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A 35-year-old male is found unconscious at the bottom of a staircase. His Glasgow Coma Scale (GCS) score is 3, and he is intubated by the paramedics for failure to protect his airway. On assessment in the emergency department (ED), the GCS score remains 3, but his examination and investigations (including a normal head computed tomographic [CT] scan) are unremarkable except for a serum ethanol of 97 mmol/L. Five hours later, he remains intubated in the ED but is starting to wake up. Should you extubate him or sedate him to keep him intubated? How do you ensure the optimal outcome for this patient?

How to safely extubate a patient in the emergency department: a user's guide to critical care