title: Prehospital Endotracheal Intubation in Warm Climates: Caution is Required.
abstract: BACKGROUND
  Out-of-hospital endotracheal intubation is a frequent procedure for trauma care. Nevertheless, in warm climates, sunlight and heat can interfere with the flow of the usual procedure. They can affect the equipment and hinder the operator. There are few data on this issue. The presentation of this case highlights three common complications that may occur when intubating under a hot and bright sun.
  
  
  METHODS
  A 23-year-old man had a car accident in Djibouti, at 11:00 a.m., in broad sunlight. The heat was scorching. Due to a severe head trauma, with a Glasgow Coma Scale score of 8, it was decided to perform an endotracheal intubation. The operator faced three problems: the difficulty of seeing inside the mouth in the bright sunlight, the softening of the tube under the influence of the heat, and the inefficiency of colorimetric CO2 detectors in the warm atmosphere in confirming the proper endotracheal tube placement. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Solutions are simple, but must be known and planned ahead, prior to beginning the procedure: Putting a jacket over his head while doing the laryngoscopy would solve the problem of dazzle; adjuncts like a stylet or gum elastic bougie have to be used at the outset to fix the softening problem; alternative methods to exhaled CO2 detection, such as the syringe aspiration technique, to confirm the proper tube placement, should be available.
authors.affiliation: Medical Unit, Base des fusiliers marins et commandos, Lanester, France.
authors.forename: Yann
authors.initials: Y
authors.lastname: Daniel
authors.affiliation: Medical Unit, Base des fusiliers marins et commandos, Lanester, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Habas
authors.affiliation: Intensive Care Unit, Hôpital d'instruction des armées PERCY, Clamart, France.
authors.forename: Maximilien
authors.initials: M
authors.lastname: Cruc
mesh_terms: D002245:Carbon Dioxide / Q000032:analysis; D003124:Colorimetry / Q000592:standards; D004632:Emergency Medical Services / Q000379:methods*; D004868:Equipment Failure; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D013472:Sunlight / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D002245:Carbon Dioxide
keywords: emergencies; hot temperature; intratracheal; intubation; sunlight; tropical climate