In this podcast, I discuss extubating patients in the ED. Specifically, I deal with patients who have only been intubated for a few hours in distinction to extubation of the patient who has been lingering in your ED for 2-3 days. The best patients for this short-term extubation are those intox folks with a low GCS and signs of trauma, overdoses, or endoscopy cases.
My approach is outlined in this article; click on the link for the full text:
Weingart SD, Menaker J, et al. Trauma Patients Can Safely Be Extubated in the Emergency Department. J Emerg Med. 2009 Aug 22. [Epub ahead of print]
Here are the steps from the article:
Photo by EddieB55
Update
- George Douros has written another excellent guideline for ED extubation.
- Sara Gray has also done a swell job discussing SaraGray-ED Extubation
More on Extubation from the EMCrit Crew
- PulmCrit Wee – The meaning of nocturnal extubation is 42
- High-flow nasal cannula to prevent post-extubation respiratory failure
Now on to the Podcast…
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Scott Weingart
An ED Intensivist from NY.
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excellent, scott.
[…] Podcast 35 – Extubation in the ED (with a link to Scott Weingart’s paper and his […]
Would a bailey’s maneuver of placing an lma…like the air-q or i-gel while the patient is intubated be advisable in some conditions? Like a difficult intubation patient..only difficult after experiencing the intubation first hand?
Had a case this past weekend when GI asked for elective intubation to protect the airway for removal of a food impaction by meat in the esophagus. Lacking experience in intubation then extubating the patient in the ED we called anesthesia… the case was taken to the OR with intubation and extubation handled by anesthesia. We had no problems with intubation. Anesthesia wanted to do it themselves upstairs. Gi did their procedure upstairs. It was unclear who did the discharge after the bolus was removed.
Too bad this procedure wasn’t done with an lma in place. I think we would have bee less reluctant to extubate an LMA on this patient.
If you think about an LMA and where it sits, I think you’ll see it will not work for Upper Endoscopy. ED Extubation can and should be done. https://emcrit.org/podcasts/extubation/