Blind orolaryngeal and oroesophageal guiding and aiming device

Abstract

To facilitate rapid, accurate, blind access to the larynx or esophagus such as for emergency intubation of a patient's trachea and suctioning of the hypopharynx or esophagus, a medical device ( 10 ) includes an anatomically contoured guide element ( 12 ) having a channel ( 22 ) therethrough. Guide element ( 12 ) is positioned about and atop the larynx such that the wall of the channel forms an upward continuation of the laryngeal wall. An orotracheal tube ( 18 ) advanced through the channel is guided exclusively into the larynx and trachea without substantial risk of accidental intubation of the esophagus or other areas of the hypopharynx. Tunnels ( 150, 160 ) may be provided through the guide element for blindly guiding or aiming other tubular-type members selectively into the esophagus or larynx. A tubular handle ( 14 ) or curved blade ( 454 ) is connected to the guide element ( 12 ) to blindly insert guide element ( 12 ) into the throat. Alternative embodiments ( 310, 350, 410, 450 ) of medical device ( 10 ) are also described.

1. A method for blindly intubating a patient's trachea comprising:
 inserting into the patient's throat an element having a tube guiding surface and an associated supporting edge, the element being sized to be received in the throat in the vicinity of the larynx and contoured to mate against reciprocal anatomical contours of and adjacent the larynx;  
 advancing the element into the throat until the reciprocal contours of the element and adjacent anatomy are mated together with the supporting edge of the tube guiding surface contiguous with at least the posterior edge of the larynx to effectively define an upward extension thereof such that the tube guiding surface is aimed into the larynx over the posterior edge thereof so that an intubation tube sliding along the tube guiding surface will be directed into the larynx and trachea; and  
 advancing an intubation tube along the tube guiding surface and into the larynx and trachea.  
 
     
     
       2. A blind intubation guide comprising:
 an element having a tube guiding surface with a supporting edge, the element being sized to be received in the throat in the vicinity of the larynx;  
 means associated with the element for situating the element in the throat with the supporting edge of the tube guiding surface contiguous with at least the posterior edge of the laryngeal opening to effectively define an upward extension thereof such that the tube guiding surface is aimed into the larynx over the posterior edge thereof so that an intubation tube sliding along the tube guiding surface will be directed into the larynx.  
 
     
     
       3. The intubation guide of  claim 2  further comprising a handle extending from the element and sized to allow manipulation of the element in the throat from outside the mouth. 
     
     
       4. The intubation guide of  claim 2  further comprising aperture means associated with the element for providing medical implement access aimed at the trachea when the element is situated in the throat with the supporting edge of the tube guiding surface contiguous with the posterior edge of the laryngeal opening. 
     
     
       5. The intubation guide of  claim 2  wherein the tube guiding surface is arcuate. 
     
     
       6. The intubation guide of  claim 2  further comprising recess means associated with the element adjacent the tube guiding surface for abutting the posterior wall of the larynx adjacent the laryngeal opening. 
     
     
       7. The intubation guide of  claim 2  further comprising a member associated with the element and positioned to substantially surround the laryngeal opening when the element is situated in the throat with the supporting edge of the tube guiding surface contiguous with the posterior edge of the larngeal opening. 
     
     
       8. The intubation guide of  claim 2  further comprising means associated with the element for effectively blocking access between the esophagus and the larynx when the element is situated in the throat with the supporting edge of the tube guiding surface contiguous with the posterior edge of the laryngeal opening. 
     
     
       9. The intubation guide of  claim 8  further comprising aperture means associated with the access blocking means for providing medical implement access to the esophagus when the element is situated in the throat with the supporting edge of the tube guiding surface contiguous with the posterior edge of the laryngeal opening. 
     
     
       10. The intubation guide of  claim 2  further including means for aligning an intubation tube with the guiding surface to be guided therealong. 
     
     
       11. The intubation guide of  claim 10  wherein the intubation tube guiding means includes a passageway through a portion of the element, the passageway being large enough for the intubation tube to pass therethrough. 
     
     
       12. The intubation guide of  claim 10  further comprising a handle extending from the element and sized to allow manipulation of the element in the throat from outside the mouth, the intubation tube guiding means including a passageway through at least a portion of the handle, the passageway being large enough for the intubation tube to pass therethrough. 
     
     
       13. The intubation guide of  claim 12  wherein the intubation tube guiding means further includes an extension of the passageway, the extension being through a portion of the element and being large enough for the intubation tube to pass therethrough. 
     
     
       14. A device for blindly inserting a tubular instrument through the mouth and into the larynx and trachea of a patient, the device comprising:
 a channel having a proximal portion and a distal portion, the proximal portion including entrance access means for insertion of the tubular instrument into the channel, the distal portion including a cusplike distal tip with a convex supporting edge, the distal portion being curved downwardly relative the proximal portion such that when the device is inserted through the patient's mouth and into the throat, the distal portion extends into the patient's oropharynx and hypopharynx with the distal tip oriented toward the glottic opening inside the larynx and with the supporting edge positioned atop and contiguous with the posterior edge of the laryngeal opening to effectively define an upward extension thereof.  
 
     
     
       15. The device of  claim 14  wherein the proximal portion if longer than the distal portion such as to extend out of the patient's mouth and provide a handle for inserting the device into the throat. 
     
     
       16. The device of  claim 14 , the distal tip edge being U-shaped. 
     
     
       17. The device of  claim 14 , the distal tip edge being V-shaped. 
     
     
       18. The device of  claim 14 , further comprising tunnel means having a portion extending separately from, and adjacent to, the channel for communication with one of the esophagus and the larynx. 
     
     
       19. The device of  claim 14  further comprising means for surrounding the epiglottis when the device is inserted into the throat. 
     
     
       20. The device of  claim 19 , the surrounding means including an aperture in the channel through which the epiglottis can pass. 
     
     
       21. A blind intubation guide comprising:
   an element being sized to be received in a patient's throat in the vicinity of such a patient's larynx, the element having at least an anterior wall and a posterior wall spaced opposite from the anterior wall to define a tube - receiving channel therebetween, the anterior wall being adapted to engage between such a patient's tongue and epiglottis when the element is received in such a patient's throat in the vicinity of such a patient's larynx, the posterior wall defining a tube - guiding surface for an intubation tube extending into the tube - receiving channel, the tube guiding surface having a lower edge positioned relative to the anterior wall such that with the element received in such a patient's throat in the vicinity of such a patient's larynx and the anterior wall engaged between such a patient's tongue and epiglottis,        the lower edge of the tube guiding surface overlies a posterior edge of such a patient's laryngeal opening to thereby create a functionally gap - free junction therewith and effectively define an upward extension thereof whereby an intubation tube sliding along the tube guiding surface will be freely directed into such a patient's larynx without impingement upon the posterior edge of such a patient's laryngeal opening.     
     
     
       22. The intubation guide of  claim 21  further comprising a handle extending from the element and sized to allow manipulation of the element in such a patient's throat from outside such a patient's mouth. 
     
     
       23. The intubation guid of  claim 21  further comprising aperture means associated with the element for providing medical implement access aimed at such a patient's trachea when the element is situated in such a patient's throat with the lower edge of the tube guiding surface defining a functionally gap- free junction with the posterior edge of such a patient's laryngeal opening.   
     
     
       24. The intubation guide of  claim 21  wherein the tube guiding surface is arcuate. 
     
     
       25. An intubation guide comprising:
   a guide element having an orotracheal tube guiding wall associated therewith, the guide element being sized to be seated in the throat in the vicinity of the larynx such that an orotracheal tube advanced along the guiding wall projects towards the laryngeal opening; and        an endoscopic fiberbundle associated with the guide element and having a distal end aimed by the guide element into the laryngeal opening from the posterior aspect thereof when the guide element is seated in the throat in the vicinity of the larynx whereby to facilitate viewing the larynx via the distal end of the fiberbundle.     
     
     
       26. The intubation guide of  claim 25  further comprising a handle element coupled to the guide element for inserting the guide element into the throat in the vicinity of the larynx. 
     
     
       27. The intubation guide of  claim 26  wherein the fiberbundle has a central portion, the central portion extending along a surface of the handle element. 
     
     
       28. The intubation guide of  claim 26  wherein the fiberbundle has a central portion, the central portion extending through the handle element. 
     
     
       29. The intubation guide of  claim 26  further comprising a laryngoscope unit secured with the handle element. 
     
     
       30. The intubation guide of  claim 26  wherein the fiberbundle has a central portion between the laryngoscope and the distal end, the central portion extending through the handle element. 
     
     
       31. The intubation guide of  claim 26  wherein the fiberbundle has a central portion between the laryngoscope and the distal end, the central portion extending along a surface of the handle element. 
     
     
       32. The intubation guide of  claim 25 , the fiberbundle extending into and through the guide element. 
     
     
       33. The intubation guide of  claim 32  wherein the guid element includes slant tunnel means extending through the guide element for defining a tubular path pointing obliquely into the laryngeal opening from its posterior aspect, the fiberbundle being situated in the slant tunnel means. 
     
     
       34. A medical device for aiming of a flexible fiberoptic laryngoscope into the larynx comprising:
   a guide element receivable through the mouth and into the back of the throat, the guide element having a channel wall extending therethrough, the guide element adapted to be positioned about the larynx such that the channel wall defines a tube - guiding path aimed towards the laryngeal opening, and slant tunnel means separate from the channel wall and extending through the guide element, the slant tunnel means terminating at the channel wall for defining a tubular path pointing obliquely into the laryngeal opening from its posterior aspect, and        a fiberbundle having a distal portion extending into the slant tunnel means whereby to visualize the larynx via the fiberbundle with a laryngoscope unit.     
     
     
       35. The medical device of  claim 34  further comprising a handle coupled to the guide element for inserting the guide element into the back of the throat by manipulation from outside the mouth. 
     
     
       36. The m dical device of  claim 35  further comprising a laryngoscope unit secured with the inserting means, the fiberbundle having a central portion between the laryngoscope and the distal portion in the slant tunnel means, the central portion extending along a surface of the inserting means. 
     
     
       37. The medical device of  claim 35  further comprising a laryngoscope unit secured with the inserting means, the fiberbundle having a central portion between the laryngoscope and the distal portion in the slant tunnel means, the central portion extending through the inserting means.