ANAESTHETICS AND AIRWAY
EXTUBATION
PromptClinical criteria to be met for extubation in ED
ResponseThink Patient factors, disease factors, department factors
Resolution of underlying issue requiring intubation
Straight forward intubation (not difficult tube)
Spontaneously breathing
Haemodynamic stability without need for inotropes
Respiratory parameters
Obeying commands
Resolution of underlying issue requiring intubation
Straight forward intubation (not difficult tube)
Spontaneously breathing
Haemodynamic stability without need for inotropes
Respiratory parameters
- Sats >95% on FiO2 <40%
- PEEP <5
- RR <30
- TV > 6mL/kg
Obeying commands
PromptList Non-clinical criteria to be met when extubating
ResponseSkilled staff in management of extubation (Nursing + medical)
Staff available to re-intubate if required
Equipment available for re-intubation
Rest of department workload stable
No more suitable place for this to occur (Eg: ICU in bed block)
Staff available to re-intubate if required
Equipment available for re-intubation
Rest of department workload stable
No more suitable place for this to occur (Eg: ICU in bed block)
PromptList Equipment required for extubation
ResponseSuction
O2 mask and supply
NIV setup
Intubation drugs + paralysis agent available and drawn up
Equipment available for urgent reintubation
O2 mask and supply
NIV setup
Intubation drugs + paralysis agent available and drawn up
Equipment available for urgent reintubation
PromptList Complications occuring with extubation
ResponseCough/sore throat - analgesia
Increased sympathetic response - Incrased HR, MAP, CO by ~40% - Analgesia, GTN, cease inotropes
Laryngospasm - jaw thrust, positive pressure ventilation, suction, low dose six, prepare for reintubation
Bronchospam - bronchodilators
Aspiration - Antibiotics, psotion upright, chest physio
Resp failure - NIV, reintubation
Increased sympathetic response - Incrased HR, MAP, CO by ~40% - Analgesia, GTN, cease inotropes
Laryngospasm - jaw thrust, positive pressure ventilation, suction, low dose six, prepare for reintubation
Bronchospam - bronchodilators
Aspiration - Antibiotics, psotion upright, chest physio
Resp failure - NIV, reintubation
PromptDescribe Management once extubated
ResponseOngoing observation and monitoring of respiratory function
Admission under appropriate team
Reassess history and examiantion
Management to address issues in stem
Admission under appropriate team
Reassess history and examiantion
Management to address issues in stem