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Another day, another extubation

***Click on links to see pictures***

Well, I made it through another day of clinicals. It wasn't a very exciting day but it was ok. I did get my third extubation. That is when a patient who is on a mechanical ventilator has improved to the point where they no longer need it. Then you extubate (the opposite of intubate) them. Here's how it works.

First you explain to them whats going on. You get one of the pads that are normally placed under the patient and spread it out on their chest. You deflate the cuff that holds the ET tube in place and listen at their neck for air movement. If you don't hear air, that means the airway has swollen and you shouldn't remove the tube. Then you re-inflate the cuff. You then suction them out with the closed suction catheter that is attached. Then you suction out the mouth and oral cavity with the Yankauer (also known as the Yonker). Then you turn off the ventilator (or place it in standby as we did with the Servo I pictured to the right). This is to ensure that it doesn't spew secretions everywhere when you pull out the tube. Then you tell the patient to cough and you pull out the tube. You then place the patient on an aerosol mask with a cool mist provided by a large volume nebulizer. Then you hope for the best.

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