There is a dearth in literature when it comes to defining the role of the emergency nurse during rapid sequence induction

and endotracheal intubation. However, from experience working in accident and emergency one can say that there are certain vital things the emergency nurse is responsible for. Before RSI and ET intubation, the emergency nurse should make sure that all the equipment, which may be required during the procedure, is functioning properly and readily available. This includes the wall mounted oxygen point, suctioning unit and adjuncts 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 the nurse in charge of the resuscitation area. It is good practice and in most cases the anaesthetic doctor will withdraw the drugs required and have them prepared. However, the emergency nurse has to make sure that the 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 to assist 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, the nurse 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 patients shoulders and back to make the patients airway 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 the responsibility of the nurse to follow the anaesthetists instruction step by step. The nurse should then perform cricoid pressure this flattens the oesophagus and gives the anesthetist a better view of the trachea. One should never release cricoid pressure until the 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 to vomit, it is the only instant when it is advisable to release (REFERENCE). At this stage the anaesthetist would have pre-oxygenated the patient, inserted the laryngoscope in position and the nurse would be holding cricoid pressure. The nurse should have suctioning equipment at hand suctioning performed as required - and the right size endotracheal tube should be handed to the anaesthetist when asked to. Once the tube is inserted and position checked (auscultation of lung fields and stomach) the nurse should release the cricoid pressure when asked to and secure the tube using tape or tube

holder. If a cuffed tube is being used, the nurse should inflate the cuff using a syringe. A CO2 detector should be attached to the end of the tube and connected to continuous monitoring. The position of the tube is finally confirmed by a chest x-ray. With the tube in position, continuous ventilation can be performed and the patient can be even connected onto a ventilator, if the equipment is available. It is the anaesthetists responsibility to set the ventilator to the desired settings. It is the nurses responsibility to regularly check that the patient is being adequately ventilated while assessing the airway and breathing. The nurse is responsible to ensure that the tube does not get dislodged (especially if the patient is being shifted from the trolley onto a bed or table if a CT or surgery is required). In addition, suctioning should be performed regularly and tape changed whenever required.