# 174 Warm Weather Outdoor Intubation
Daniel, Habas, & Cruc in a new article, describe an incident on a "scorching" day in Djibouti, give advice of the difficulty they had from solar glare, softening of ETTs and in using color-changers to check for CO2. They suggest shading, stylets or bougies, and syringe-checks.
Other possibilities come to mind. Just as infants have been burned by overheated laryngoscope bulbs, bulbs or blades that have been too long in the sun might burn tissues.
There is plenty of literature support for bougies improving view, tactile confirmation of tracheal placement, and making awkward intubations less clumsy and safer; it is reasonable to have as routine backup or because any outdoor intubation is awkward.
I recall, too, having to discard my IV cannula and re-prep the site because sweat from my face had dropped onto the cannula. (Tennis wristbands might have helped.) I've also had irrigation fluids needed to splash a heat stroke patient having become hot stored in the ambulance. Still, it was wet and did still cool, (wasn't scalding hot) and conducts heat 10X>air, especially if air is forced over for evaporation and convection (We did.). If no ice, a thermal cooler might have delayed absorbing ambient temperature.
In a heat stress casualty, the increased capacitance of dilated vessels, coupled with dehydration, may make it hard to find a vein. Dependency of the extremity and a blood pressure cuff tourniquet may help, particularly if hands can help blood to pool. The old trick of having a helper raise the legs into the air may help. Intraosseous access would be rapid, reliable, and would not require the set-up of a cut-down or central line placement.
While you're out in a hot sunny clime, remember to wear a high-crowned broad-brimmed hat to shade your eyes and keep you 10°-15° F cooler. Water supply, breakdown kit, communications and air-signaling gear, subsistence, all need to be considered. It's easy to drive farther than you can hike out, especially if having to stretcher-carry or man-pack a casualty with you.
Daniel, Y., Habas, S., & Cruc, M. (2016). Prehospital Endotracheal Intubation in Warm Climates: Caution is Required. The Journal of Emergency Medicine.
Koh TH, Coleman R. Oropharyngeal burn in a newborn baby: new complication of light-bulb laryngoscopes. Anesthesiology. 2000 Jan;92(1):277-9. No abstract available. PMID: 10638930
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