Emergency physicians (EPs) are always interested in what are the “tried-and-true” as well as the “latest-and-greatest” devices that will provide the best results for their patients. This article, while not a comprehensive list of every such device introduced over the past few years, does provide an overview of the most notable ones applicable for use in the ED.
Tonometry
The standard iCare tonometer device (TA01i; iCare Finland Oy, Vantaa, Finland),1 began to gain acceptance in the United States in 2007 (Figure 1). Early studies2 have shown its measurement accuracy of intraocular pressure (IOP) to be equivalent to traditional tonometers such as the Tono-Pen XL Applanation Tonometer (Reichert Techonologies, Depew, New York).3
The iCare tonometer is easy to calibrate and use. Consisting of a pin inserted into a magnetic housing, the magnet quickly pushes the blunt end of the pin out to make contact with the cornea. Six quick measurements provide the clinician with an average IOP. The device can be used without anesthesia and is also applicable for at-home use.
Airway Devices
C-MAC Tip System
While direct laryngoscopy will always have a role in clinical practice, there has been a revolution in airway management over the past few years, with video laryngoscopy rapidly replacing direct laryngoscopy. The C-MAC Tip system (Karl Storz Endoscopy-America, Inc, El Segundo, California) is one of the devices currently available.4,5 While this device is not at the lower end of the cost spectrum in airway devices, it is, in this author’s opinion, among the highest quality video laryngoscopes on the market. The hub of C-MAC Tip system is a video screen that accepts input from multiple devices. The most common is the video MacIntosh blade, which is shaped like a traditional MacIntosh but with a slightly thicker handle—allowing both direct and indirect intubation.
The C-MAC Tip system is a great teaching tool, allowing learners to perform direct laryngoscopy while providing reassuring visualization to the instructor of the intubation on the screen. (No longer does the instructor need to repeatedly ask the learner what he or she is viewing!) Moreover, when required, the clinician performing the intubation can look at the screen to benefit from the superior visualization of indirect laryngoscopy.
The C-MAC can also accept input from the D-Blade, which facilitates indirect intubation of anterior airways; however, it does not allow direct intubation when secretions or blood obscure the camera, though there is a suction channel that assists in clearing secretions. The clinician can also add a nasal pharyngeal scope as well as an adult or pediatric bronchoscope. The modularity of the C-MAC system is therefore a flexible addition to any airway armamentarium.
Regarding its use in emergency medicine, in addition to cost considerations, a potential concern is the ability of the plastic adapters to hold up to frequent, repetitive use in a setting such as a busy ED.
Wireless Vital Signs Monitoring Systems
Patient vital signs monitoring systems can currently double as four-point restraints. One new device, the ViSi Mobile Monitor System (Sotera Wireless, Inc, San Diego, CA), however, may make this a thing of the past.6 This system allows for inpatient monitoring of respiratory rate (RR), pulse oximetry, continuous blood pressure (BP), and temperature, as well as a multilead electrocardiogram. The entire system attaches to a small wrist-mounted device, which connects to a hospital monitoring system through a WiFi network (Figures 2a and 2b).ViSi Mobile Monitor
Another example of a wireless monitoring device is the EarlySense Chair Sensor system (EarlySense, Ltd, Ramat Gan, Israel) (Figure 3).7 This device assesses heart rate (HR) and RR simply by seating the patient in a chair. In the near future, this device will likely have the ability to take full vital signs. While not quite ready for prime-time in the ED, systems such as the EarlySense Chair Sensor offer a glimpse of the future in vital sign monitoring technology.
Vascular Access
Traditional intravenous (IV) line placement continues to be the standard of care for vascular access, but is not always feasible. Intraosseous needles, which have been around for decades, are seeing a new renaissance of use thanks to devices such as the Arrow EZ-IO Intraosseous Vascular Access System (Teleflex, Shavano Park, Texas).8 With these standards in mind, some new considerations are on the market, including the AV400 vein visualization system (AccuVein, Inc, Huntington, New York).
Arrow EZ-IO Intraosseous Vascular Access System
Teleflex, the maker of the EZ-IO, has recently made a push for humeral placement in order to achieve faster flow rates. Teleflex recommends using the longer needles (normally reserved for obese patients) with specific placement suggestions to facilitate retention of the needle. The Teleflex Web site8 and mobile application provide succinct, easy-to-understand instructions on placement.