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Direct laryngoscopy is the most common method of tracheal intubation in the Emergency Department. However, in about 1% to 3% of Emergency Department patients requiring intubation, direct laryngoscopy will be very difficult or impossible.1,2 This may be due to many different causes including jaw immobility, limited cervical spine mobility, or excessive airway bleeding. In these situations, blind intubation using a lighted stylet is a proven valuable technique.3–7 Lighted stylet intubation relies on the transillumination of the soft tissues of the anterior neck to indicate intratracheal endotracheal (ET) tube placement. A bright, well-defined glow is seen in the anterior neck when the light is in the trachea. However, a diffuse, less intense glow is seen with esophageal intubation. Lighted stylet intubation is a relatively easy technique to learn and rapid to perform.
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The first published report of using a light source to guide intubation was in 1959.8 They described the device and technique in order to perform blind nasal intubations in the operating room. However, this technique did not receive much attention until the late 1970s when the Flexi-lum light wand (Concept Corporation, Clearwater, FL) was introduced.9 Over the years, more powerful and less heat emitting light sources have been developed along with more flexible stylets. Today there are at least four currently available devices, all of which are inserted into an ET tube instead of a standard stylet. These include the Trachlight (Figure 17-1), the Light Wand (Figure 17-2), the Flexible Lighted Stylet (Figure 17-3), and the Tube-Stat (Figure 17-4). Although there are slight differences in design, they all rely on using a lighted stylet to transilluminate the anterior neck and guide blind intubation of the trachea.
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The trachea lies anterior to most structures of the neck and is covered anteriorly only by skin, subcutaneous tissue, and pretracheal fascia. A light source positioned within the trachea will transilluminate a bright and discrete glow that can easily be seen on the surface of the neck. In contrast, the esophagus lies posteriorly and is surrounded by numerous soft tissue structures. A light source directed within the esophagus will be diffused by the surrounding tissue and appears dull. At the bedside, the Emergency Physician can easily discriminate between the dull, diffuse transillumination of an esophageal light source and the more discrete, intense signal ...