What to Do When You Can't Insert a Nasal Airway

Navigating Airway Challenges: The Smart Moves

Dealing with a patient who has an altered mental status can feel like walking a tightrope; one wrong move can lead to serious consequences. It's crucial to have a toolkit of techniques on hand, particularly when it comes to airway management. So, what do you do when you find yourself struggling to insert a nasal airway on one side?

The answer isn't as complicated as it seems. When you hit a wall using the right nare, what should be your next step? Before you panic and start second-guessing, let’s explore what you can do.

Think Left: Why Switching Nares Makes Sense

First things first, if you can’t score the insertion in the right nare, you could consider attempting it in the left nare. You might think, “Why switch sides?” Well, the nasal passages are not uniform. Just like a pair of shoes, one might fit better than the other! This isn’t just a matter of personal comfort; the anatomy of the nasal passages can differ significantly between individuals. You might come across obstructions or anatomical differences that can hinder the insertion process.

So, try the left nare! It’s a logical and efficient method that can save time when every second counts. Establishing a clear airway is non-negotiable in critical situations.

The Oropharyngeal Option

Now, you’re probably asking yourself: “What if the left nare doesn't work either?” Here’s the thing: You’ve got options! If both nares seem like they’re throwing a fit at your attempts, consider going for an oropharyngeal airway instead. This can be particularly useful in patients with altered mental status, as it bypasses some of the mucosal challenges that nasal airways may endure.

However, you have to be mindful. It’s all about technique; when inserting an oropharyngeal airway, be conscious of the patient's gag reflex. If they're truly altered in mental status, they might be less prone to gagging, but inserting without caution can evoke unwanted responses.

Oxygen: A Quick Fix?

What about supplemental oxygen? Sure, providing that can be critical, especially in cases of respiratory distress, but it’s not necessarily a substitute for securing an airway. Supplemental oxygen can help maintain oxygen saturation levels while you figure out the best method to manage airflow. However, remember that if the airway isn’t secure, no amount of oxygen is really going to fix things. So save the oxygen for when you need to buy yourself some time.

Stay Calm, Stay Focused

Sometimes, the toughest part about working in emergency medical situations is managing your own stress. You know what? It’s totally normal to feel that rush of anxiety when a procedure isn’t going as planned. Take a breath! Focus on what's essential—airway management.

If nothing else, remind yourself that nursing or EMT work is as much about problem-solving as it is about technical knowledge. Your training has prepared you for these moments. Keep your cool and trust your instincts as you navigate through the challenge.

Beyond the Basics: Other Factors at Play

Let’s take a moment to discuss something that often gets overshadowed in the heat of the moment: communication. If you’re working on a team, don’t hesitate to shout out for support or consult with a partner. Having a second set of eyes—or hands—can make all the difference, especially during high-pressure situations.

Verbalizing what's going on can also help to ground you. “Hey, I’m having trouble with the right nare; I’ll try the left.” This simple statement can clarify the situation for your team and lead to a collaborative approach. After all, you’re all in this together!

Final Thoughts

In conclusion, when faced with the challenge of inserting a nasal airway in a patient with an altered mental status, remember these key steps: try the left nare first, think about oropharyngeal options if needed, and communicate with your team.

The world of emergency medicine is filled with unexpected twists and turns, but having a few strategies in your back pocket can not only boost your confidence but also enhance patient outcomes. And when things get tough? Focus on the basics and keep the lines of communication open. They can pave the way through even the most challenging scenarios.

Now, go out there and tackle those airway challenges with resilience and determination. You’ve got this!