Surgical instrument for emergency medicine

The invention relates to a surgical instrument, especially for emergency medicine, in particular a so-called coniotomy device with which access to the lung is created for supplying air to the lung in cases in which breathing is hindered in the larynx, which device can be fixated internally and externally and has a short, straight indwelling cannula with a fixative rim at its end and with a trocar, the cutting edge of which is perpendicular to the cricoid cartilage, does not allow any wall contacts within the trachea, causes no injuries to the elastic fibers of the ligamentum conicum and can also be equipped with a small closure sac inserted into the trachea along with the cannula, which can be blown up from outside and which makes it possible to close the trachea in the upwards direction, preventing any escape from the trachea of the breathing air blown into the indwelling cannula.

BACKGROUND OF THE INVENTION 
1. Field of the Invention 
The invention relates to a surgical instrument for emergency medicine, in 
particular a so-called coniotomy device with a trocar, an indwelling 
cannula that can be inserted into the trachea and a collar affixed outside 
to the neck. 
2. Description of Related Art 
Coniotomy devices of this type are known to the art. The German Patent 88 
85 715 C7, for instance, describes such a device, under which a collar to 
be positioned on the neck, with a flange inclined at an angle of less than 
45 degrees to the collar surface, is equipped with a fastening component, 
into which an axially conducted catheter system with a cannula and stylet 
can be inserted and, after the successful introduction into the breathing 
tract, can be arrested by means of a clamp stop on the fastening 
component. 
Moreover, U.S. Pat. No. 3,906,956 describes such an instrument that has an 
L-shaped configuration and an opening for a trocar. 
Furthermore, U.S. Pat. No. 4,791,690 discloses a similar instrument that 
features a self-limiting depth penetration device, restricting penetration 
to the back third of the trachea, and has tube-shaped nozzles originating 
on both sides from an oval flange, allowing passage of an air tube to be 
inserted into the trachea. 
Finally, similar instruments have become known from the two U.S. Pat. Nos. 
3,476,112 and 2,923,299 and the German Patent 19 514 433. 
It is evident that these known coniotomy devices have considerable 
disadvantages. Their structure is too complicated for use in emergencies, 
consisting as they do of too many individual parts to be assembled prior 
to use. Moreover, they are too difficult to manipulate even for an 
experienced physician in such situations, leading to the loss of valuable 
time that could possibly be decisive in saving the life of the patient. 
Instruments equipped with complicated mechanics and with cannulas inserted 
into the trachea in bent form can rarely be used in real-life situations; 
in particular, those with bent cannulas are totally inappropriate for 
emergency medicine. 
SUMMARY OF THE INVENTION 
This is where the invention can help. The object of the invention, as 
described in the claims, is to create a coniotomy device that is simple in 
structure, fast and easy to manipulate, one that allows for visual 
inspection of the trachea and, if needed, i.e., in the case of severe 
injuries, for instance in the area of the jaw, one that securely prevents 
the escape through the upper section of the larynx of air introduced into 
the trachea. 
The advantages associated with the invention include in particular its 
simple structure, being a coniotomy device that consists of only two 
self-fixating parts, assuring both internal and external fixation by means 
of the circular rim at the end of the indwelling cannula and the lateral 
fixative wings of the base section, as well as its quick and easy 
handling, thanks to its straight form, an extremely important advantage 
especially in severe emergencies. Furthermore, the device does not allow 
for any contact of the instrument with the inner wall of the trachea, 
which largely rules out the danger of reflexive spasms. A further 
advantage lies in the fact that the cutting edge, thanks to its 
perpendicular alignment, prevents the transection of the elastic fibers of 
the lig. conicum, thereby making later, otherwise unavoidable plastic 
surgery unnecessary. Moreover, the ability to inspect visually the 
trachea, made possible by the short, straight form of the indwelling 
cannula, represents a significant advantage. Moreover, thanks to the 
possibility of inserting a small closure sac into the trachea, the upwards 
escape of air blown into the trachea can be prevented. Finally, the 
insertion of the blocking cannula into the base section is totally 
unproblematic.

DESCRIPTION OF THE PREFERRED EMBODIMENTS 
As can be seen in FIG. 1, the coniotomy device consists essentially of only 
two parts, namely the base section 1 and the trocar 8. The base section 1 
is equipped with two fixative wings 2 and 3, with which it is affixed 
externally to the patient=s neck. The number 17 designates an eyelet in 
each case. Furthermore, the base section 1 has an attachment 4 for the 
so-called ambulatory bag, only suggested in the figure, as well as an 
air-pump squeeze-pouch 7 and an indwelling cannula to be inserted into the 
trachea 23 of the patient. The indwelling cannula 5 is short and has a 
circular fixative rim 6 at the end, which prevents the coniotomy device 
from slipping out once it has been introduced into the trachea 23. 
Consequently, the device is affixed both externally and internally. The 
trocar 8 has a scalpel-like cutting edge 10 with a perpendicular alignment 
and, in certain cases, a limit stop 11 with which the penetration depth of 
the trocar 8 can be restricted. 
To facilitate understanding, the thyroid cartilage is designated with 19, 
the cricoid cartilage with 20, the skin with 21 and the mucus membrane of 
the trachea 23 with the number 22 in the figures. 
It has proven advantageous to limit the optimal length L of the indwelling 
cannula 5 between the base section 1 and its end to about 17 mm, including 
the rim at the end, which should be about 1 mm thick. For special 
applications, the indwelling cannula 5 can have a telescopic design, for 
instance, so that its length can be adjusted as needed. The inner diameter 
of the indwelling cannula 5 is adequately dimensioned with 4-6 mm, 6 mm 
being provided as the diameter for large-sized adults. To prevent the 
trocar 8 from twisting, a fixative groove and tongue device 14 is also 
provided at least in a partial section of the indwelling cannula 5 and the 
trocar 8 or its shaft 9. This ensures the perpendicular alignment of the 
scalpel-like cutting edge (10) of the trocar (8), provided that the base 
section 1 is properly mounted. 
A further variation of the invention provides that a blocking cannula 18 
with two separate air channels be inserted into the passageway of the 
indwelling cannula. The one air channel 12 is equipped on the outside with 
a closure pad 13 and terminates on the inside in a closure sac 15. By 
pressing on the closure pad 13, this closure sac 15 can be blown up, as 
needed, inside the trachea above the point of the air supply line 16, 
thereby preventing an escape in the direction of the cranium of the air 
blown into the trachea 23 through this air supply line 16. 
The indwelling cannula 5, which is straight and very short, gives the 
attending physician the additional possibility of visually inspecting, to 
an adequate degree, the trachea T, in which case, after removal of the 
trocar 8, a thin fiber-optic cable, also not represented in the figures, 
can be inserted additionally to illuminate the inner wall of the trachea. 
A suction device or the like can also be inserted through the indwelling 
cannula 5. Photographic recording is also possible by means of an 
endoscope introduced through the indwelling cannula 5. Finally, the 
fixative rim 6 can also be designed as a source of illumination of the 
trachea T. The use of such suction, illumination and/or visual inspection 
devices will be necessary for the attending physician only in occasional 
cases; however, the measures necessary to implement such devices can 
already be integrated into the coniotomy device at the time of production. 
The coniotomy device is extremely easy to use, so that it can be 
administered without a problem by physicians, registered nurses or other 
assistants. In the case of intubation hindrances that make orotracheal 
intubation impossible, access into the trachea of the patient can be 
gained with the coniotomy device according to the invention. The procedure 
is the following: 
The attending physician feels his way along the thyroid cartilage with his 
left index finger up to its lower border, so that the fingertip lies on 
the lig. conicum. The tip of the coniotomy device is placed on the skin of 
the hollow so created and pressed through the body surface perpendicularly 
into the tracheal region. Prior to insertion, the index finger is removed. 
At the same time, the thumb and middle finger hold the larynx of the 
patient in place. After inserting the scalpel-like cutting edge 10, slight 
resistance can be felt as it penetrates the elastic membrane, when the 
fixative rim 6 penetrates this membrane. At this moment, the tip of the 
trocar is still about 7 mm distant from the back wall of the trachea; 
consequently, there is only a minimal risk of injuring the back wall of 
the trachea. After removing the trocar 8, the physician can begin 
immediately with the artificial respiration of the patient by using an 
air-pump squeeze-pouch 7 or a so-called ambulatory bag or the like. 
Naturally, the invention is not limited to the application in the closed 
breathing tract in the pharyngeal region and the nose, ears and throat 
area. In addition, the instrument can be used successfully in various 
other surgical applications.