This document provides a checklist for addressing common ventilator alarms and troubleshooting a crashing ventilated patient. It lists potential causes and solutions for decreasing oxygen levels, high or low end-tidal carbon dioxide, and high or low airway pressures. It also outlines a two-step process for responding to a crashing ventilated patient by first identifying the problem using the mnemonic "DOPES" and then fixing the problem using "DOTTS".

1. • Ventilator Alarm Checklist
Decreasing Spo2
O Check patient & quality of
trace
* Ensure probe adequately
attached
* Check bilateral chest expansion
* Auscultate chest
* Check tube position @ lips
* Consider suctioning
0 ^ FiO2%
* Consider PEEP, Tidal Volume
* Retake ABG/VBG
• ETCO2
High ETCO2 (>45mmHg)
* Acidotic retaining Co2
* ^ Set Resp Rate
* ^ Tidal volume
Low ETCO2 (<35mmg)
• Alkalotic blowing of Co2
O W Set resp rate
O VTidal volmue

2. • Paw High
• (High airway pressures)
• * Tube in R main bronchus
• * Bronchospasm
• O Mucous plugs
• * Pneumothorax
• * Air-trapping
• © Pt cough/biting/gagging on
• ETT
• * Patient-ventilator dyssynchrony
• * Pmax set too low
• * PEEP set too high
• Paw Low
• (Low airway pressures)
• ETT Cuff deflation
• • Oesophageal intubation
• O TV set too low
• * Chest wounds/drains allowing air to escape
• * Disconnection in ventilator circuit

3. Crashing Ventilatored Patient
Checklist
• Step 1 (D.O.P.E.S.)
• Indentify problem:
• • Displaced ET tube/cuff not inflated.
• O Obstruction of ET tube
• * Pneumothorax
• * Equipment malfunction
• * Stacking (Breath stacking/auto peep)
• Step 2 (D.O.T.T.S)
• Fix Problem:
• * Disconnect pt from ventilator
• * Oxygen - Oxygenate patient with BVM - feel
for resistance
• * Tube position/function - ETT
migration/kinking/plugging
• * Tweak the vent- check settings
• * Sonogram- look for pneumothorax,
mainstem intubation