Extubation isn’t traditionally considered a core emergency medicine skill. However, there is definitely a role for the procedure if resources permit — either because access block is so bad and the patient has been in the department for days and has recovered (yes it does happen some places!) or because there really is no need for the patient to remain intubated in the short term (e.g. intubated purely for a scan).
George Douros from EDTeaching.com has developed this algorithmic guide to the process of extubation in the ED:
It is based on the work of Scott Weingart and the Difficult Airway Society guidelines.
There are other great FOAM resources on this topic here:
- DAS — Extubation guidelines
- EMCrit Podcast 35 – Extubation in the ED (with a link to Scott Weingart’s paper and his protocol)
- LITFL CCC — Laryngospasm and Post-extubation stridor
- PulmCCM.org — Tobin: “Minimal” PEEP and pressure support during SBT kills some patients (AJRCCM)
- Resus.ME — Extubation Guidelines (from the Difficult Airway Society)
- Trauma Professional’s Blog — Extubation in the Emergency Departmen