This document discusses the nursing role in airway management. It emphasizes that nurses must ensure all patients have a patent airway and assess using ABCs of CPR. It also outlines important considerations like deterioration of consciousness compromising the airway, signs of obstruction, and techniques and devices for opening and maintaining a clear airway. The document provides guidance on indications for advanced airway devices, checklists for equipment, and the importance of teamwork in effective airway management.

1. Nurses role in Airway
management
DR.KP

2. • Ensure that all patients presenting to the ED
have an adequate and secure patent airway
• All nursing assessments should start with the
‘ABC’ of CPR
• Without a patent airway, any further patient
assessment is futile, and irreversible brain
damage will occur within minutes

3. Patient – talking; GCS – 15/15

4. Patient – talking; GCS – 15/15
But, Also remember that a conscious patient
with a GCS of 15 may still have debris or
secretions in the airway that must be assessed.

5. Caution!
• Any reduction in GCS can cause the tongue to
partially or completely fall back, thus
occluding the airway
• Also following facial trauma, there may be
presence of blood, swelling, and/or foreign
body such as teeth, in the airway

6. Most important question
• Is the airway patent?
YES
NO
Patient is able to say his
name
No stridor or abnormal
noise
No secretions or blood in
airwayPatient is not able to say
his name or is unable to
open his mouth or very
drowsy
Stridor or abnormal noise
present
Secretions or blood in
airway present

7. Nursing role
• Assess the airway for patency
• Use manual methods to open an obstructed
airway
• Use basic airway adjuncts to intervene if the
airway is compromised, e.g. suction, oral
airway

8. • Assist in the maintenance of the airway using
advanced airway adjuncts, e.g. intubation,
surgical airway
• Deliver O2, when required, using appropriate
methods
• Continually assess airway patency and
ventilatory status of the patient using clinical
observation and relevant monitoring

9. • Explain procedures clearly to the patient and
any family members

10. Look, Listen, Feel
• Standard assessment approach to be used in
unresponsive patients
• Look for chest rise and fall
• Listen for breathing and any abnormal airway
sounds
• Feel for breath

11. Look, Listen, Feel

12. Airway maneuvers
Head tilt – Chin lift Jaw thrust

13. Airway adjunct devices
• Oropharyngeal airway • Nasopharyngeal airway

14. Advanced airway devices
ET tubes LMA

15. Indications for definitive airway
Failure to maintain a patent airway and
protect against aspiration
• Inadequate gag reflex and inability to handle
secretions
• Decreased mental status (GCS < 8) not due to
a rapidly reversible cause (eg, hypoglycemia,
opioid overdose)
• Severe maxillofacial trauma

16. Failure to adequately oxygenate or ventilate
• Hypoxemia unresponsive to supplemental
oxygen, as measured by pulse oximetry with
good waveform
• Hypercapnea, as measured by ABG or end
tidal CO2 (ETCO2) with decreased mental
status or other adverse effect.

17. Anticipated clinical deterioration
• Status epilepticus, multiple trauma +/− head
injury, certain overdoses (TCA), penetrating
neck trauma, tiring asthmatic, etc.

18. Clinical Scenario examples
• Head Injury patient –
with poor GCS
• COPD patient – with
CO2 retention
• Epileptic patient –
with uncontrolled
seizures
• Sepsis patient – with
severe acidosis
• Face trauma patient
– with oral bleeding
• Drug overdose patient
– with respiratory
depression

19. Checklist for equipments required for
managing airway
• Personal protection equipments
• Monitor connected to patient – BP, SPO2, PR
• IV access, tourniquet
• Oxygen face mask, tubings
• OPA, NPA
• BMV device
• Suction device
• Laryngoscope and blades – all sizes

20. • ET tubes all sizes
• Stillet, Bougie
• Syringe for inflating cuff
• Cuff manometer, stethoscope
• LMA
• RSI drugs
• IV fluids and drugs for cardiac arrest
• Infusion / syringe pumps

21. • Tube securing tapes
• Ventilator and its tubing's
• ETCO2 monitor
• Transport team to shift to CXR bay for tube
position confirmation
• Post intubation management
• Magill forceps
• Difficult airway devices

23. Team work for airway management
Team leader / EP
Airway Nurse
IV nurse
Airway trolley
Multipara monitor
IV drugs and
fluids trolley
Back up nurse
/ Timer /
Documenter

24. • Always follow the team leader / protocol
• Be aware of basic terminologies and drug
pharmacology
• Always have a rapport with the IV nurse and
team leader
• Note timings of the procedure
• Ensure consent approval and good
communication with the relatives
• Have a debriefing with all team members after
the procedure

25. To Summarize…
• Always check airway patency for any patient
presenting to the ER
• Always bear in mind – Look, Listen and feel
• Assign the roles of team leader, airway nurse
and IV nurse
• All equipments and drugs should be checked
regularly
• Knowledge regarding different airway devices,
drugs and team work are essential for the
better management of the patient