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ett-preduringpost

ett-preduringpost

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Published by Christian Micallef

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Published by: Christian Micallef on Dec 08, 2011
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12/08/2011

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There is a dearth in literature when it comes to defining the role of the emergency nurseduring rapid sequence induction and endotracheal intubation. However, from experienceworking in accident and emergency one can say that there are certain vital things theemergency nurse is responsible for.Before RSI and ET intubation, the emergency nurse should make sure that all theequipment, which may be required during the procedure, is functioning properly andreadily available. This includes the wall mounted oxygen point, suctioning unit andadjuncts as well as self and oxygen inflating bags, different types and sizes of masks,circuits, laryngoscope handles in addition to straight and curved blades in different sizes,endotracheal tubes (size according to the APLS formula [(age +4) / 4], one size smaller and one larger), tape to fix the tube, stethoscope, carbon dioxide detectors and monitor (with all required leads for ECG, Spo2, CO2, etc.) and all the other equipment listed previously in (AAAAAA). All the above mentioned should be routinely checked by thenurse in charge of the resuscitation area.It is good practice and in most cases – the anaesthetic doctor will withdraw the drugsrequired and have them prepared. However, the emergency nurse has to make sure thatthe drugs required for RSI and the respective reversal agents are available if required.From experience, it is wise and of best practice to assign a specific emergency nurse toassist the anaesthetist during the procedure. This will make sure there is a continuation of care as the nurse is responsible in the pre, during and post-intubation periods. Ideally, thenurse should have prior experience in assisting during endotracheal intubation in order to provide the best quality of care.Having all the equipment readily available – the next thing is the proper positioning of the patient. Depending on the age and size of the patient, the nurse should use adjuncts -such as a rolled towel underneath the patient’s shoulders and back – to make the patient’sairway as easily accessible for endotracheal intubation as possible.After good communication between the anaesthetist and the nurse and the rest of the team – the anaethetist will then proceed to induce anaesthesia. At this stage, it is theresponsibility of the nurse to follow the anaesthetist’s instruction step by step. The nurseshould then perform cricoid pressure – this flattens the oesophagus and gives theanesthetist a better view of the trachea. One should never release cricoid pressure untilthe anaesthetist asks to - this ensures that there is no risk of gastric content aspiration.However, if the person performing the cricoid pressure feels that the patient is about tovomit, it is the only instant when it is advisable to release (REFERENCE).At this stage the anaesthetist would have pre-oxygenated the patient, inserted thelaryngoscope in position and the nurse would be holding cricoid pressure. The nurseshould have suctioning equipment at hand – suctioning performed as required - and theright size endotracheal tube should be handed to the anaesthetist when asked to. Once thetube is inserted and position checked (auscultation of lung fields and stomach) – the nurseshould release the cricoid pressure when asked to and secure the tube using tape or tube

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