they know when they're ready . . .

detroitdano · Feb 13, 2010

People that extubate themselves and never have to be reintubated crack me up. Typically if you've got that kind of strength, intubation is most likely unnecessary at that point, haha.

sunnycalifRN · Feb 13, 2010

Yep, this guy was so obviously ready . . . I mean, his handwriting was "perfect", he was calm, breathing 16, etc, etc. . . I had told him to please be patient, but . . . oh, well.

The problem is that the interns and residents are "not authorized" to give the extubation orders, must be chief resident or fellow. Actually, recently, one of my fellow ICU nurses had some surgery done (at another hospital) and she also self-extubated because they were piddling around, waiting for the textbook ABG.

I wish they'd just give us a protocol!!

scoochy · Feb 13, 2010

They certainly do know when they are ready!

Ivanna_Nurse, BSN, RN · Feb 19, 2010

Sunny, your description of the little raspy voice made me laugh. :) I agree with you 100% Ivanna

aCRNAhopeful · Feb 19, 2010

What is the risk of vocal cord damage when a patient self extubates? I'd probably consider self extubating too if I were stuck on a vent any longer than necessary. I would probably try to see if I could cut the cord to the cuff first but I think I'd find a way.

sunnycalifRN · Feb 20, 2010

depending on how inflated the ETT cuff is, vocal cord damage from self-extubation could occur. And, you don't have to cut the cuff line, I've had a patient rip the valve off the end, and the cuff definitely deflated!

aCRNAhopeful · Feb 26, 2010

Good to know

blueheaven · Feb 26, 2010

All I can say is when I extubated myself...one of the WORST sore throats that I've ever had!!!!

Ahhphoey · Feb 27, 2010

Sometimes our ICU team is soooooo slow to give us the "OK" to extubate some of our post-op patients . . . example, patient off all sedation for 3 hrs . . . wide awake, writing notes (that are legible), on 35%, PEEP 5/PS 5 . . . hemodynamics are fine, ABG perfect. He's good to go! I ask the intern for orders . . . he's got to ask his resident . . . who has to ask his chief resident . . . who has to ask the fellow . . .
Meanwhile, I'm fiddling around with something or other . . . and I hear this raspy voice, "couldn't wait any more" . . . the patient just pulled the tube himself. Hahaha!! I think if I was a patient, in the same situation, I'd do the same thing!!!:D

:lol2: Too funny! Unfortunately, the only patient I ever had to extubate herself was far from ready and had to be emergently reintubated, and later trached.

sunnycalifRN · Mar 1, 2010

Too funny! Unfortunately, the only patient I ever had to extubate herself was far from ready and had to be emergently reintubated, and later trached.

Oh, yes . . . we had a patient who was no where near ready for extubation, who just woke up from sedation, and before anyone could stop him, extubated himself . . . immediately became stridorous and required an emergent cricothyrotomy to get an airway. This isn't the type of patient I'm referring to.

BurgdorfRN · Mar 1, 2010

Yep, this guy was so obviously ready . . . I mean, his handwriting was "perfect", he was calm, breathing 16, etc, etc. . . I had told him to please be patient, but . . . oh, well.
The problem is that the interns and residents are "not authorized" to give the extubation orders, must be chief resident or fellow. Actually, recently, one of my fellow ICU nurses had some surgery done (at another hospital) and she also self-extubated because they were piddling around, waiting for the textbook ABG.
I wish they'd just give us a protocol!!

Our post op-CABG orders give parameters for the RRT so we don't have to get the orders to pull the ET tube.