Accidental extubation is a medical emergency. What should the nurse do immediately?

• A. Call the physician immediately
• B. Administer bronchodilator
• C. Reinsert the endotracheal tube
• D. Immediately deliver rescue breaths using a bag valve mask and 100% oxygen until reintubated

Answer: (D)

When accidental extubation occurs, the priority is to maintain oxygenation by providing immediate ventilation through a bag-valve mask with 100% oxygen. The airway is no longer secured, so there’s a real risk of hypoxemia if breathing isn’t supported right away. Using a BVM delivers breaths until the airway can be reestablished, buying time to reinsert the endotracheal tube safely. After initiating rescue ventilation, summon help and prepare equipment for reintubation so the airway can be secured as quickly as possible. Bronchodilator therapy isn’t the immediate need here, and while reintubation is necessary, it should be performed by the appropriate clinician once ventilation is underway.