Overview
Introduction
A patient intubated for severe COPD suddenly becomes restless.
A patient intubated for severe COPD suddenly becomes restless. The peak inspiratory pressure has risen from 24 to 31 cm H₂O, SpO₂ has fallen to 86% despite FiO₂ 0.8, and the end-tidal carbon dioxide waveform disappears. The nurse calls for help, examines the patient and circuit, and sees that the endotracheal tube has moved outward. This is not a routine high-pressure alarm. The nurse maintains the airway with a jaw-thrust and oral airway, disconnects from ineffective ventilation, provides 100% oxygen with a bag-valve-mask, and prepares for urgent reintubation by the airway-trained clinician. The sequence matters because oxygenation and airway continuity are threatened simultaneously. Troubleshooting the ventilator before supporting the patient would waste the short interval in which hypoxaemia can worsen rapidly. Clinical trajectory check Link new findings to the underlying process and the compensatory response that is succeeding or failing. Reassess objective trends such as perfusion, oxygenation, mental status, pain pattern, labs, and response to time-limited interventions so the next action reflects improvement or deterioration rather than a memorized label. For REx-PN (Canada), items rarely announce the topic in the...