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PHARM Podcast 002 – Seeing the Light

Key points of the podcast

  1. In the prehospital setting, personal equipment should be light, portable, small, cheap , easily replaceable and serve multiple functions
  2. A portable light source is essential, day or night, as a clinical examination tool and portable illumination
  3. My shopping list for a prehospital light source include : minimum 200 lumens intensity, LED, standard battery power(AA or CR123), hand carried or mountable with a clip, converts to head mounted illumination
  4. Hands free lighting is the way to go. Examine and do procedures like chest drain insertion or finger thoracostomies in low light conditions where your line of sight is illuminated!
  5. Transillumination or pan illumination using LED high intensity light source to find superficial non palpable veins. Traditionally used in paediatrics to find veins, this technique can be used in all age groups. Refer to accompanying demonstration video. Transillumination is technique of illuminating through the full thickness of a body part like a hand or foot. Pan illumination is the technique of localised soft tissue illumination allowing vessels to be shadow outlined locally. Yes with IO access in prehospital medicine, this is not so useful but still handy to know in case no IO or USS available. Useful areas to look for superficial veins with this technique are lateral infraclavicular area, medial lower humeral area, volar forearm, lateral neck, medial ankle and dorsum foot.

Accompanying images

  1. Closeup image of LED Torch privately purchased from www.zebralight.com
  2. Image of camping head torch, baseball type peaked cap with clip mounted LED torch, LED torch. This is my prehospital personal light set
  3. Closeup image of LED Torch with reversed mounting clip attached to cap peak

Acknowledgements : Dr Thien Le Cong,my brother, who taught me the above techniques and suggested the LED high intensity light source

Conflicts of interest : None. All devices were privately purchased and no sponsorship is provided or sought

Now on to the Podcast

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6 Comments Post a comment
  1. What I’ve always used for routine purposes is a strong penlight (I use this, as it’s cheap: http://www.amazon.com/Streamlight-66118-Stylus-Flashlight-Holster/dp/B0015UC17E but I know that there are better ones; the last few years have seen leaps and bounds in flashlight technology) with a rubber band wrapped around the back, giving you a place to bite if you need some hands-free use. As long as there’s a clip, you can also clip it to a seatbelt or epaulet in a pinch. But I do have a stronger light available for scene searches and the like.

    April 8, 2012
    • Minh Le Cong #

      Thanks for feedback, Brandon! That pen torch looks good. I agree. I used to carry around expensive personal gear but ended up losing most of it after a while. It should be fairly cheap and easy to replace. Lighting technology has advanced significantly. LED lights for medical devices are great. LED laryngoscopes in my view provide the best illumination for laryngoscopy and a personal LED torch of high intensity is very handy out in the field. Disposable LED laryngoscopes are now available and very affordable. They have replaced the German design MAC blade and LED handle light source that I used to carry. Head mounting for yur personal light source is the way to go. Holding it in your mouth is handy but you end up drooling over your torch!

      April 9, 2012
      • Yep, the mouth’s no good for anything prolonged. I do still have an expensive SureFire floating around, but nowadays it seems like you can get twice as bright and probably nearly as reliable for half the cost. Definitely it’s reached the point where there’s little reason to get anything other than an LED torch. Minh, may I assume that you carry a separate low-intensity penlight for pupillary assessment?

        April 9, 2012
      • Minh Le Cong #

        I actually use the light from my disposable laryngoscope. Its bright but not high intensity

        April 9, 2012
  2. +1 on the zebralights, but why didn’t you go with a model that comes with the headstrap (it is a 90 degree angle version). I have one and the headstrap is comfortable; it comes out if you want to use it as a regular light.

    April 12, 2012
    • Minh Le Cong #

      yeah I saw the headstrap model..did not look comfortable but if y reckon its fine then thats my spare torch in my kit now.
      For those who dont follow me on twitter, I posted some pictures of me transilluminating my larynx as well as my seven yo daughter’s with the zebralight. it only works for high intensity light source and preferably in dim light conditions, you have to place the torch over the cricoid area in the midline and angle the beam towards the pharynx…with some firm..ahem..cricoid pressure(perhaps it is useful after all!)

      will try to get a videolaryngoscope image on the next intubation case with transillumination of the larynx

      April 12, 2012

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