Sync template from atomicqms-style deployment

Forms/Ventilator-Weaning/FRM-VENT-001-Extubation-Readiness-Checklist.md

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+# Extubation Readiness Checklist
+
+| Form ID | FRM-VENT-001 | Revision | 1.0 |
+|---------|--------------|----------|-----|
+
+---
+
+## Patient Information
+
+| Field | Entry |
+|-------|-------|
+| Patient Name | |
+| MRN | |
+| Age/DOB | |
+| Date | |
+| Time | |
+
+## Pre-Extubation Assessment
+
+### Clinical Criteria
+
+#### 1. Underlying Condition Resolved/Improved
+- [ ] Yes
+- [ ] No - Explain: ____________
+
+#### 2. Hemodynamic Stability
+- [ ] MAP appropriate for age without significant vasoactive support
+- [ ] Heart rate stable
+- [ ] No active bleeding
+
+**Current Vasoactive Medications:**
+| Medication | Dose |
+|------------|------|
+| | |
+
+#### 3. Oxygenation
+- [ ] FiO2 ≤ 0.40 (or ≤ 0.50 for neonates)
+- [ ] PaO2/FiO2 ratio > 200
+- [ ] SpO2 > 90% on current settings
+
+**Current Settings:**
+- FiO2: ______
+- PEEP: ______ cmH2O
+- Latest ABG: pH _____ pCO2 _____ pO2 _____ HCO3 _____
+
+#### 4. Ventilation
+- [ ] PaCO2 acceptable for patient
+- [ ] Peak pressure ≤ 20 cmH2O (or age-appropriate)
+- [ ] Spontaneous breathing on minimal support
+
+**Current Settings:**
+- Mode: ______
+- Rate: ______
+- PIP/PS: ______ cmH2O
+- Spontaneous rate: ______
+
+#### 5. Spontaneous Breathing Trial (if performed)
+- [ ] Performed
+- [ ] Not performed
+
+**If performed:**
+- Duration: ______ minutes
+- Mode: [ ] T-piece [ ] CPAP [ ] PS/CPAP
+- Tolerated: [ ] Yes [ ] No
+
+#### 6. Airway Protection
+- [ ] Adequate cough reflex
+- [ ] Appropriate gag reflex
+- [ ] Manageable secretions
+- [ ] Alert/appropriate neurological status
+
+**Secretion Description:**
+- Amount: [ ] Minimal [ ] Moderate [ ] Copious
+- Character: ____________
+
+#### 7. Sedation Status
+- [ ] Minimal or weaning sedation
+- [ ] Able to follow commands (if age-appropriate)
+
+**Current Sedation:**
+| Medication | Dose | Last Given |
+|------------|------|------------|
+| | | |
+
+#### 8. Metabolic Status
+- [ ] Adequate nutrition
+- [ ] No significant electrolyte imbalances
+- [ ] Normal temperature
+
+**Latest Labs:**
+- Na: _____ K: _____ Cl: _____ HCO3: _____
+- Ca: _____ Mg: _____ Phos: _____
+
+#### 9. Post-Extubation Plan
+- [ ] Non-invasive support planned: ______
+- [ ] High-flow nasal cannula available
+- [ ] Room air trial planned
+- [ ] RT available at bedside for extubation
+
+### Special Considerations
+
+#### For Neonates:
+- [ ] Caffeine on board (if applicable)
+- [ ] Weight > 500g (or institution-specific threshold)
+- [ ] Postmenstrual age considerations addressed
+
+#### For Long-Term Ventilation:
+- [ ] Airway evaluation performed (if >7 days intubated)
+- [ ] Consider subglottic edema risk
+- [ ] Dexamethasone considered (if appropriate)
+
+## Contraindications to Extubation
+
+- [ ] Active seizures
+- [ ] Neuromuscular blockade
+- [ ] Recent airway surgery
+- [ ] Significant facial/airway trauma or edema
+- [ ] Other: ____________
+
+## Physician Review
+
+**Attending Physician Notified:** [ ] Yes [ ] No
+
+**Extubation Approved:** [ ] Yes [ ] No
+
+**If No, reason:** ____________
+
+## Extubation Procedure
+
+**Extubation Date/Time:** ____________
+
+**Post-Extubation Support:**
+- [ ] Room air
+- [ ] Nasal cannula: ______ L/min
+- [ ] High-flow nasal cannula: ______ L/min, FiO2: ______
+- [ ] CPAP: ______ cmH2O
+- [ ] BiPAP: IPAP ______ EPAP ______
+
+**Immediate Post-Extubation Assessment (within 1 hour):**
+- SpO2: ______ %
+- RR: ______ breaths/min
+- HR: ______ bpm
+- Work of breathing: [ ] Minimal [ ] Moderate [ ] Severe
+- Stridor: [ ] None [ ] Mild [ ] Moderate [ ] Severe
+
+## Signatures
+
+| Role | Name | Signature | Date/Time |
+|------|------|-----------|-----------|
+| RN | | | |
+| RT | | | |
+| MD/NP | | | |
+
+---
+
+*Form FRM-VENT-001 Rev 1.0*