Clinical Pearls: Is It Time To Extubate, An Objective Approach
I spent a lot of years working at the bedside in the ICU. I can tell you one thing a nurse won’t tolerate and that’s an agitated and intubated patient. IYKYK. It’s scary, it’s physically taxing for you, and it’s not good for the patient. So naturally I would immediately call the provider with the “can we extubate” query when they woke up fighting. In my mind they were awake, right? Let’s liberate them from the ventilator!
This is only one scenario in which the clarity I gained in NP school blew my mind at how naive I was as a nurse. Maybe naive isn’t the right word, uninformed perhaps? IDK, I think my point is I didn’t realize there was a systematic approach to assessing extubation readiness. I didn’t properly think through all the reasons why a person would need a vent, nor appreciate all the ways in which a person can fail an extubation attempt. One key factor I learned is that objective medical analysis of the diagnosis and current exam is crucial in predicting risk and then weighing the risk/benefit ratio to determine what is safest for the patient. In this post I’ll walk you through the step by step process of performing this assessment to eliminate as much doubt as possible and set your patient up for success. Skip to the end for a bedside checklist.
Clinical Pearls: Intubation Starts Here
Beyond practicing the technique of intubating, nurse practitioners should spend time learning to identify the patients at risk of cardiac arrest. If you can put a finger on the major risk, there are definite strategies you can employ to improve odds of success without decline. In this article, I discuss specific approaches to: GIB/vomiting, hypoxia, shock, asthma, and metabolic acidosis.
Clinical Pearls: Evaluating For Intubation
When is it time to say it’s time? I think back on the really bad days of the pandemic when I walked from room to room asking myself this question repeatedly. Honestly, for intensive care unit level covid that’s what it felt like - a few random meds that typically didn’t help, supportive care, and careful vigilance for when it was time to go on the dreaded vent. Our patients feared it, our families feared it; it was the elephant in the room every time you walked in. Outside of covid pneumonia, there are a million reasons why a patient needs mechanical vent support and failing lungs are just one component. This is a very common question I get asked when I am training a nurse practitioner student Here’s how I approach evaluating a patient for intubation need.
Clinical Pearls: Pleural Effusions
Pleural effusions can be a big barrier to improving respiratory status in the ICU. Deciding how and when to treat them becomes easier once you break down how to diagnose and treat.