A patient who was on ventilator and being ventilated for past few days, suddenly pulls out the endotracheal tube. What is the next step of management?
(A) Assess the patient, give bag and mask ventilation and look for spontaneous breathing (B) Sta bag and mask ventilation and reintubate (C) Sedate and reintubate (D) Make him sit and do physiotherapy
(A) Ans. a. Assess the patient, give bag and mask ventilation and look for spontaneous breathingIn self-extubation, assess the patient, give bag and mask ventilation and look for spontaneous breathing.Unplanned ExtubationUnplanned extubation of mechanically ventilated patients is relatively commonSelf-extubation refers to the patient's action, who deliberately removes the endotracheal tube (MC type of unplanned extubation, typically occur at night)Accidental extubation is attributed either to personnel's inappropriate manipulation of the tube during patient care or to a non-purposeful patient's action, e.g. coughing (mostly occur in the morning) Risk Factors for Unplanned ExtubationPatient factorsStaff factorsMaleDeliriumLight sedationDifficulty in securing tube (e g. facial swelling, facial burns)Previous unplanned extubationJunior staffNurse-to-patient ratioInadequately secured endotracheal tubeand/or checks