Hi everyone. Need some advice. I'm coming off orientation soon and I need some guidance. I've admitted many post op heart pts and one of the things I'm still not completely comfortable with is the waking up/extubation part.
When it's time to reverse them and shut off the propofol, I'm so nervous bc sometimes they are all over the place and its hard to calm them down. I normally have fentanyl right there if I need it. I wish there was a recipe to make them wake up and calm.
Does anyone have any tricks from their exp? Thanks for listening.
Jul 1, '13
There's no one magic solution. You try to figure out why they are agitated. Most importantly, do you know they aren't in tamponade? Because that will make them try to crawl out of their skin. Chest tubes are all patent and draining? HCT is good? CI and SVO2 good? BP good? Yes? Pain under control? (sometimes you just have to guess). Sometime's it just their personality. They are going to be a jerk because that's who they are and they are going to 'buck the vent' until they go home. Got a gut feeling that something ain't right? Just can't put your finger on it? Re-sedate and figure it out. Don't feel bad about it. If they're breathing good, gasses are good, just pull it. If you were wrong, well, you gave it your best and just go from there. Just rule out the nasties first so you know there isn't something else besides the ET tube making them crazy, and go from there. It just takes a while to get a feel for it I guess. (15 years of experience here)
Last edit by Biffbradford on Jul 1, '13