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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 ,
Ken Jackimczyk ,
Bruce Horwood  and
Daniel Christenson
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: adam.smith0213@gmail.com
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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.

Keywords

difficult intubationliquid crystal displaypolarized lensesprehospital intubationvideo laryngoscopy

Information

Type
Case Report
Information
Prehospital and Disaster Medicine , Volume 34 , Issue 1 , February 2019 , pp. 104 - 107
Copyright
© World Association for Disaster and Emergency Medicine 2019 

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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):67-71.10.1093/bja/aei275CrossRefGoogle Scholar
2. Hussain, LM, Redmond, AD. Are pre-hospital deaths from accidental injury preventable? Br Med J. 1994;308(6936):1077-1080.10.1136/bmj.308.6936.1077CrossRefGoogle ScholarPubMed
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):10-15.10.3310/hta2170CrossRefGoogle ScholarPubMed
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):103-107.10.1111/j.1553-2712.2009.00622.xCrossRefGoogle ScholarPubMed
5. Rocca, B, Crosby, E, Maloney, J, Bryson, G. An assessment of paramedic performance during invasive airway management. Prehosp Emerg Care. 2000;4(2):164-167.10.1080/10903120090941443CrossRefGoogle ScholarPubMed
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):486-490.10.1097/00005373-200508000-00037CrossRefGoogle ScholarPubMed
7. Erlich, PF, Seidman, PS, Atallah, O, Haque, A, Helmkamp, J. Endotracheal intubations in rural pediatric trauma patients. J Pediatr Surg. 2004;39(9):1376-1380.10.1016/j.jpedsurg.2004.05.010CrossRefGoogle Scholar
8. Mort, TC. Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesth Analg. 2004;99(2):607-613.10.1213/01.ANE.0000122825.04923.15CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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):119-125.10.1111/1742-6723.12358CrossRefGoogle ScholarPubMed
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):927-930.10.1007/s00540-013-1651-3CrossRefGoogle ScholarPubMed
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):739-748.10.1016/j.annemergmed.2012.03.031CrossRefGoogle 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):700-707.10.1111/acem.12674CrossRefGoogle ScholarPubMed
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):280-286.10.1016/j.jemermed.2014.10.007CrossRefGoogle 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):149-154.10.3109/10903127.2012.729128CrossRefGoogle 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):650-653.10.1136/emj.2010.098707CrossRefGoogle 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):414-420.10.1016/j.annemergmed.2012.11.001CrossRefGoogle 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):149-152.10.1016/j.jclinane.2010.01.006CrossRefGoogle ScholarPubMed
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;16:8.10.1186/s12873-016-0069-2CrossRefGoogle ScholarPubMed
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):684-687.10.1111/j.1365-2044.2010.06366.xCrossRefGoogle 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 ScholarPubMed
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;31:213.10.1097/00003643-201406001-00610CrossRefGoogle 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):128-130.10.1177/0310057X1204000114CrossRefGoogle Scholar