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Pediatric Extubation What should have happened overnight: 1) Sedation…

- - - - Look at the vent & ensure on minimal settings & breathing above set rate
        1) SIMV-RR = 6-10
        2) FiO2 < 50%
        3) Lower PEEP
        4) Breathing above the set RR
        5) Good volumes on spont breaths
        
        Check Cuff Leak
        1) Grab syringe & drop the cuff
        2) Assess for audible leak - "Do I hear an audible leak?"
        3) Look at Vti & VTe (diff > 10-15% btwn Vti & VTe)
        4) Cuff back up
        
        If didnt hear audible cuff leak & no leak for inhaled & exhaled volumes
        1) Grab the bagger & make sure its turned on. Make sure that you have the manometer set up so that you can easily see it when you assess the leak
        2) Place it right next to the kid
        3) Put stethoscope in ears & let the bell be on the bed
        4) Attach syringe to the cuff
        5) Place the vent onto stand-by, disconnect, place onto bagger
        6) Check VS, make sure they're still okay
        7) Place stethoscope on neck & give CPAP on bagger up to 30cmh20
        
        < 15cmh20 is fine
        
        15cmH20 = Would talk to physician about getting Dex
        8) Cuff back up
        9) Place them back onto the vent
        10) Check cuff pressure
        
        If heard audible cuff leak
        1) Cuff back up
        2) Place them on the vent
        3) Check cuff pressure
        
        Connect with the Doctor
        "Hey, we had a successful ERT overnight, they have a _cuff leak, I think __"
        
        Given order to extubate the kid
        Or given order to extubate once steroids were given 4 hours later
        WOULD HAVE TO RECHECK CUFF LEAK IF HAD TO GIVE DEX - IF DIDNT HAVE A CUFF LEAK WOULD EXTUBATE ANYWAYS
        
        Connect with the Nurse
        "Hey, we have an order to extubate, would you mind turning off the sedation?"
        
        1 more item...
        
        If didn't sxn before, sxn now before you do cuff leak & assess cough reflex