Extubations

[KungPOWChicken]

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So I had this case today where on emergence the patient had clear signs of being extubatable. 1) 4/4 twitches prior to reversal agent. 2) TV's 650. 3)Spontaneous eye opening. To me this patient clearly was extubatable. My staff comes in the room I'm about to pull to tube and she's having him squeeze her hand debating whether he is strong enough because his had grip "feels somewhat weak". I'm thinkin WTF. I've had other staff who've made patients suffer trying to assess they're muscle strength like this while others who have the balls to pull the tube using some common sense. Obviously if the patient is borderline on their reversal or a difficult intubation you've got to use caution but not having any balls and seeing your patients' eyes pop out with pressures through the roof is a little crazy

 

[dfk]

So I had this case today where on emergence the patient had clear signs of being extubatable. 1) 4/4 twitches prior to reversal agent. 2) TV's 650. 3)Spontaneous eye opening. To me this patient clearly was extubatable. My staff comes in the room I'm about to pull to tube and she's having him squeeze her hand debating whether he is strong enough because his had grip "feels somewhat weak". I'm thinkin WTF. I've had other staff who've made patients suffer trying to assess they're muscle strength like this while others who have the balls to pull the tube using some common sense. Obviously if the patient is borderline on their reversal or a difficult intubation you've got to use caution but not having any balls and seeing your patients' eyes pop out with pressures through the roof is a little crazy

yea, i guess i would too after a nice anesthetic/pain control/intrusive surgery/NPO for x hours... gimme a break.

 

[urge]

Sounds like your attending is over cautious. However, I cannot blame her for checking. I have extubated people with normal tidal volumes who are totally weak and cannot even maintain a patent airway because I trusted the anesthetist (4/4 tof, sustained... my arse!) It's the attending who looks like a douchebag when the pt craps out.

 

[BIS40]

do my new favorite.........im a peds fellow and kids, especially teens can wake up rough.........if they are staying in house, the precedex wake up is the bomb..........1 mcg/kg over 15 minutes timed to extubaton.....open your eyes......great

 

[2win]

are you a CRNA? or a student? Just asking to taylor my answer...

 

[jetproppilot]

So I had this case today where on emergence the patient had clear signs of being extubatable. 1) 4/4 twitches prior to reversal agent. 2) TV's 650. 3)Spontaneous eye opening. To me this patient clearly was extubatable. My staff comes in the room I'm about to pull to tube and she's having him squeeze her hand debating whether he is strong enough because his had grip "feels somewhat weak". I'm thinkin WTF. I've had other staff who've made patients suffer trying to assess they're muscle strength like this while others who have the balls to pull the tube using some common sense. Obviously if the patient is borderline on their reversal or a difficult intubation you've got to use caution but not having any balls and seeing your patients' eyes pop out with pressures through the roof is a little crazy

Ahhh, the joys of academic medicine.....

 

[huktonfonix]

You didnt give any info about the patient. To me that and the ease of intubation would be the main factors. In other words most young healthy patients can get away with less than adequate NMB recovery (doesnt mean we should do this, it just means we get away with it a lot). An older sicker patient with less reserve may not tolerate this or the potential aspiration risk as well.

 

[Planktonmd]

So I had this case today where on emergence the patient had clear signs of being extubatable. 1) 4/4 twitches prior to reversal agent. 2) TV's 650. 3)Spontaneous eye opening. To me this patient clearly was extubatable. My staff comes in the room I'm about to pull to tube and she's having him squeeze her hand debating whether he is strong enough because his had grip "feels somewhat weak". I'm thinkin WTF. I've had other staff who've made patients suffer trying to assess they're muscle strength like this while others who have the balls to pull the tube using some common sense. Obviously if the patient is borderline on their reversal or a difficult intubation you've got to use caution but not having any balls and seeing your patients' eyes pop out with pressures through the roof is a little crazy

I am usually very cautious and not in any way aggressive in my practice, but waiting for patients to squeeze your hand hard or to do other ridiculous things won't fly in the real world (private practice), you simply don't have time for that type of nonsense.

 

[huktonfonix]

So I had this case today where on emergence the patient had clear signs of being extubatable. 1) 4/4 twitches prior to reversal agent. 2) TV's 650. 3)Spontaneous eye opening. To me this patient clearly was extubatable. My staff comes in the room I'm about to pull to tube and she's having him squeeze her hand debating whether he is strong enough because his had grip "feels somewhat weak". I'm thinkin WTF. I've had other staff who've made patients suffer trying to assess they're muscle strength like this while others who have the balls to pull the tube using some common sense. Obviously if the patient is borderline on their reversal or a difficult intubation you've got to use caution but not having any balls and seeing your patients' eyes pop out with pressures through the roof is a little crazy

Also, did he check her grip strength prior to induction? Its like anything else. Get a baseline if youre going to check it later. Maybe thats her normal grip.