Question 1: How will you manage extubation?

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Patient awaiting extubation

Question 1: How will you manage extubation?

Answer: The patient remains at risk of regurgitation and aspiration at extubation. Extubate with the patient AWAKE in the left lateral position. If a nasogastric tube is in situ, aspirate it prior to extubation to empty the stomach. You may consider placement of a gastric tube specifically for this purpose e.g. bleeding tonsil.

Question 2: Why the left lateral position?

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Patient in left lateral position awaiting extubation

Question 1: How will you manage extubation?

Answer: The patient remains at risk of regurgitation and aspiration at extubation. Extubate with the patient AWAKE in the left lateral position. If a nasogastric tube is in situ, aspirate it prior to extubation to empty the stomach. You may consider placement of a gastric tube specifically for this purpose e.g. bleeding tonsil.

Question 2: Why the left lateral position?

Answer:

  1. Aspiration is less likely in the lateral than in the supine position as gravity no longer favours drainage into the lungs
  2. If reintubation is required, a standard laryngoscope blade is far easier to use in the left than the right lateral position
Patient in left lateral position awaiting extubation