42 RESPIRATORY MANAGEMENT FOLLOWING SPINAL CORD INJURY Appendix H: Post-Tracheoplasty/ Post-Extubation Protocol The following protocol is a policy/procedure used by Craig Hospital, Englewood, Colorado (undated). Rationale: To establish guidelines for the management of post-tracheoplasty/extubation patients. II. Chest x-ray is ordered for all post-tracheoplasty patients to rule out atelectasis. III. Stretch IPPB instituted with 0.5cc Albuterol and 20mg Cromolyn sodium every 4 hours. IV Quad cough as needed. . V . Titrate O2 to 92%. A. Every 6 hours and prn for 24 hours. B. Every 12 hours and prn for 48 hours. C. Daily for 2 days. VI. If excessive bleeding occurs, consider DDAVP with , physician’s order, 20mcq IV . VII. Use CPAP or BiPAP with physician’s order if atelectasis is documented. Scope: Respiratory therapists and all other clinicians with demonstrated competencies. Policy Statement: The following criteria will be used for all posttracheoplasty and post-extubation patients. Procedure: I. Pulmonologist is to be advised as soon as the patient returns from surgery.