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==Differential Diagnosis== | ==Differential Diagnosis== | ||
===DOPE<ref>EMRA Critical Care Handbook</ref><ref>Monica E. Kleinman et al. Pediatric Advanced Life Support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. AAP. 2010. http://pediatrics.aappublications.org/content/126/5/e1361.full</ref>=== | |||
* | *'''D'''isplaced ETT | ||
* | *'''O'''bstruction (anywhere along circuit) | ||
* | *[[Pneumothorax|'''P'''neumothorax]] | ||
* | *'''E'''quipment failure (ventilator malfunction or disconnect) | ||
==Diagnosis== | ==Diagnosis== | ||
Revisión del 10:29 26 ago 2015
Background
Clinical Features
Differential Diagnosis
DOPE[1][2]
- Displaced ETT
- Obstruction (anywhere along circuit)
- Pneumothorax
- Equipment failure (ventilator malfunction or disconnect)
Diagnosis
Management
- When in doubt, disconnect the pt from the ventilator and begin bag ventilation
- Eliminates the vent (E) circuit as source of the problem
- Helps gauge lung compliance
- Airway
- Is the tube still in? (D)
- Is it patent? (O)
- Auscultate and/or CXR
- Breathing
- Is the chest rising? Breath sounds equal b/l? (P)
- Lung sounds not always reliable → get CXR if continued clinical concern
- Is the chest rising? Breath sounds equal b/l? (P)
- Immediately disconnect from ventilator (allows for expiration of stacked breaths)
- "DOPES like DOTTS" Mnemonic
Troubleshoot
- D - Displacement of tube
- Attach end-tidal CO2 to verify and check depth (cm at lip)
- O - Obstruction of tube/circuit
- Use suction catheter to remove mucus plug, or make sure pt not biting down
- P - Pneumothorax
- Verify via US
- E - Equipment failure
- Connect to BVM
- S - Stacked breaths - Auto-PEEP especially in COPD/Asthma pts
- Disconnect from ventilator
Fix
- Disconnect vent and put light pressure on pt chest
- Oxygen 100%
- Bag and take time to evaluate your patient
- Tube Position & Function
- Pass bougie or suction all the way through the tube, OR take a look with DL
- Tweak Vent Settings
- Drop TV, then decrease RR, and then increase flow rate
- Caution as it causes hypercapnia and resp acidosis, which is harmful in pts with increased ICP or tox ingestion
- Sonography
Auto-PEEP (Breath stacking) troubleshooting options
- Bronchodilators if COPD/asthma
- Decrease RR
- Decrease I:E ratio (increase expiratory time)
- Quicker inspiratory flow rate
- Decrease TV
- Increase sedation
See Also
References
- ↑ EMRA Critical Care Handbook
- ↑ Monica E. Kleinman et al. Pediatric Advanced Life Support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. AAP. 2010. http://pediatrics.aappublications.org/content/126/5/e1361.full