The disclosed subject matter pertains generally to the area of medical devices, and more specifically to the area of video laryngoscopy.
Many medical instruments rely on the skill of the caregiver for proper use. To enhance those skills, some medical instruments may be provided with one or more features that give the caregiver more feedback on how well the caregiver is using the medical instrument. One feedback feature that has been popularized with laryngoscopes—a tubular endoscope inserted into the larynx through the mouth to observe the interior of the larynx—is a video camera which allows a caregiver to see and capture an image during the procedure. These video laryngoscopes as they are called are specialized laryngoscopes that provide real-time video of the airway anatomy captured by a small video camera on the blade inserted into the airway. They provide a video image on a small screen on the laryngoscope device, or on the screen of a device that is connected to the laryngoscope device.
Video laryngoscopes are particularly useful for intubating “difficult airways.” Although video laryngoscopes can be costly to purchase and use; they may speed up the time to successful intubation by allowing the caregiver to better see the airway during the intubation process. Video laryngoscopy is becoming more commonly used to secure an airway in both hospital and pre-hospital environments.
Laryngoscopy to facilitate endotracheal intubation is one of the most challenging critical care procedures widely performed in prehospital emergency medical care. Some laryngoscopes are designed with a camera or fiber optics on the blade to facilitate enhanced visualization of the target structures during laryngoscopy, and some of the video laryngoscopes allow recording of the video data stream. Such products record the entire data stream from power-on to power-off of the device (or stream that entire interval of data to an accessory recording device such as a computer). However, the data of value comprises only a (potentially very small) portion of the entire recorded data stream. The excess data recorded is undesirable because it increases file size and memory requirements, necessitates more time for data transfer and data review, and increases the risk of privacy concerns surrounding the content of the captured data.
There is a long-felt yet unmet need for improvements in the area of video laryngoscopes.
Embodiments are directed to a laryngoscope that facilitates targeted recording (video, or audio, or both video and audio) of time intervals associated with active laryngoscopy. In accordance with the teachings of this disclosure, a characteristic that reliably defines the interval of active laryngoscopy is used to trigger recording. One such characteristic is that the operator's hand is gripping the handle of the laryngoscope. Accordingly, preferred embodiments implement a laryngoscope having a handle so designed that when the handle is gripped by the operator's hand, recording is initiated and continued for as long as the operator's hand maintains a grip on the laryngoscope handle.
In describing more fully this disclosure, reference is made to the accompanying drawings, in which illustrative embodiments of the disclosure are shown. This disclosure may, however, be embodied in a variety of different forms and should not be construed as so limited.
Generally described, the disclosure is directed to a laryngoscope that includes a capture device and a grip sensor. The grip sensor is configured to detect that the laryngoscope is being gripped, such as by a medical care giver. In response to detecting that the laryngoscope is being gripped, data from the capture device is stored in a non-volatile manner. Specific embodiments and implementations are described below.
Initial Discussion of Operative Environment
The laryngoscope illustratively has a blade 107 attached by some connector mechanism 114 to a handle 112. The handle allows a caregiver to control the placement of the blade of the laryngoscope into an oral cavity 109 of the patient against the patient's tongue in connection with the laryngoscope procedure.
The laryngoscope shown in
In the setting of emergency airway management, intubation is usually a time-sensitive procedure, due to risk of physiologic deterioration from the prolonged apnea resulting from lengthy intubation attempts, or due to the risk of interrupting other life-saving interventions such as chest compressions in a cardiac arrest patient or rapid evacuation and transport of a traumatically injured patient. It is therefore important to accomplish the laryngoscopy task quickly, preferably, within a single attempt. Making multiple attempts extends the period without adequate gas exchange, and consequent hypercapnia and hypoxia. For this reason, quality assurance measures are desirable to measure, monitor, and provide feedback on the timing of intubation attempts and the associated change in physiological measures (such as pulse oximetry and capnometry). The video captured by a video laryngoscope provides one form of enhanced quality assurance and quality improvement measure by providing video feedback on the procedure as it is performed, and, if the video is recorded, allowing detailed video review after the procedure is over.
Having thus introduced background on laryngoscopy, we now turn to features that are provided by this disclosure.
The image capture portion 210 may include a light source, an image reflector unit, a window configured for diffusing light, a camera shutter, a scanner shutter, a lens system, light channels, a photodetector array, and/or a decode module. The photodetector array, in one example, may comprise a photo-sensitive charge coupled device (CCD) array that upon exposure to reflected light when enabled, generates an electrical pattern corresponding to the reflected light. Alternatively, a laser scanner and a photo-detector may be used to illustrate that different types of photodetectors besides the charge coupled photo sensitive element arrays may be used with this disclosure. As is known in the art, the light source (or a separate light source) illuminates a subject and the photodetector array converts light reflected from the subject into corresponding electrical signals. The electrical signals are in turn rendered on the monitor 225 for viewing by a user.
It should be appreciated that the image capture portion 210 may be implemented in any appropriate location or even in multiple locations. As illustrated in
In this embodiment, the monitor 225 is formed integral (or coupled) to the handle 250. Alternatively or in addition, the monitor 225 may take the form of a display that is separate from the handle 250. For example, the separate display may be connected to the laryngoscope 200 by a wired or wireless connection. Various monitors may be used with embodiments of this disclosure, such as an LCD screen, an e-paper (or other bi-stable) display, a CRT display, or any other type of visual display. One illustrative embodiment that uses one or more remote monitors is illustrated in
The laryngoscope 200 of this particular embodiment further includes power button 216 and a grip sensor 275. The power button 216 operates to activate the laryngoscope 200 when in use and power on its various elements, e.g., the image capture portion 210, including its light source, and the monitor 225. The grip sensor 275 may be any suitable sensor that can detect that an operator is gripping the handle 250, thereby indicating that the laryngoscope 200 is in active use. The grip sensor 275 may be implemented as a pressure sensor, force sensor, temperature sensor, optical sensor, impedance (e.g., capacitive or resistive) sensor, or the like. Alternatively, the grip sensor 275 could be implemented as a tactile or electromechanical switch. In preferred embodiments, when the handle is gripped by the operator's hand (as detected by the grip sensor 275), recording is initiated and continued for as long as the operator's hand maintains a grip on the laryngoscope handle 250. Although shown in
In operation, an operator may handle the laryngoscope 200 in preparation for its use as described above in conjunction with
In an embodiment where the image capture portion 210 is located remote to the handle 210 (e.g., wirelessly connected to a remote electronic monitoring and medical care support system), the grip sensor 275 and laryngoscope 200 may cause a signal to be sent to the remote component (not shown) to initiate recording on that remote component.
Processor 820 may be implemented in any number of ways. Such ways include, by way of example and not of limitation, digital and/or analog processors such as microprocessors and digital-signal processors (DSPs); controllers such as microcontrollers; software running in a machine; programmable circuits such as Field Programmable Gate Arrays (FPGAs), Field-Programmable Analog Arrays (FPAAs), Programmable Logic Devices (PLDs), Application Specific Integrated Circuits (ASICs), any combination of one or more of these, and so on.
Memory unit 830 may be implemented in any number of ways. Such ways include, by way of example and not of limitation, volatile memory (e.g., RAM, etc.), nonvolatile memories (e.g., hard drive, solid state drive, etc.), read-only memories (e.g., CD-ROM, DVD, etc.), or any combination of these. Memory 830 may include programs containing instructions for execution by processor 820. The programs provide instructions for execution by the processor 820, and can also include instructions regarding protocols and decision making analytics, etc. In addition, memory unit 830 can store rules, configurations, data, etc. Although illustrated as being collocated with the other components of the laryngoscope 300, it should be appreciated that the memory unit 830, or an ancillary memory unit (not shown), could alternatively be located on a remote wired or wirelessly connected component.
Communication module 840 may be implemented as hardware, firmware, software, or any combination thereof, configured to transmit data between the laryngoscope 300 and other devices. In an illustrative embodiment, the communication module 840 may include a wireless module and/or a hardwire connect module. The wireless module may illustratively be a Wi-Fi module. Additionally or alternatively, the wireless module may be a Bluetooth module, a cellular communication module (e.g., GSM, CDMA, TDMA, etc.), a Wi-Max module, or any other communication module that enables a wireless communication link for the bidirectional flow of data between the image capture device and an external device. The hardwire connect module may be a hardware and software based data connector configured to connect with a data outlet of an external device such as a computer. The hardwire connect module may be implemented as one or more ports and associated circuitry and software that allow bidirectional flow of data between the laryngoscope 300 and other devices. Illustratively, the hardwire connect module may be an Ethernet connector, an RS232 connector, a USB connector, an HDMI connector, or any other wired connector. The communication module 840 is capable of enabling transmission of data captured using the image capture module 860 to other devices.
The image capture module 860 is hardware and software configured to provide the optical functionality required for the capture of photo image, a video stream of images, or a coded image. Examples of the image capture module 860 may include a complementary metal-oxide semiconductor (CMOS), N-type metal-oxide semiconductor (NMOS), a charge coupled device (CCD), an active-pixel sensor (APS), or the like. The image capture module 860 may additionally include video processing software, such as a compression/decompression module, and other components, such as an analog-to-digital converter. The image capture module 860 still further includes a light source (not shown) which is used to illuminate the subject area under view. Still further, the image capture module 860 could be implemented with additional features, such as a zooming and/or panning capability.
Although only a single image capture module 860 is shown in
An optional audio capture module 870 may also be included for capturing audio signals. In such an embodiment, the optional audio capture module 870 may include a microphone or other audio signal capture hardware (e.g., an analog-to-digital converter, etc.), and may also include audio processing software, such as a compression/decompression module, or the like.
The image capture module 860 and the optional audio capture module 870 could either or both be located somewhere in the body of the laryngoscope 200 (e.g., the handle, the blade, or a directly-attached extension to the laryngoscope 200, such as the monitor). Alternately or in addition, the image capture module 860 and the optional audio capture module 870 could either or both be located on a remote wired or wirelessly connected component of an electronic monitoring and medical care support system (e.g. a vital signs monitor, a monitor/defibrillator, a tablet device used for purposes such as documentation, or a mechanical chest compression system).
Power source 880 is a component that provides power to the several components of the laryngoscope 300. Power source 880 may be a battery, an externally provided power source, or a combination of both.
User interface 850 is hardware and software configured to enable an operator to interact with and control the several components of the laryngoscope 300, such as the processor 820, the memory unit 830, the image capture module 860, the communication module 840, and the optional audio capture module 870. The user interface may include a keypad 852 (either physical or virtual), a monitor 854, a power button 856 for turning on the laryngoscope 300, and a grip sensor 858 for initiating the capture of a media stream (e.g., images, video, audio, or any combination thereof). For example, user interface 850 may include a monitor 854 to display a series of instructions and a touch screen keyboard for the operator to enter data to configure the laryngoscope 300 for a particular operation.
For example, the monitor 854 may initially show a home screen with an activate virtual button to activate the capture of image data. On pressing the activate button, the monitor 854 may display a menu of instructions to navigate the operator to configure the laryngoscope 300 to the desired settings. Alternatively, the menu may pop up automatically on the screen of the display when the power button 856 is pressed.
User interface 850 may also include a speaker (not shown), to issue voice prompts, etc. User interface 850 may additionally include various other controls, such as pushbuttons, keyboards, switches, and so on, for purposes not relevant to the present disclosure.
In operation, and as discussed above, an operator may press (or otherwise trigger) the power button 856 to power on the several components of the laryngoscope 300, including the image capture module 860 (and, in particular, its illuminating light source), the processor 820, and the memory unit 830. In this way, the laryngoscope 300 is operative to begin capturing images from the image capture module 860. Additionally or alternatively, the laryngoscope 300 may also be operative to begin capturing audio from the optional audio capture module 870.
As discussed above, upon detection of the operator's grip upon the grip sensor 880, the processor 820 causes data from the image capture module 860 (and/or the audio capture module 870) to be recorded by the memory 830. Conversely, when the grip sensor 880 no longer detects the presence of the operator's grip, the processor 820 causes the data from the image capture module 860 (and/or the audio capture module 870) to cease being recorded, although the image capture module 860 may continue to stream images.
In addition, in embodiments that implement communication between the laryngoscope 300 and other devices, such as via the communication module 840, various functions and features may be distributed or duplicated at those other devices. Turning briefly to
It will be appreciated that the laryngoscope 599 of this embodiment may be in direct communication (e.g., Bluetooth, Wi-Fi, NFC, hard-wire, etc.) with devices that are reasonably co-located with the laryngoscope 599. Alternatively, the laryngoscope 599 may be in indirect communication with other devices (e.g., hospital computer 528) through intermediary communication components. For example, the laryngoscope 599 may connect directly to the defibrillator/monitor 572, which then relays signals to the hospital computer 528.
In the embodiment illustrated in
Similarly, one or more of the remote devices may include recording mechanisms for recording all or a portion of the images being conveyed by the laryngoscope 599. These and other embodiments will become apparent to those skilled in the art from a careful study of this disclosure.
Enhancements to the Data Storage Process
A laryngoscope configured in accordance with the present disclosure may further include logic to enhance or simplify the capture of relevant data during a laryngoscopy while reducing irrelevant data. More specifically, it is envisioned that an operator of a video laryngoscope may be in a stressful and difficult situation and may be occupied or preoccupied with several tasks simultaneously. To that end, it may be detrimental to the recording process if data streaming from the image capture module 860 are only recorded immediately upon activation of the grip sensor 858. For instance, an operator of the laryngoscope 300 may need to remove his or her hand briefly or readjust his or her grip on the laryngoscope 300 during operation. Embodiments of the disclosure may be implemented to address this situation. Referring now to
Upon the grip sensor 858 detecting the operator's grip, rather than only storing image data from that moment forward, prior image data may also be stored to non-volatile memory 410 for later use. For instance, as illustrated in
In yet another enhancement, the laryngoscope 300 could be configured to continue writing image data to non-volatile memory 410 for some fixed or configurable interval of time after the grip sensor detects that the handle is no longer being gripped. Such an enhancement would further ameliorate the possibility of relevant data being lost due to brief or temporary releases of the handle.
In still another enhancement, the amount of data stored from prior-to the triggering handle-grip event, and/or after the sensor(s) detects that the handle is no longer being gripped, could be configured to be different for video vs audio data, in a system where both types of data are automatically recorded upon triggering from a handle-grip event. For example, audio data for an interval prior to and after the actual laryngoscopy may provide value for capturing details about the preparation for the procedure, and the confirmation of successful completion of the procedure, whereas video data while the operator's hand is not holding the handle is likely of no explicit value.
Certain additional embodiments may become apparent to those skilled in the art based on the preceding disclosure. For example, one alternative embodiment may be implemented in systems in which the amount of storage space is not a constraint, yet identification of most-relevant image (or audio) data remains desirable. In such an embodiment, image data may be captured and stored to non-volatile memory for later use. In this way, the entirety of the image data stream may be available for later analysis. However, it continues to remain desirable to have easy and quick access to the most-relevant image (or audio) data recorded. Thus, the grip sensor 858 may be used to trigger the recording of a time-stamped event that is synchronized or embedded within the stream of image data. In this way, for example, a user may later quickly jump to those events (e.g., intubation, extraction, etc.) within the full recorded data stream. Still further, the grip and release events could be used to configure timing of a report of 15 intubation that, in addition to the audio or video recording, also includes physiologic data, queried from a host monitor, from a period of time related to the times of grip and release (for example, 60 seconds before grip to 180 seconds after release).
In still another alternative embodiment, a (non-video) laryngoscope may be configured with an audio loop recorder, rather than an image capture device, that captures audio data for an interval related to the grip and release times. Such an alternative embodiment would be low-cost, yet could be used in a system in which responders are trained to “talk to the device” and provide verbal comments describing the event as it progresses.
In yet another alternative embodiment, the grip sensor may be implemented in a manner that not only recognizes the presence versus absence of the operator's hand grip, but also measures the magnitude of the grip force/pressure, and/or the amount of handle surface area that is being directly contacted by the operator's hand. Such quantitative measurements could then be recorded by the laryngoscope system, allowing enhanced review and analysis of these aspects of laryngoscopy technique.
In an extension of the above embodiment, a certain pattern of applied grip pressure/force—such as, for example, two squeezes in rapid succession akin to a double mouse click on a computer—could be used to trigger recording of a discrete snapshot image, separate from the continuous video file that may also be in the process of being recorded. Such an operator-triggered snapshot image capture capability would allow the operator to capture a favorable or optimal image of interesting or noteworthy airway anatomy or airway conditions, for purposes such as documentation, education, and quality improvement. One specific use of such an operator-triggered snapshot image capture capability would be to facilitate transfer or transmission of that image by the laryngoscope system (and/or a communicatively-coupled monitor-defibrillator system) into the patient care report, the patient's medical record, or a handoff report, specifically to alert and illustrate to downstream care providers specific airway features that may make the patient more challenging to intubate. Such a “difficult airway handoff alert and illustration”, forwarded from a first care provider who has already navigated a difficult airway, to a downstream care provider who may otherwise be unaware of the specific challenges posed by the particular patient's airway, would allow downstream care providers to make safer and more informed decisions about additional airway management procedures such as endotracheal tube exchange or extubation.
In yet another alternative embodiment, the grip sensor could be incorporated into a sleeve that fits over/around the handle of the laryngoscope, rather than into the handle itself. Such a sleeve could then also be used on direct (non-video) laryngoscopes as well, wherein the hand grip detected by the sensor could be used for the aforementioned tasks of initiating and terminating recording of audio data, as well as recording specific event times associated with handling of the laryngoscope.
In yet another alternative embodiment, the pressure or force sensor indicative of active use of the laryngoscope could be located elsewhere on the laryngoscope. For example, a pressure or force sensor could be incorporated into the laryngoscope blade, allowing detection of contact and lifting force applied the anterior structures of the airway. Such pressure or force detection could then b e used to similarly control video and/or audio recording as in the earlier-described embodiments. The magnitude of the pressure or force could also be measured and recorded, which would be useful for analysis of laryngoscopy technique and correlation to physiologic responses to the laryngoscopy procedure. In a related embodiment, one or more pressure or force sensors could be incorporated into the rear base of the laryngoscope blade and/or handle, such that the sensors could detect force being applied to the patient's upper (maxillary) teeth, which might result in dental trauma. Detection of such dental contact force could be used to trigger an alert or alarm notifying the operator of the hazard.
In yet another alternative embodiment, one or more proximity sensors, pointed in one or more directions, could be located in or near the blade of the laryngoscope. These sensors could be used to detect entry of the blade into a confined space such as the patient's mouth, or close approach of the blade-side of the handle to the patient's face. Detection of close proximity to the face or mouth while the video laryngoscope is on could then be used to similarly control video and/or audio recording as in the earlier-described embodiments.
Other embodiments may include combinations and sub-combinations of features described above or shown in the several figures, including for example, embodiments that are equivalent to providing or applying a feature in a different order than in a described embodiment, extracting an individual feature from one embodiment and inserting such feature into another embodiment; removing one or more features from an embodiment; or both removing one or more features from an embodiment and adding one or more features extracted from one or more other embodiments, while providing the advantages of the features incorporated in such combinations and sub-combinations. As used in this disclosure, “feature” or “features” can refer to structures and/or functions of an apparatus, article of manufacture or system, and/or the steps, acts, or modalities of a method.
In the foregoing description, numerous details have been set forth in order to provide a sufficient understanding of the described embodiments. In other instances, well-known features have been omitted or simplified to not unnecessarily obscure the description.
A person skilled in the art in view of this description will be able to practice the disclosed invention. The specific embodiments disclosed and illustrated herein are not to be considered in a limiting sense. Indeed, it should be readily apparent to those skilled in the art that what is described herein may be modified in numerous ways. Such ways can include equivalents to what is described herein. In addition, the invention may be practiced in combination with other systems. The following claims define certain combinations and subcombinations of elements, features, steps, and/or functions, which are regarded as novel and non-obvious. Additional claims for other combinations and subcombinations may be presented in this or a related document.
This patent application is a continuation of U.S. application Ser. No. 16/409,301, filed May 10, 2019, which is a continuation of U.S. application Ser. No. 15/423,453, filed Feb. 2, 2017, now issued as U.S. Pat. No. 10,299,668, which claims the benefit of and priority to U.S. Provisional Patent Application Ser. No. 62/290,220 filed on Feb. 2, 2016, entitled “Laryngoscope With Handle-Grip Activated Video/Audio Recording,” the benefit of and priority to U.S. Provisional Patent Application Ser. No. 62/449,922 filed on Jan. 24, 2017, entitled “Laryngoscope With Changeable Blade Shape And Size,” and the benefit of and priority to U.S. Provisional Patent Application Ser. No. 62/290,195 filed on Feb. 2, 2016, entitled “Carbon Monoxide (CO) Environmental Monitoring on an Emergency Medical Device, Monitor or Defibrillator” the disclosures of which are all hereby incorporated by reference for all purposes. The present disclosure is further related to prior-filed U.S. patent application Ser. No. 14/491,669 field on Sep. 19, 2014, entitled “Multi-Function Video System,” and to prior-filed U.S. patent application Ser. No. 11/256,275 filed Oct. 21, 2005, entitled “Defibrillator/Monitor System having a Pod with Leads Capable of Wirelessly Communicating,” the disclosures of which are hereby incorporated by reference for all purposes.
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