Mechanical Ventilation

Question 1

What are 4 major problems encountered post intubation?

Answer 1

1. Increased peak inspiratory pressure (high pressure alarms)
2. Hemodynamic instability/hypotension
3. Hypoxia
4. Decreased peak inspiratory pressure

Question 2

What is the DOPES mnemonic?

Answer 2

DDx for the alarming ventilator
Displacement of tube
Obstruction of tube (mucous plug, blood, kinnking)
Pneumothorax
Equipment failure (ventilator, tubing)
Stacking breathes (auto-PEEP)

Question 3

What is the DOTTS mnemonic?

Answer 3

Approach to the alarming ventilator
Disconnect patient from vent, gentle chest pressure
100% O2 from manual BVM - check ease of bagging
Tube position
Tweak the vent (dysynchrony, adjust rate)
Sonography - assess for PTX, mainstem intubation, plugging

Question 4

What are potential causes for post intubation hypotension?

Answer 4

induction medications
tension pneumothorax
auto-peep/breath stacking
decreased preload 
primary disease problem
RV dysfunction

Question 5

How can you help a patient with high peak pressures and low compliance?

Answer 5

adequate sedation +/- paralysis
lung protective ventilation
HOB up
gastric decompression