A patient in the emergency department has an endotracheal tube in place and is on the ventilator. His relative comes running to you telling you that the patient has pulled the tube out of his mouth. What would be your next step?

Appeared in: AIIMS Rishikesh & Jodhpur NO - 2017

Explanation

A partially extubated endotracheal tube is a non-functional airway and can act as an obstruction, compromising patient safety.
The immediate priority is to remove the displaced tube to clear the airway.
Following removal, the nurse must immediately provide ventilation using a bag-valve-mask (BVM) to maintain oxygenation and carbon dioxide removal.
Simultaneously, the nurse should assess the patient's ability to breathe spontaneously. This action directly addresses the 'Airway' and 'Breathing' components of emergency care.

Option A: Applying a face mask only provides supplemental oxygen; it does not provide ventilation (air movement). If the patient has inadequate respiratory effort, this action will not prevent hypoxia or respiratory arrest.
Option B: Chest physiotherapy is for secretion clearance and is not an intervention for an acute airway emergency. It is irrelevant and wastes critical time.
Option C: Re-intubation is an advanced procedure outside the scope of practice for a general staff nurse. Furthermore, the patient must be stabilized with manual ventilation before any re-intubation attempt.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Management of Accidental Extubation in acute care settings.
Nurses must be able to recognize and act immediately in an airway emergency, as a delay of even a few minutes can lead to hypoxic brain injury or death.
The ABC (Airway, Breathing, Circulation) framework is the cornerstone of emergency response. This scenario is a classic example of prioritizing Airway and Breathing.
Always have emergency equipment, including a BVM and suction, at the bedside of any patient with an artificial airway.

How to Approach the Question

Identify the question type: This is a clinical scenario asking for the next or priority action.
Analyze the situation: The patient has a compromised artificial airway. This is a life-threatening emergency.
Apply the ABC (Airway, Breathing, Circulation) principle. The primary problem is a blocked or non-functional airway and inadequate breathing.
Evaluate each option based on the ABCs and the nurse's scope of practice.
Option D directly addresses Airway (removing the obstruction) and Breathing (providing ventilation with a BVM).
Eliminate other options: Option A is insufficient, B is irrelevant, and C is outside the nurse's scope and not the first priority. Therefore, D is the only correct and immediate action.

Concept Tested & Keywords

Concept Tested: Management of Accidental Extubation
Stem keywords: endotracheal tube, ventilator, pulled the tube out, emergency department
Lead-in keywords: next step
Clinical cues: The patient was on a ventilator, indicating they were unable to maintain their own airway or breathing adequately.
Negative lead-in flag: false

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E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 30-32

Practise the full AIIMS Rishikesh & Jodhpur NO - 2017

Attempt every question from this paper in a timed mock, then review the full solution for each one.