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Background: unplanned extubation (UE), which is defined as deliberate self-extubation by a patient receiving mechanical ventilation support or accidental extubation by staff nursing and medical procedures. Objective: assess the effect of accidental and selfextubation on mechanically ventilated patients' outcomes. Design: a descriptive research design was used in this study. Research question: what is the effect of accidental and self-extubation on mechanically ventilated patients' outcomes? Setting: This study was conducted in general and trauma intensive care units at Assuit University Hospital. Subjects: sixty critically ill patients attached with the endotracheal tube and mechanical ventilation Results: the majority of the studied critically ill patient had respiratory consequences after UE and statistically significant differences between self-extubation and accidental extubation patients regarding occurrences of aspiration and tachycardia on the first day. Conclusion: Unplanned extubation (UE) is a frequent event after endotracheal intubation with mechanical ventilation (MV). Self-extubation is the most common type of UE and accidental removal of the tube is a very poor patient outcome and needs more aggressive management than patients with self-extubation.

Case based learning is an effective teaching strategy which helps students to generate and develop critical thinking and clinical judgment skills. It also allows nurses to function effectively in the intensive care environment. Aim. To determine the effect of Case based learning on internship critical care nursing students' clinical judgment. Design. Quasi experimental. Methods. Sixty internship critical care nursing students were included in this study. The students have been randomly assigned into two equal groups: study and control group. Lasater Clinical Judgment in Practice Survey and Lasater Clinical Judgment in Simulation Rubric have been used. Both groups have been completed pretest and posttest of clinical judgment. Results. Internship nursing students' clinical judgment confidence was significantly increased between the pretest and post-test in both study and control group. Also There is statistically significant difference between groups regarding clinical judgment skills (p=0.001). Conclusion. Case based learning is a valuable teaching and learning strategy in improving internship critical care nursing clinical judgment skills and confidence.

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