Abstract:
A hand held intubation camera device including a hand held display unit, the display unit including a trigger for actuating a camera. The device also including a disposable stylet connectable to the display unit, the stylet including a camera element formed at a distal end operable by the hand held display unit, and a light emitting element. The device also including a single use interconnect preventing a disposable stylet from being reinserted into the hand held display unit once removed following an initial use.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
       [0001]    The instant application claims the benefit of U.S. provisional application 60/836,002, filed on Aug. 7, 2006, the disclosure of which is incorporated herein by reference. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The present invention relates to a system to aid in the positioning, confirmation and documentation of an endotracheal tube in general, and more particularly to a disposable stylet connected to a display and storage device that is inserted within an endotracheal tube to aid in proper positioning, confirmation and documentation of the endotracheal tube within a patient. 
       BACKGROUND 
       [0003]    Intubation is a medical procedure in which an endotracheal tube (hereinafter “ET”) is positioned into the trachea, effectively bypassing the mouth, nose and throat, to provide oxygen directly to the lungs. Intubation is a common procedure performed on any person who cannot manage their own airway. In a hospital setting, this includes people receiving general anesthetic in preparation of surgery, but also includes many emergency situations, where injury and trauma impairs one&#39;s airway. 
         [0004]    Millions of intubations are performed each year in the U.S. but despite this frequency, complications due to improper or difficult intubations are an all too common occurrence. Injuries as a result of improper intubation account for nearly 25% of all anesthesiology malpractice claims. Failed ET intubations are one of the largest problems facing surgical teams and emergency responders today. Yearly there are hundreds of malpractice lawsuits filed relating to mishaps during intubation. Many of these lawsuits are quite serious stemming from serious injury and even death of the patient. 
         [0005]    The insertion of an ET is often accomplished using a laryngoscope, but using a laryngoscope requires skill and proper training. The laryngoscope is inserted into the mouth to push away the tongue and lift the epiglottis so that a view of the glottis (space between the vocal cords) is possible. The goal is then to feed the ET into the airway and the trachea instead of the esophagus (which is located directly behind the trachea), and then to maintain such placement during patient transport or until the ET is removed. If the ET is mistakenly placed in the esophagus the mistake can be fatal or lead to brain injury and permanent disability. Statistically, about 8% of all intubations are difficult, which leads to an increased chance of improper intubation. 
         [0006]    The problem is that even when a patient&#39;s mouth is open, even using a laryngoscope, the vocal chords are not visible, and by feeding the ET into the airway, even visual inspection of the glottis becomes blocked. Even if properly placed, a problem may still occur when proper placement of the ET is re-checked following placement for example, when patients are transported by ambulance after the patient has been intubated by emergency medical services, where the movement might have dislodged, or partially dislodged the ET. 
         [0007]    There are generally three types of instruments that have been utilized to provide video assisted tracheal intubation. The first is the ET itself, the second is the laryngoscope blade, and the third is an intubation stylet, i.e. a device which is slid through the center of the ET and aids in the insertion of the ET into the airway. In each case, an image is transmitted, usually via fiber optic material or the like, from the tip of the instrument to a display that is visible to the doctor during use of the instrument. 
         [0008]    With respect to the first two types of instruments, namely the ET and the laryngoscope blade, these generally tend to be modifications of the regularly utilized instruments. Specifically, some form of ultra thin fiber optic is integrated into the instrument which feeds to a display monitor at the end of the instrument or remote of the instrument. Such video-intuboscopy and video laryngoscopy have generally been utilized in hospital settings where extensive monitor equipment is available. Such devices have provided limited, if any, assistance to first responders such as EMS personnel. The video-optical intubation stylet that has been suggested also uses optical fibers for image transmission from the stylet tip to the video camera monitors. However, these also require remote imaging and provide difficult video monitoring, especially in emergency response conditions. 
         [0009]    It has also been recently suggested to use video electronics, such as a miniature electric camera which is incorporated in the distal end of the endotracheal tube itself or the stylet. However, no practical implementation of such device has been suggested and no suitable display mechanism has been provided to facilitate usage by emergency responding personnel. Furthermore, most of these devices that have been suggested provide complex structure with inadequate monitoring for the convenience of the medical personnel utilizing such instruments. 
       SUMMARY OF THE INVENTION 
       [0010]    A stylet for an ET comprises a distal end for viewing the position of the stylet or ET, and a proximal end for connection to a display and storage device. The distal end is preferably equipped with a light, a lens and means for translating visuals into electronics, such as, for example, a charged coupled device (CCD) or a sensor complementary metal oxide semiconductor (CMOS) device. The proximal end of the stylet is preferably equipped with a connector for connection to a display and storage device that allows for viewing the visuals experienced at the distal end. Thus, the distal end of the stylet is provided with one portion of an electronic camera, i.e., the portion that captures visuals, while the proximal end of the stylet is connected to a display and storage device that constitutes the other portion of an electronic camera, i.e., the portion that displays and stores the captured visuals. This splitting of the electronic camera function into a relatively inexpensive component (stylet) and a relatively expensive component (display and storage device) renders the stylet disposable, and allows for the use of a new, sterile stylet with each new procedure. This is also beneficial because the stylet is usually the only component of the system that makes contact with the patient and therefore there is no need to undergo the added expense of sterilizing the stylet if it can be disposed of instead. 
         [0011]    The display and storage device is preferably comprised of a handgrip that is coaxial with a connected stylet, and a display connected to the top of the handgrip, such that the display is angled in preferably two directions with respect to the axis of the handgrip. With this orientation, peering into the display is easily viewed while handling with one hand and permitting insertion of the stylet through the ET and into the patient with the other. Thus, the user&#39;s gaze is directed toward the patient and the ET and, at the same time on the display, which improves focus and coordination of the entire procedure as all instruments are within the user&#39;s view. The display and storage device is further equipped with a recording feature for recording the procedure if desired either as still photos or as a video clip, both which can be taken by a camera element in the stylet, and an output device for connecting the display and storage device to another device. Preferably, the display and storage device is provided with a USB port or the like for exporting captured footage to a computer or the like. 
         [0012]    Another aspect of the present invention is a hand held intubation camera device including a hand held display unit, the display unit including a trigger for actuating a camera. The device also including a disposable stylet connectable to the display unit, the stylet including a camera element formed at a distal end operable by the hand held display unit, and a light emitting element. The device also including a single use interconnect preventing a disposable stylet from being reinserted into the hand held display unit once removed following an initial use. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0013]      FIG. 1  depicts a hand held camera device, a stylet and an endotracheal tube according to one aspect of the present invention; 
           [0014]      FIG. 2  is a rear view of the hand held camera device of  FIG. 1 ; 
           [0015]      FIG. 3  is a front view of the hand held camera device of  FIG. 1 , showing a USB port and memory card slot; 
           [0016]      FIG. 4  is a side view of the hand held camera device of  FIG. 1 ; 
           [0017]      FIG. 5  is a front view of the hand held camera device of  FIG. 1 ; 
           [0018]      FIG. 6  is a side view of the hand held camera device of  FIG. 1 ; 
           [0019]      FIG. 7  is a bottom perspective view of the hand held camera device of FIG. 1; 
           [0020]      FIG. 8  depicts a stylet according to another aspect of the present invention; 
           [0021]      FIGS. 9-11  show insertion of a stylet into a hand held camera device; 
           [0022]      FIG. 12  shows a single use safety guard preventing re-insertion of a stylet following initial use; 
           [0023]      FIG. 13  shows a comparison of new and used stylets; 
           [0024]      FIG. 14  shows a length stop according to one aspect of the present invention; 
           [0025]      FIG. 15  shows a cap of a length stop; 
           [0026]      FIG. 16  shows a length stop inserted into a port; 
           [0027]      FIG. 17  is a cross-sectional view of a distal end of a stylet according to one aspect of the present invention; 
           [0028]      FIG. 18  is an perspective view of a distal end of a stylet shown in  FIG. 17 ; 
           [0029]      FIG. 19  is an perspective view of a distal end of a stylet shown in  FIG. 17 ; 
           [0030]      FIG. 20  is an perspective view of a distal end of a stylet shown in  FIG. 17 ; 
           [0031]      FIG. 21  depicts a medical professional using the hand held camera device and stylet of the present invention to insert an intubation tube in a patient; 
           [0032]      FIG. 22  shows a distal end of a stylet according to another aspect of the present invention; 
           [0033]      FIG. 23  shows the distal end of the stylet of  FIG. 22  with the housing removed; 
           [0034]      FIG. 24  shows the distal end of the stylet of  FIG. 22  with the lens and barrel being removed; 
           [0035]      FIG. 25  shows the distal end of the stylet of  FIG. 22  with the lens and barrel; 
           [0036]      FIG. 26  shows the distal end of the stylet of  FIG. 22  with the lens holder removed. 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0037]    The following detailed description is of the best mode or modes of the invention presently contemplated. Such description is not intended to be understood in a limiting sense, but to be an example of the invention presented solely for illustration thereof, and by reference to which in connection with the following description and the accompanying drawings one skilled in the art may be advised of the advantages and construction of the invention. In the various views of the drawings, like reference characters designate like or similar parts. 
         [0038]      FIG. 1  shows an endotracheal tube (ET)  100  for insertion into a patient. Though a variety of sizes are known to those of skill in the art a single size is shown here and the invention described herein is alternatively usable with any of the other sizes without departing from its scope. 
         [0039]    The ET includes a proximal end  102 , which remains outside the patient upon insertion. The proximal end  102  includes a port  103  which receives a stylet  200 . The port  103  is formed with a tab  104  for manipulation of the ET  100  and allow for easier grasping of the ET during use. The ET  100  includes a distal end  106 . The proximal end  102  and distal end  106  are connected via a lumen, and both ends have openings therein to allow for passage of a stylet, as will be discussed below, and allows for the passage of oxygen following insertion. The distal end  106  has a balloon cuff  110  near the distal end to secure the ET in the trachea of a patient. The balloon cuff  112  is inflated by an inflation line  108  which is connected to a pressurized air or oxygen source (not shown). 
         [0040]      FIG. 1  shows a disposable stylet  200 . The stylet  200  include a distal end  202 , including an illumination source, and a camera for viewing the insertion of the ET  100 . On a proximal end  204  is a single use lock out mechanism that will be discussed below. In sliding engagement along the length of the stylet  200  is a length stop  400 , which will also be discussed in detail below. The stylet  200  is preferably made out of malleable or semi-malleable material so that it can flex or alter its shape as it passes into the ET  100  to accommodate the needs and biology of the patient. The stylet  200  is preferably coated with a silicon material to facilitate passage through the ET  200 . The distal end  202 , though shown as substantially straight, may optionally be curved to coincide with the curvature of the ET  100 , and ease insertion therein. 
         [0041]      FIG. 1  also includes a portable handheld camera display  300 . As described above, the stylet  200  includes a camera. Pictures taken by the camera are shown on a display  302 . The controls of the handheld camera display  300  is shown in greater detail in  FIG. 2 . The controls includes a 30-second timer  304 , a mode or video button  306 , a play button  308 , a next button  310  and a back button  312 . The buttons can be depressed either by the user&#39;s hand not holding the camera display  300 , or when occupied, the user&#39;s thumb.  FIG. 3  shows a cover  314 , which protects a recordable media slot  316 , in which a recordable media such as SD-ram or other flash memory  318  is inserted.  FIG. 3  also shows a USB port for downloading images taken by the camera to a computer. 
         [0042]    In addition to still photographs of the positioning of the ET, the handheld camera display  200  and stylet  200  with camera element can be used as a video camera to make video clips of the entire insertion procedure. As will be appreciated the making of video clips requires additional memory of the recordable media, however, this is well within the current state of recording media technology. 
         [0043]    To use the camera display  300 , a user presses the play button  308 . For initial activation, pressing the play button  308  starts the device from an off or suspended state. Pressing the play button  308  the first time causes the last picture taken by the camera and recorded on the recordable medium  316  to be displayed on the display  302 . 
         [0044]    Modes of operation include a play mode, which displays pictures which have been taken, and a shoot mode, which activates the camera and takes pictures. The Next and Back buttons  310  and  312  are used to scroll through the pictures or video clips on the recordable media. 
         [0045]    Upon taking a photo or video clip, the date, time and if desired other identifiers such as the name or ID of the patient may be added to the photographs or video clips to document the proper placement of the ET  100  in a patient. Under one preferred embodiment, upon depressing the trigger or shoot button  322 , shown in  FIG. 4  causes a series of six pictures to be taken in succession, at for example a 0.2-15 second delay. This delay may be set by the user, depending upon the procedure being under taken. For example, for initial insertion, in conjunction with the 30-second timer, it may be desirable that the pictures be taken every 5 seconds, to show that placement was proper and timely and within the 30-second time limit for proper intubation. Alternatively, if making a quick check of the placement of the intubation tube before transferring a person from an ambulance to a gurney for movement into a hospital, a faster time period may be desired. Further the delay may be set by the manufacturer, thus producing a standardized set of photos of video for every intubation procedure.  FIG. 4  also shows an on/off switch  324  for turning the device on and off as desired. However, the operating system of the device also includes an automatic shut off, which powers down the device if no buttons are pushed in a certain time period, for example, for a period of two minutes. 
         [0046]    The 30-second timer is useful for the practitioner, as it has been determined that 30 seconds is an optimal time period for insertion of an ET. Taking longer can result in a lack of oxygen to the patient. One method in the past that has been taught to medical personnel is to hold their own breath, during the insertion. However, this is imprecise, to say the least, and can cause the medical personnel to rush the insertion. The 30-second timer provides a better alternative, and with the inclusion of alarms at various timings including 15, and 5 seconds, or at other desirable time periods, the medical professional can accurately gauge their progress in the insertion of the ET  100 . 
         [0047]    Another feature of the present invention is that the orientation of the portable handheld camera display  300 . First, in  FIG. 4 , the top portion  326  of the device  300  has an angle to the handle  328  of approximately 110 degrees. That is the top portion  326  and the handle  328  are at an angle to each other of approximately 20 degrees greater than perpendicular. This causes the display  302 , to be angled in the direction of the user, when the user grasps the handle  328  in a manner such that the user&#39;s index finger is positioned over the trigger  322 . 
         [0048]    In addition to the angling upwards of the display  302  in relation to the handle. As shown in  FIG. 5 , the bottom portion  330  and top portion  326  are also angled with respect to the handle  328 .  FIG. 5  shows approximately a 20 degree angle, that is when looking at  FIG. 5  the handle  328  appears to be angled to the right approximately 20 degrees. This results in the display  302  being not only angled up but also to one side, both of which allow for better viewing of the display during insertion. Other angles of orientation may be incorporated into the device without departing from the scope of the present invention. 
         [0049]      FIG. 6  shows another side view of the camera display  300 , showing a delete or format button  332 , which can be used to delete images from the recording medium  318 .  FIG. 6  also shows a brightness switch  334  which is used to control the brightness and intensity of the display  302 . 
         [0050]      FIG. 7  shows a bottom view of the hand held camera display  300 . From this view a battery compartment  326  can be seen, in this compartment batteries, which power the device are stored. It has been found that by keeping the power source in the hand held camera device  300 , the size of the distal end  202  of the stylet  200  can be optimally minimized. Also shown in this view are a stylet insertion cavity  338  and stylet release buttons  340 . 
         [0051]    A stylet  200  from  FIG. 1  is also shown in  FIG. 8 . The stylet  200  includes a distal end  202  and a proximal end  204 . In use the proximal end, and specifically, an interface  206  is inserted into the insertion cavity  338  of the hand held camera display  300 . The battery in the hand held camera display  300  powers a camera element and led lights which are housed in the distal end of the stylet  200 . The stylet  200  has wires running inside of the protective coating  208  to connect the distal end  202  with the interface  206  electrically, and therewith the hand held camera display  300 . 
         [0052]    The interface  206  of the stylet  200  includes a single use lock out mechanism. The single use lock out mechanism  210  may be for example a button  210  on one side of the interface  206 . When the stylet is new and unused, the button  210  is in a depressed position. This allows the interface to be inserted into the stylet insertion cavity  338  of the hand held camera display  300 . In this position, the stylet  200  and hand held camera display are ready for use, that is, they are ready to be positioned within an ET  100 , and to allow viewing of the positioning of the ET and the taking of pictures and/or video of the placement. 
         [0053]    Once insertion is completed, or after all uses with a particular patient are completed, the stylet  200  is removed from the hand held camera display  300  by depressing the release button(s)  340 , located on either one or both sides of the handle  328 . This action causes the button  210  to pop out and create a physical barrier to re-insertion of the stylet  200  into the hand held display device  300 . This promotes sanitation and removes the need for sterilization of the stylet, which heretofore was the requirement for re-use. This procedure from insertion through removal of the interface  206  with the hand held camera display  300  is shown in greater detail in  FIGS. 9-12 .  FIG. 9  shows a new stylet  200 , with the button  210  not extended being inserted into the base of the hand held camera display  300 .  FIG. 10  shows the same elements from more of a bottom view.  FIG. 11  shows the stylet  200  fitting within the hand held camera display  300 .  FIG. 12  shows that upon removal, accomplished by depressing the release buttons  340 , the button  310  on the interface  206  of the stylet is forced into an extended position. This position effectively prevents re-use of a stylet  200 , as it cannot be physically inserted back into the hand held camera device  300 . 
         [0054]      FIG. 13  shows a sample comparison of interfaces  206  of stylets  200  in a new and a used condition. Though described herein as a button which prevents physical re-insertion of the stylet  200  into the hand held camera display  300 , other security devices, to prevent the reuse of the stylets can also be used either singularly or in conjunction with button  210 . Other security means could include an identification means in the interface of the stylet, which is recorded by the hand held camera display  300 . Following removal if a stylet  200  having such an identifier is reinserted, the hand held camera display  300  will cease to operate unless a different, never used stylet is inserted. Another, method might include, the hand held camera device  300  itself placing an identifier on the stylet  200  such that if that stylet  200  is ever placed into another hand held camera device  300 , it too will not operate unless a new and unused stylet  200  is inserted. Other security methods to ensure the single use only aspect of the disposable stylet are also considered within the scope of the instant invention. 
         [0055]    Another aspect of the present invention is the length stop  400 , shown in  FIG. 1 . This length stop  400  provides a means of controlling the length of the stylet  200  to be inserted into the ET  100 . The length stop  400  is shown in greater detail in  FIG. 14 . The length stop  400  includes a cap  402  and having a plunger  404 . The length stop also includes a body portion  412 . The length stop  400  slides over the stylet  200  while the plunger  404  is depressed. Upon determining a desired length of the stylet  200  for insertion into the ET  100 , the plunger  404  is released, and a biasing means  406  causes the plunger  404  to impinge on the stylet  200  and substantially prevent the movement of the length stop  400  on the stylet  200 . 
         [0056]      FIG. 15  shows an internal view of a cap  402  of the length stop  400 . The cap  402  includes a stationary portion  408 , and the plunger  404 . The plunger  404  is biased by the biasing means  406 . Both the stationary portion  408  and the plunger  404  include orifices  414 . When the plunger  404  is depressed against the biasing means to the point of contacting the stops  410 , the orifices  414  substantially align. When the plunger is released, the biasing means  406  causes the orifices  414  to no longer align, and the edges of the orifice in the stationary portion  408  and the plunger  404  each impinge on the stylet  200  and prevent the movement of the length stop  400  on along the stylet  200 . In addition, the edges of the orifices may include serrations or ridges to assist in the gripping of the stylet  200 . 
         [0057]    The body  412  of the length stop  400  may optionally have a tapered profile as shown in  FIG. 14 . This tapered profile allows for ease of insertion of the length stop into the ET  100 , as shown in  FIG. 16 . Specifically the tapered profile of the length stop  400  enables insertion into the port  103 , which is formed on the proximal end  102  of an ET  100 . This enables a medical professional to set the length of the stylet  200  using the length stop  400 , and insert the stylet up to the end of ET  100 , and have confidence that this length does not cause the stylet  200  to extend too far or be too short. This reduces the time necessary for insertion of the ET  100  and the taking of pictures using the camera in the stylet  200 . 
         [0058]    In practice the medical professional may set the length stop  400  on the stylet  200  and insert the stylet  200  into the ET  100  such that the length stop  400  is inserted into the port  103  prior to insertion of the ET  100  into the patient. Alternatively, in some instances it may be desirable to set the length stop  400  on the stylet  200 , but not insert the length stop  400  into the port  103 , until after the ET  100  is positioned in the patient. 
         [0059]    It will also be appreciated that the stylet  200  can be used independent of an ET  100  to image and record other visuals from other locations in the body, and its use and benefit is not dependent on the concurrent use of an ET or other protective covering. Further the stylet  200  and hand held camera device  300  can be used to examine other orifices of the body including the anus, nostrils, ears, etc. Still further, the stylet  200  and hand held camera device  300  may be used in other animals, not just humans. And in another preferred embodiment the stylet  200  may be used in industrial applications as well, for example for inspecting the internal components of an internal combustion engine, or other small spaces, requiring inspection. 
         [0060]    To assist in determining this length, the stylet  200  may include markings denoting standard ET  100  lengths, such that a medical professional need only match the known ET  100  size to the corresponding marking on the stylet  200  and set the length stop to that point to ensure accurate insertion of the stylet  200 . Other arrangements of a length stop  400  can be envisioned by those of skill in the art, and are considered within the scope of the instant invention. 
         [0061]      FIG. 17  shows a cross section view of a distal end  202  of the stylet  200  according to one embodiment of the present invention. The distal end  202  includes a first housing  206  and shown separated and extended from the body portion  208  by a plurality of signal and power wires  210 . While  FIG. 17  shows three wires, it will be understood that other arrangements may be used as needed to transmit either a signal function or a power function or both. Alternatively, a bundle of wires can be utilized to perform the same functions. The wires  210  terminate in a printed control board (PCB)  212  onto which is placed a CCD or sensor CMOS module  214  (hereinafter a CMOS  214  module for purposes of convenience) or the like that functions as a camera component, and a plurality of LED leads  216 ,  218  that extend to LEDs  220 ,  222 . 
         [0062]    As shown more clearly in  FIG. 18  the LED leads  216 ,  218  are positioned on either side of the CMOS module  214 , which represents an efficient use of space since CMOS devices are typically square and therefore there is room on the side within the circumscribing circle on which the CMOS module  214  is supported so that the leads  216 ,  218  which connect to LEDs  220 ,  222  can be connected without requiring additional space. 
         [0063]      FIG. 19  shows the plurality of lenses  224  and  226  retained within the second housing  228  that is spaced between LEDs  220  and  222 . In operation, the LEDs  220 ,  222  illuminate images (not shown) that are transmitted through the lenses  226 ,  224  to the CMOS module  214 , which convert the images to electronic signals that are delivered via the signal and power lines  210  through the stylet  200  and are then displayed on the hand held camera display  300  where the electronic signals are converted back to images. While the LEDs  220  and  222  are shown on opposite sides of the CMOS  214 , they may also be on two contiguous sides of the CMOS such that the LED&#39;s are at right angles to one another. 
         [0064]      FIG. 20  shows the lenses  224  and  226  and the second housing  228  inside of the first housing  206 , and connected via the wires  210  to the body portion  208  and the remainder of the stylet  200 . 
         [0065]    With this orientation, as shown for example in  FIG. 21  peering into the hand held camera display  300  is akin to peering down the stylet  200  and into the patient  500 , since the stylet is directed through the ET  100  and into the patient  500  during use. Thus, the user&#39;s gaze is directed toward the patient  500  and the ET  100  and, if used during insertion of the ET  100 , the laryngoscope  350  which improves positioning and coordination of the entire procedure as all instruments are aligned within the user&#39;s view and the user is not required to divert his or her gaze away from the patient. 
         [0066]    The batteries stored under the battery cover  336  provide power to the CMOS module camera component  214  via wires  210  extending through the stylet  200 . The hand held camera device  300  could also be provided with an A/C connection to provide A/C power if desired. Wires  210  also connect the camera component with the hand held camera  300 . Optionally, the CMOS module camera component  214  could be operably connected to the hand held display device  300  by a remote connection if the system also includes a remote transmitter (not shown) in the stylet  200  and a receiver (not shown) in the hand held display device  300  for receiving video signals from the transmitter. Alternatively, such a system can include infrared technology or the like. The CMOS module  214  and related wireless transmitter (not shown) could also communicate with an alternate display, or other equipment such as remote locations via Bluetooth™ technology. Such communication can also be used to transmit the information via the Internet or the like, thereby facilitating real-time remote incident analysis, advice, assistance, and/or teaching 
         [0067]    Construction of the stylet  200  in the above-described manner enables the stylet  200  to be disposable. The components used are relatively inexpensive components (i.e. CMOS module, lenses and LEDs), as compared with other stylets currently in use. No fiber optic lines are used preferably such that the stylet  200  is much more flexible that known stylets. Further, by placement of the light source at distal end  202 , there is no need to transmit light the length of the stylet  200 . The positioning of the CMOS  214  at the distal end  202  of the stylet  200  enables the entire system of the stylet  200  and hand held camera device  300  to operate as a single camera device. 
         [0068]    Another orientation of the distal end  202  of the stylet  200  is shown in  FIGS. 22-26 . In  FIG. 22 , a distal end  202  of the stylet  200  is shown having a substantially continuous cross section. This helps eliminate the possibility of the stylet  200  becoming lodged in the ET  100 . The distal end  202  includes a housing  206  which may be transparent  205 .  FIG. 23  shows the distal end  202  following removal of the housing  205 . In this view the lens  226  is shown formed integrally with a barrel  227 . The barrel  227  and lens  226  are inserted into a holder  229 . On the top and bottom of the holder  229  are formed LEDs  220  and  222 . These LEDs are connected via wires  210  to the hand held camera device  300 . In this embodiment there are eight wires  210  used. Two each for each of the LEDs and four which are connected to a T-shaped PCB  212 . Unlike the design described above, the LEDs do not connect back to the PCB, but are directly wired to the power source, in the hand held camera device  300 .  FIG. 24  shows how the integral lens  226  and barrel  227  can be removed from the holder  229 .  FIG. 25  shows that removal of the holder  229  exposes the CMOS  214 , which is formed on a portion of the T-shaped PCB  212 . Finally,  FIG. 26  shows the holder  229  removed, and the wires  210  coming around the T-shaped PCB  212 , on which the CMOS  214  is mounted. It is believed, that by using the smallest CMOS currently sold, this arrangement minimizes the size of the distal end of the stylet  200  as well as minimizes the cost of production. 
         [0069]    Another aspect of the present invention is the packaging of the ET  100  and stylet  200  as a pre-connected kit for immediate use. This packaging is particularly useful for emergency responders where seconds are critical to successful treatment. By having the stylet  200  and ET  100  packaged together with the stylet  200  pre-inserted into the ET  100  at the correct distance, the emergency responder need only open a single sterilized package and insert the ET  100  immediately. At the responder&#39;s choice the ET can be inserted before or after connection of the stylet  200  to the hand held camera device  300 . 
         [0070]    The stylet  200  can also be packaged and sold separately. This may be useful, particularly for emergency rooms and the like who receive patients or hold patients who have already been intubated, but the process of moving the patient may have caused the ET to shift, requiring review of its placement using the stylet  200 . 
         [0071]    While the present invention has been described at some length and with some particularity with respect to the described embodiments, it is not intended that it should be limited to any such particulars or embodiments or any particular embodiment, but it is to be construed so as to provide the broadest possible interpretation in view of the prior art and, therefore, to effectively encompass the intended scope of the invention.