprise an outer cladding layer provided over the rib cage, any sternum, and any Y-shaped tubing. The outer cladding layer is intended to replicate the fat layer of a human sternum and may be formed of any suitable material that will replicate the fat layer. In embodiments of the invention the cladding may be formed of a foam-type or other insulating sheet material.

A medical training model according to the present invention may further comprise an outermost skin layer that is formed over all of the other components of the model on the anterior side. The skin layer may be formed of any appropriate material and may, for example, be formed of silicone or any other material commonly used as a skin substitute in other medical models.

If the medical training model of the present invention comprises an aorta it may be advantageous that the aorta is provided with an external fluid supply such that if the aorta is cut then fluid is pumped out of the aorta. Any external fluid supply may be pressurized to replicate the pressure in a human aorta. The fluid in the aorta may be a fluid selected to best replicate blood and may be coloured and/or have a consistency matched with blood. The fluid supply for an aorta and/or any pump for the aorta may be provided externally to the training model.

In order to better replicate a human aorta, an aorta of a training model according to the present invention may comprise an inner flexible fluid-filled tube located within an outer fabric casing. This construction has been found to replicate the human aorta well. However, any other construction that replicates a human blood vessel may be utilized. For example, the outer casing may be formed of plastic or any other suitable material, rather than fabric.

In order to better replicate a traumatic injury it may be advantageous that a wound is provided on the model heart. This can be provided in any suitable manner. For example, the wound may be formed in the model heart by cutting or opening the model heart. Alternatively or additionally a model wound may be adhered or otherwise attached to the outer side of the model heart. Suitable wounds are readily available and will be apparent to the person skilled in the art.

If the Y-shaped tubing is provided it may be provided with one or more pumps to maintain pressure within the tubing should they be punctured. This will act to replicate bleeding from the mammary arteries should they be punctured. Any pump may be located externally to the model or in any other suitable location.

Further features and advantages of the present invention will be apparent from the embodiment shown in the Figures and described below. Unless otherwise indicated by the claims or the description any feature of the embodiment shown in the drawings can be included in an embodiment of the invention independent of any other feature.

Drawings Figure 1 is a schematic of a cross-section through an exemplary embodiment of the present invention; Figure 2 is a schematic of the embodiment of Figure 1 showing the internal features of the model; Figure 3 shows the ribcage of the embodiment of Figure 1 mounted on the backboard; Figure 4 shows the internal construction of some of features of the embodiment of Figure 1; and Figure 6 shows the embodiment of Figure 1 in use.

An exemplary embodiment of a medical training model according to the present invention is shown in the Figures.

The model 1 comprises a pair of lungs 2 located either side of a model heart 3 and within a thoracic cavity 4. The thoracic cavity is defined by a backboard 5 and a plurality of ribs 6. The ribs 6 are wrapped in an adhesive wrap 7 that acts to imitate the intercostal muscles. The model heart 3 is located within a fluid filled bag 8. Filaments 9 are adhered to the outer side of the fluid filled bag 8 to imitate the phrenic nerves. A silicone wound 10 is adhered to the outer side of the model heart 3. Model bronchi 11 and a trachea 12 extend from the lungs 2.

A breakable sternum 13 is provided centrally above the model heart 3. The sternum 13 is formed of plaster of paris. Outward of the sternum 13 and the ribs 6 a layer of padding 14 is provided to imitate the fat layer of a human thorax. Outward of the layer of padding 14 a silicone skin layer 15 is provided to cover the whole of the upper side of the model 1.

Y-shaped tubing 16 comprising two lateral branches 16a, 16b connected to a supply line 16c at a proximal end and sealed at a distal end is provided such that each lateral branch 16a, 16b is located laterally either side of the sternum 13. The Y-shaped tubing 16 contains fluid and imitates the mammary arteries.

An artificial aorta 17 is also provided. The artificial aorta 17 is located in a position in which it would be found in the human body and extends from proximal end adjacent to the model heart 3 and downwardly to a distal end. The artificial aorta is formed of an inner fluid filled tube 18 located inside a knitted outer tube 19.

For clarity Figure 2 shows a schematic of a training model 1 according to the present invention without the outer layers. In particular the silicone skin layer 15, the padding layer 14, the sternum 13, and the adhesive layer 7 are omitted from this Figure. Whilst the ribs 6 are shown the number and positioning of the ribs is purely schematic and is not accurate with those provided in an actual model 1 according to the present invention. In an actual model 1 according to the present invention the number and positioning of the ribs would more closely conform to a human ribcage.

Figure 2 shows the position of the Y-shaped tubing in relation to the ribs 6. In particular, the position of the lateral branches 16a, 16b of the Y-shaped tubing imitating the mammary articles is clearly shown. Each rib 6 is hinged at its attachment to the backboard 5 to allow them to be opened outwards in the manner they would be in a clamshell thoracotomy. Figure 2 also shows that the Y-shaped tubing 16 is connected to a fluid filled bag 20 to provide a fluid supply.

The ribs 6 and the backboard 5 of the model 1 are shown in Figure 3. Each rib 6 is positioned to correspond to a rib of a human ribcage and is mounted to the backboard at a proximal end by a wired hinge. Each rib 6 is then fixed to a corresponding rib at a distal end. Wire 21 can then be used to reinforce the ribcage by joining the distal ends of the ribs 6 to one another along a centre-line of the ribcage.

Figure 4 shows the model of Figures 1 and 2 without the padding layer 14 or the silicone skin layer 15. The adhesive layer 7 over the ribs 6 is shown. The positioning of the Y-shaped tubing 16 is shown in relation to the sternum 13. As set out above, the sternum 13 is formed of plaster of paris and is breakable.

The lungs 2 are shown in position within the thoracic cavity 4. Each lung 2 is attached via a tube 22 that extends through a bronchi 11 to a manual pump 23. These manual pumps 23 can be operated to inflate and deflate the lungs 2 during use of the model 1.

The model heart 3 is shown most clearly in Figure 2. The model heart 2 may be a simple anatomical model heart 3 that can be purchased cheaply from an appropriate store. The model heart 3 has a silicone wound 10 adhered on an outer side to replicate a traumatic cardiac injury. The model heart 3 is located within a fluid filled bag 8. This may be a simple plastic bag that is filled with coloured water and that is sealed in an appropriate manner. Yellow filaments 9 are adhered to an outer side of the bag and imitate phrenic nerves. The aorta 17 is attached to the fluid filled bag 8 at a proximal end.

The use of the model 1 is illustrated in Figure 1. The model I_ is intended for training in clam shell thoracotomies. During use the manual pumps 23 will be used to operate the lungs to mimic pneumothorax. The medic will then "operate" on the model in the same manner as they would on a real patient undergoing a clam shell thoracotomy. This includes cutting through the silicone skin layer 15 and padding 14 to expose the sternum 13. The sternum 13 will then be broken and the ribs 6 will be spread to access the thoracic cavity and the model heart 3 in particular. The medic will then need to access the model heart 3 by piercing the fluid filled bag 8, which mimics the pericardium whilst avoiding the filaments 9, which mimic the phrenic nerves. Whilst using the model 1 the medic will need to avoid puncturing either the aorta 17 or the Y-shaped tubing 16, which mimics the mammary arteries.

The model of the present invention can be made simply with low cost materials. Further, the model more accurately replicates pneumothorax, phrenic nerves, mammary arteries and the aorta than models according to the prior art.

Claims

Claims 1 A medical training model comprising: an enclosure defining a thoracic cavity; a rib cage within the thoracic cavity formed of a plurality of resilient members; a pair of inflatable lungs located in the enclosure and within the rib cage; a model heart located between the lungs; wherein the model further comprises: i) Y-shaped tubing comprising two lateral branches connected to a supply line at a proximal end and sealed at a distal end, the Y-shaped tubing located anterior to the rib cage and within or adjacent to the thoracic cavity and a fluid supply attached to the supply line such that the Y-shaped tubing contains fluid; and/or ii) an artificial aorta, wherein the artificial aorta comprises a fluid filled tube located adjacent to the model heart.
2. A medical training model according to claim I, wherein: the model comprises a backboard defining a posterior side of the enclosure and the resilient members are mounted at a lateral side to the backboard.
3. A medical training model according to claim 2, wherein one or more of the resilient members are attached to the backboard by means of a hinge.
4. A medical training model according to any preceding claim, wherein: the model further comprises a rigid breakable sternum located anterior to the rib cage.
5. A medical training model according to any preceding claim, wherein: the model heart is located within a sealed fluid-filled bag.
6. A medical training model according to claim 5, wherein: the fluid-filled bag comprises one or more filaments mounted thereon and extending at least partially around the bag.
7. A medical training model according to any preceding claim wherein: the model further comprises an adhesive wrapping provided over the rib cage.
8. A medical training model according to any preceding claim wherein: the model further comprises an outer fat layer is provided over the rib cage.
9. A medical training model according to any preceding claim wherein: the model further comprises an outermost skin layer formed outwardly from all over components of the model.
10. A medical training model according to claim 9, wherein the outermost skin layer s formed of silicone.
11. A medical training model according to any preceding claim wherein the model comprises an artificial aorta that is provided with an external fluid supply.
12. A medical training model according to claim 11, wherein the aorta further comprises an outer fabric casing provided around the fluid filled tube.
13. A medical training model according to any preceding claim, wherein a wound is provided on the model heart.
14. A medical training model according to any preceding claim, further comprising one or more pumps for inflating and deflating the lungs.