Device to Provide Optimal Positioning for Endotracheal Intubation or Cricothyroidotomy in the Emergency Department, in the Operating Room, and by First Responders on the Scene of Emergency Situations

Abstract

By providing elevation of the upper back above the hospital bed, extension of the entire cervical spine will provide better visualization than achieved by the prior art such as the sniffing position. An additional benefit of using this device is that with full extension of the neck, the position for cricothyroidotomy is also optimized, should standard endotracheal intubation fail. This device will be of particular benefit in the intubation of obese patients, providing good extension and adequate visualization without the need for excessive strength to manipulate the patient's head and neck. The same position also facilitates placement of central venous catheters in the internal jugular or subclavian veins in obese or kyphotic patients.

Claims

1. A product for positioning a human body comprising A block having: A substantially flat bottom surface; A primary ramped surface; A plateau support surface; A rear surface; and At least one side supporting surface.

2. A product in accordance with claim 1, further comprising the primary ramped surface rising and extending from a front fall off surface to the plateau support surface.

3. A product in accordance with claim 2, wherein the primary ramped surface rises at an angle of approximately 20 degrees with the bottom surface.

4. A product in accordance with claim 1, further comprising the rear surface ramps down at approximate 50 degrees with the bottom surface. The side surfaces ramp down from the plateau support surface at approximately 60 degrees with a line included in the plane of the bottom surface.

5. A product in accordance with claim 1, further comprising the at least one side surface ramps down from the plateau support surface at an angle of approximately 60 degrees with a line included in the plane of the bottom surface.

6. A product in accordance with claim 1, further comprising wherein the relationship of the surfaces is such that the symmetry allows for placement of the block between the shoulder blades of a person so that the neck can fall rearwardly and the shoulders can fall to the sides, and the neck and head falling downwardly.

7. A product in accordance with claim 1, further comprising the bottom surface having a length to width proportion of approximately a length 1.5 times its width.

8. A product in accordance with claim 1, further comprising the height of said plateau support surface from the bottom of the device is approximately the length of the device.

9. A method to position a human body using a block having various surfaces, wherein the relationship of the surfaces is such that the symmetry allows for placement of the device between the shoulder blades of a person so that the neck can fall rearwardly and the shoulders can fall to the sides, and the neck and head falling downwardly.

10. A system to position a human body wherein the relationship of the surfaces is such that the symmetry allows for placement of a block between the shoulder blades of a person so that the neck can fall rearwardly and the shoulders can fall to the sides, with the neck and head falling downwardly by the force of gravity alone to expose the throat area of a patient to be intubated.

Description

VI. BRIEF DESCRIPTION OF THE DRAWINGS

[0017] FIG. 1 is an elevated view of health care professionals intubating a patient;

[0018] FIG. 2 is a schematic sectional view of an intubation procedure similar to that shown in FIG. 1;

[0019] FIG. 3 is an elevated view of location points on a human body that are used for intubation procedures;

[0020] FIG. 4 is an elevated view of the cutting position for an intubation procedure on a patient;

[0021] FIG. 5 is a schematic view of four steps comprising parts of an intubation procedure;

[0022] FIG. 6 is an elevated schematic view of a prior art procedure;

[0023] FIG. 7 is an elevated schematic view of a prior art procedure;

[0024] FIG. 8a is an elevated schematic view of a first position for an obese patient;

[0025] FIG. 8b is an elevated schematic view of a second position for an obese patient;

[0026] FIG. 9 is an x-ray or radiographic view of a patient in a prior art position;

[0027] FIG. 10 is an x-ray or radiographic view of a patient in a neutral position;

[0028] FIG. 11 is an x-ray or radiographic view of a patient in a position similar to FIG. 9;

[0029] FIG. 12 is a schematic view of a prior art position;

[0030] FIG. 13 is a schematic view of a neutral position;

[0031] FIG. 14 is a schematic view of a position using the invention;

[0032] FIG. 15 is an elevated view of an obese patient in a neutral position;

[0033] FIG. 16 is an elevated view of an obese patient using the invention;

[0034] FIG. 17 is a top view of the positioning device;

[0035] FIG. 18 is an elevational side view of the positioning device;

[0036] FIG. 19 is a front elevational view of the positioning device; and

[0037] FIG. 20 is an elevated perspective view of the positioning device.

VII. DETAILED DESCRIPTION OF A NOVEL DEVICE THAT USES A NEW POSITIONING MECHANISM INSTEAD OF THE TRADITIONAL SNIFFING AND RAMPED POSITIONS

[0038] The sniffing position and the newer variant known as the ramped position continue to be taught as the ideal methods of positioning for visualization of the airway during endotracheal intubation. Both positions require flexion of the neck as a key component. In the majority of patients, proper visualization is easily achieved by use of the laryngoscope alone, making debate over these positions irrelevant.

[0039] However, in a significant number of cases, certain individual characteristics of the patient make visualization difficult, complicating the process of intubation. Obesity in particular presents a great challenge, with difficulty greatly increasing with the size and weight of the patient. The sniffing and ramped positions have both been demonstrated by many to be beneficial for obese patients in particular.

[0040] In his 2001 critique of the sniffing position's validity, Adnet did MRI images of patients in three positions: neutral position, simple extension, and the sniffing position with the neck flexed and the head extended. He concluded that the sniffing position provided no added benefit over simple extension of the neck, as demonstrated below. However, what was not appreciated in these images was that simple extension of the neck inherently caused flexion of the lower neck. Similarly, extension of the head also induced extension of the upper neck.

[0041] Thus, in Adnet's study, the sniffing position and simple neck extension both caused flexion at C6 and C7 while the rest of the neck was extended backwards. These were essentially variations of the same position and a valid comparison to true neck extension was not actually achieved.

[0042] Further inspection of the anatomy demonstrates that the vocal cords are located at about the level of the 5th cervical vertebral body. Because of this, flexion at the base of the neck has little effect on the position of the vocal cords relative to the visual axis.

[0043] Furthermore, in the presence of the obstructing surface of a bed beneath the patient's head and neck, the real benefit of flexion in the sniffing position is to enable upper cervical extension along with the extension of the head. It is not anatomically possible to achieve significant extension at the occipitoatlantal joint without also inducing extension of the upper neck. Thus, it is extension (not flexion) of the neck that enables optimal alignment. But extension of the neck is hindered by the surface of the bed. By flexing the lower cervical spine in the sniffing position, some degree of upper cervical extension is actually enabled. It is this extension that is the key element of the sniffing position, as shown in FIGS. 9, 10 and 11.

VIII. THE NEW POSITION: A NEW MODEL OF AIRWAY VISUALIZATION BASED ON A NEW PRODUCT AND IMPROVED USE OF MANIPULATED POSITION

[0044] In many cases, particularly in cases of morbid obesity, true extension of the entire cervical spine will provide better visualization of the vocal cords for endotracheal intubation, as shown in FIG. 12. Before the sniffing position became established dogma, many early authors described positions of extension in the process of laryngoscopy. Some of them described the head as hanging down in the neutral position, as shown in FIG. 13. Although the hospital bed prevents full cervical extension, a simple lift of the upper back can provide the space needed to achieve an extended position.

[0045] By providing elevation of the upper thoracic region, full extension of the entire cervical spine will provide better visualization than previously demonstrated in other positions. This new position will be referred to as the BUMP position as shown in FIG. 14. FIGS. 15 and 16 further demonstrate an obese patient in neutral (left) and in the BUMP position of full extension (right); dotted red line represents the unseen position when engaging this obese patient of an improvised BUMP device.

[0046] An additional benefit of using this device is that with full extension of the neck, the position for cricothyroidotomy is also optimized, should standard endotracheal intubation fail. This device is of particular benefit in the intubation of obese patients, providing good extension and adequate visualization without the need for excessive strength to manipulate the patient's head and neck.

[0047] The same position also facilitates placement of central venous catheters and other lines in the internal jugular or subclavian veins in obese or kyphotic patients. This is accomplished because in lifting the upper back, gravity causes the head and shoulders to drop back for better exposure of the neck and chest.

IX. THE NEW AIRWAY POSITIONING DEVICE

[0048] The device of the present invention has a platform elevated by a gentle upward incline on one end and a steep drop off on the opposite end. The gradual incline allows it to be placed under the patient's back quickly and easily, without injury to the patient. The elevated plateau provides space above the bed to enable full extension of the cervical spine. Unlike other devices designed to achieve the sniffing or ramped positions, this device is different in that it does not promote cervical flexion at any level.

[0049] This device is also unique in that the plateau declines laterally on both sides in order to allow the patient's shoulders to fall backwards. This enables better positioning, especially if cricothyroidotomy is necessary. Allowing the shoulders to drop back also provides better exposure of the neck and chest, facilitating central venous catheterization of the subclavian and internal jugular veins which is often difficult in the neutral position, particularly in obese patients. The device will also have a handle at the steep end, not pictured below.

[0050] The product can be injection molded using high-density polyethylene plastic, approximately 5 mm thick. This will make the device strong, lightweight, portable, and durable. Portability and durability, although an advantage in the emergency room setting, is even more significant in the first responder environment out in the field. As the height of the plateau will need to be greater for larger patients, It will be available in several stackable sizes. The ideal dimensions and the angles of the various inclines have not been fully determined yet and will be a work in progress. The device could also be padded, and optionally adjustable in height. A variation may also fashion the device as a portable emergency response case of kit within which other airway supplies may be stored and carried.

[0051] As shown in FIGS. 17, 18, 19 and 20, the device 10 has a main block 12 with a flat or substantially flat bottom surface 100, a primary ramped surface 102, a plateau support surface 104, a rear surface 106, and side supporting surfaces 108 and 110. The surfaces work together to provide the needed positioning as described above. The relationship of the surfaces is such that the symmetry allows for placement of the device 10 between the shoulder blades of a person so that the neck can fall rearwardly and the shoulders can fall to the sides, and the neck and head falling downwardly, particularly in morbidly obese patients, although the device can be utilized with all patients. The force of gravity is normally enough to hold the patient in place on the device 10. For smaller people and children, a smaller size may be optimal. Similarly, for larger people, there may be a larger size available.

[0052] The exact specifications can vary, but proportions exist wherein the primary ramped surface rises at an angle of approximately 20 degrees with the bottom surface and extending from a front fall off surface 112 to the plateau support surface 104. The rear surface ramps down at approximate 50 degrees with the bottom surface. The side surfaces ramp down from the plateau support surface 104 at approximately 60 degrees with the bottom surface. The angle measurements are taken and observed from a vertex intersecting with a line within the bottom surface and a line within the respective rear surface, side surface, fall off surface, or primary ramped surface respectively.

[0053] The bottom surface 100 has length to width proportions of approximately a length 1.5 times its width. It is a solid surface is the described embodiment, but may have other alternate configurations. The height of the plateau support surface 104 from the bottom of the device is approximately the length of the device. Typically it would be 4 inches high on a length of approximately 12 inches long. An alternate version may be 6 inches high on a length of approximately 18 inches long. Various other versions (and heights and lengths) are also included in the invention. No sharp edges exist on the embodiment as shown, with various levels of rounded edges 114 and 116 as shown.

[0054] The plateau support surface 104 can be a flat surface or preferably be a surface with a slight angulation of approximately 3 to 5 degrees from a line parallel and included in the bottom surface 100 of the device where it ramps in the same direction as the primary ramped surface 102.

[0055] Various embodiments and variations have been discussed in the foregoing description. However, the embodiments discussed herein are not intended to be exhaustive or limit the invention to any particular form. The terminology which has been used is intended to be in the nature of words of description rather than of limitation. Many modifications and variations are possible in light of and within the above teachings and the invention may be practiced otherwise than as specifically described.