INTUBATED PATIENT. Step by Step 4-16-07 Dora M Alvarez MD. INITIAL PROCES. Call from ED requesting bed for and intubated patient
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Step by Step
Dora M Alvarez MD
Review /Check X Ray if not done before and document ET tube position
2. If patient is intubated because:
- Patient should remained, deeply sedated /paralyzed and given full respiratory support till hemodynamically stable
4. Facial trauma, protective airway > Patient should remained, deeply sedated /paralyzed? and given full respiratory support till airway is consider maintainable.
2. Off sedation, awake, able to follow up commands, (open eyes spontaneously)
3. Positive gag reflex, good cough effort
4. Able to maintain open airway.
5. Able to lift Head and grip
6. Tolerating weaning down Ventilator support to
7. Patient is breathing on his own, without significant effort or increase work of breathing (retractions) and has been able to maintain an normal Pa CO2 by ABG and /Or ETCO2
8. Patient is hemodynamically stable
9. For patient who can cooperate and able to follow directions, ask respiratory therapy to check NIF (Negative Inspiratory Flow) which assess respiratory muscle strength.
10. “If Patient is trying to take the tube out” > and fits above criteria, wean quickly to prevent accidental extubations.
2. Nasal CPAP
3. CPAP / SIMV