Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-12-01T03:28:21.960Z Has data issue: false hasContentIssue false

Use of Polarized Sunglasses During Video Laryngoscopy: A Cause of Difficult Prehospital Intubation

Published online by Cambridge University Press:  10 January 2019

Adam James Smith*
Affiliation:
Maricopa Integrated Health System, Phoenix, ArizonaUSA
Ken Jackimczyk
Affiliation:
Maricopa Integrated Health System, Phoenix, ArizonaUSA Air Methods, Greenwood Village, ColoradoUSA The University of Arizona College of Medicine – Phoenix, Phoenix, ArizonaUSA
Bruce Horwood
Affiliation:
Maricopa Integrated Health System, Phoenix, ArizonaUSA Air Methods, Greenwood Village, ColoradoUSA The University of Arizona College of Medicine – Phoenix, Phoenix, ArizonaUSA
Daniel Christenson
Affiliation:
Davis County Sheriff’s Department, Farmington, UtahUSA
*
Correspondence: Adam James Smith, MD 2252 N 44th St #2099 Phoenix, Arizona 85008 USA E-mail: [email protected]

Abstract

Background

In the prehospital setting, many providers advocate for video laryngoscopy as the initial method of intubation to improve the likelihood of a successful first attempt. However, bright ambient light can worsen visualization of the video laryngoscope liquid crystal display (LCD).

Case Report

A patient involved in a motor vehicle accident was evaluated by an Emergency Medical Services (EMS) crew. Initial endotracheal intubation attempt using video laryngoscopy was aborted after the patient desaturated. The primary reason for the failure was poor visualization of the video laryngoscope LCD, despite attempts to block direct sunlight. Debriefing revealed that the intubating provider was wearing polarized sunglasses.

Discussion

Because LCDs emit polarized light, use of polarized sunglasses may cause the display to appear dark. Thus, the purpose of this Case Report is to raise awareness of a potential safety issue that is likely under-recognized by prehospital providers but can be easily avoided.

SmithAJ, JackimczykK, HorwoodB, ChristensonD. Use of Polarized Sunglasses During Video Laryngoscopy: A Cause of Difficult Prehospital IntubationPrehosp Disaster Med. 2019;34(1):104–107.

Type
Case Report
Copyright
© World Association for Disaster and Emergency Medicine 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Conflicts of interest: none

References

1. Helm, M, Hossfeld, B, Schäfer, S, Hoitz, J, Lampl, L. Factors influencing emergency intubation in the pre-hospital setting – a multi-centre study in the German helicopter emergency medical service. Br J Anaesth. 2006;96(1):67-71.Google Scholar
2. Hussain, LM, Redmond, AD. Are pre-hospital deaths from accidental injury preventable? Br Med J. 1994;308(6936):1077-1080.Google Scholar
3. Nicholl, J, Hughes, S, Dixon, S. The costs and benefits of paramedic skills in pre-hospital trauma care. Health Technol Assess. 1998;2(17):10-15.Google Scholar
4. Cheung, KW, Kovacs, GJ, LeBlanc, DJ, Gao, J, Sandeski, R, Leslie, RA. Minimal illumination for direct laryngoscopy and intubation in different ambient light settings. Acad Emerg Med. 2010;17(1):103-107.Google Scholar
5. Rocca, B, Crosby, E, Maloney, J, Bryson, G. An assessment of paramedic performance during invasive airway management. Prehosp Emerg Care. 2000;4(2):164-167.Google Scholar
6. Davis, DP, Stern, J, Sise, MJ, Hoyt, DB. A follow-up analysis of factors associated with head-injury mortality after paramedic rapid sequence intubation. J Trauma. 2005;59(2):486-490.Google Scholar
7. Erlich, PF, Seidman, PS, Atallah, O, Haque, A, Helmkamp, J. Endotracheal intubations in rural pediatric trauma patients. J Pediatr Surg. 2004;39(9):1376-1380.Google Scholar
8. Mort, TC. Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesth Analg. 2004;99(2):607-613.Google Scholar
9. Hossfeld, B, Frey, K, Doerges, V, Lampl, L, Helm, M. Improvement in glottic visualization by using the C-MAC PM video laryngoscope as a first-line device for out-of-hospital emergency tracheal intubation – an observational study. Eur J Anaesthesiol. 2015;32(6):425-431.Google Scholar
10. Vassiliadis, J, Tzannes, A, Hiros, K, Brimble, J, Fogg, T. Comparison of C-MAC video laryngoscope with direct Macintosh laryngoscope in the emergency department. Emerg Med Australas. 2015;27(2):119-125.Google Scholar
11. Jones, BM, Agrawal, A, Schulte, TE. Assessing the efficacy of video versus direct laryngoscopy through retrospective comparison of 436 emergency intubation cases. J Anesth. 2013;27(6):927-930.Google Scholar
12. Sakles, JC, Mosier, J, Chiu, S, Cosentino, M, Kalin, L. A comparison of the C-MAC video laryngoscope to the Macintosh direct laryngoscope for intubation in the emergency department. Ann Emerg Med. 2012;60(6):739-748.Google Scholar
13. Sakles, JC, Javedani, PP, Chase, E, Garst-Orozco, J, Guillen-Rodriguez, JM, Stolz, U. The use of a video laryngoscope by emergency medicine residents is associated with a reduction in esophageal intubations in the emergency department. Acad Emerg Med. 2015;22(6):700-707.Google Scholar
14. Sakles, JC, Mosier, JM, Patanwala, AE, Dicken, JM, Kalin, L, Javedani, PP. The C-MAC video laryngoscope is superior to the direct laryngoscope for the rescue of failed first-attempt intubations in the emergency department. J Emerg Med. 2015;48(3):280-286.Google Scholar
15. Guyette, FX, Farrell, K, Carlson, JN, Callaway, CW, Phrampus, P. Comparison of video laryngoscopy and direct laryngoscopy in a critical care transport service. Prehosp Emerg Care. 2013;17(2):149-154.Google Scholar
16. Cavus, E, Callies, A, Doerges, V, et al. The C-MAC video laryngoscope for prehospital emergency intubation: a prospective, multi-centre, observational study. Emerg Med J. 2011;28(8):650-653.Google Scholar
17. Mosier, J, Chiu, S, Patanwala, AE, Sakles, JC. A comparison of the GlideScope video laryngoscope to the C-MAC video laryngoscope for intubation in the emergency department. Ann Emerg Med. 2013;61(4):414-420.Google Scholar
18. Aziz, M, Brambrink, A. The Storz C-MAC video laryngoscope: description of a new device, case report, and brief case series. J Clin Anesth. 2011;23(2):149-152.Google Scholar
19. Russo, SG, Nickel, EA, Leissner, KB, Schwerdtfeger, K, Bauer, M, Roessler, MS. Use of the GlideScope-Ranger for pre-hospital intubations by anesthesia trained emergency physicians – an observational study. BMC Emerg Med. 2016;16:8.Google Scholar
20. Ueshima, H, Asai, T. Tracheal intubation in daylight and in the dark: a randomized comparison of the Airway Scope, Airtraq, and Macintosh laryngoscope in a manikin. Anaesthesia. 2010;65(7):684-687.Google Scholar
21. Nao, Y, Kato, T, Kusunoki, S, Kawamoto, M, Yuge, O. Use of the AirWay Scope for tracheal intubation in bright sunlight. Masui. 2007;56(12);1408-1410.Google Scholar
22. Theiler, L, Nabecker, S, Riggenbach, C, Kotarlic, M, Kleine-Brueggeney, M, Greif, R. Intubation success rates of video-laryngoscopes under extreme daylight conditions: a manikin study on a Swiss glacier. Eur J Anaesthesiol. 2014;31:213.Google Scholar
23. Peatross, J, Ware, M. Physics of Light and Optics. Provo, Utah USA: Brigham Young University; 2015: 143-155.Google Scholar
24. Urone, PP, Hinrichs, R. Polarization. College Physics. Houston, Texas USA: Rice University, OpenStax; 2012.Google Scholar
25. Murphy, DB, Spring, KR, Davidson, MW. Introduction to polarized light. MicroscopyU. https://www.microscopyu.com/techniques/polarized-light/introduction-to-polarized-light. Accessed 2017.Google Scholar
26. Woodford, C. LCDs (liquid crystal displays). Explain that Stuff. https://www.explainthatstuff.com/lcdtv.html. Accessed 2017.Google Scholar
27. Montgomery, RW, Nakagawara, VB. Sunglasses for Pilots: Beyond the Image. Washington, DC USA: Federal Aviation Administration Publication.Google Scholar
28. Loughnan, TE, Gunasekera, E, Tan, TP. Improving the C-MAC video laryngoscopic view when applying cricoid pressure by allowing access of assistant to the video screen. Anaesth Intensive Care. 2012;40(1):128-130.Google Scholar