Case Study: To Tube or Not to Tube
Mr. Cowell is a 72-year-old patient who fell and developed a subdural hematoma in the right side of his skull. The patient had emergency surgery to evacuate the hematoma. He came out of surgery connected to a ventilator, intubated with an endotracheal tube. The standard extubation protocol is 12 hours postoperation, provided the patient meets the necessary criteria. Two days postoperation, the neurosurgeon decides to discontinue the ventilator and extubates the patient, even though the patient has not met the full criteria. After extubation the patient is put on a nasal cannula. Shortly after extubation, Mr. Cowell’s oxygen saturations decline, and he complains of difficulty breathing and is unable to cough effectively. The respiratory therapist increases his oxygen, gives him a breathing treatment, and suctions him per hospital protocol. After 2 hours of observation, the nurse and respiratory therapist come to consensus that the patient is not showing significant improvement. The nurse and the respiratory therapist recommend the patient be intubated; however, the neurosurgeon insists that the patient needs to be breathing on his own 5 days after the operation. The patient continues to deteriorate, and 2 hours later the attending anesthesiologist reintubates the patient.
Discussion Questions
- Who are the members of the interprofessional team in this case?
- What specific communication problem(s) can you identify and how did it contribute to the poor healthcare outcomes?
- Which specific Sub-competencies from all four Core Competencies, could have improved the healthcare outcomes for the patient in this case?
- Which other healthcare professionals might have joined the interprofessional team to consult during the initial decision-making process regarding tube removal? Provide your rationale.
Case Study: To Tube or Not to Tube
Mr. Cowell is a 72-year-old patient who fell and developed a subdural hematoma in the right side of his skull. The patient had emergency surgery to evacuate the hematoma. He came out of surgery connected to a ventilator, intubated with an endotracheal tube. The standard extubation protocol is 12 hours postoperation, provided the patient meets the necessary criteria. Two days postoperation, the neurosurgeon decides to discontinue the ventilator and extubates the patient, even though the patient has not met the full criteria. After extubation the patient is put on a nasal cannula. Shortly after extubation, Mr. Cowell’s oxygen saturations decline, and he complains of difficulty breathing and is unable to cough effectively. The respiratory therapist increases his oxygen, gives him a breathing treatment, and suctions him per hospital protocol. After 2 hours of observation, the nurse and respiratory therapist come to consensus that the patient is not showing significant improvement. The nurse and the respiratory therapist recommend the patient be intubated; however, the neurosurgeon insists that the patient needs to be breathing on his own 5 days after the operation. The patient continues to deteriorate, and 2 hours later the attending anesthesiologist reintubates the patient.
Discussion Questions
- Who are the members of the interprofessional team in this case?
- What specific communication problem(s) can you identify and how did it contribute to the poor healthcare outcomes?
- Which specific Sub-competencies, from all four Core Competencies, could have improved the healthcare outcomes for the patient in this case?
- Which other healthcare professionals might have joined the interprofessional team to consult during the initial decision-making process regarding tube removal? Provide your rationale.