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(1) Dislodgement or obstruction of the endotracheal tube
(2) Faulty oxygen source
(3) Pneumothorax
(4) Equipment failure
(5) Ballon leak
Disconnect the ventilator and
administer high-flow 100% oxygen using a BVM
administer high-flow 100% oxygen using a BVM
Disconnection allows the release of trapped gas in the patient with severe bronchospasm :
these patients usually have evidence of bronchospasm and/ or hypotension in addition to hypoxia.
Also, if the patient is easy to ventilate and re-oxygenate,
then the problem probably lies with the ventilator or the circuit.
then the problem probably lies with the ventilator or the circuit.
先 disconnect 區分是 Patient or Ventilator problem
Assess the patien - MASH approach
Movement of the chest during ventilation :
is it absent or is movement only on one side?
Is the chest hyper-expanded?
is it absent or is movement only on one side?
Is the chest hyper-expanded?
Arterial saturation (SaO2) and PaO2
Skin color of the patient (is he turning blue or pinking up?) :
SO2 monitor lags behind the true oxygen saturation of the patient.
SO2 monitor lags behind the true oxygen saturation of the patient.
Hemodynamic stability
If the patient is difficult to manually ventilate,
determine if the problem lies with the endotracheal tube
or with the patient.
or with the patient.
Check ETCO2 to ensure the ETT is not in the esophagus and is patent.
Pass a suction catheter and/ or a bougie to ensure the ETT is not obstructed.
Consider a CXR to check ETT position if hypoxemia is not critical,
especially if endobronchial intubation is suspected
especially if endobronchial intubation is suspected
Pneumothorax, Lung collapse (look for asymmetrical chest movement)
Pulmonary edema
Bronchospasm (chest wall movement may be minimal — look for hyper-expansion)
Pulmonary embolus
If the bag is easy to compress during manual ventilation,
but there is little or no chest movement
circuit leak (e.g. cuff leak, disconnection, or a hole in the circuit), OR
dislodgement of the endotracheal tube —
you may be ventilating the oropharynx or the stomach
you may be ventilating the oropharynx or the stomach
If the patient is easy to ventilate with the bag
and the hypoxemia rapidly resolves
and the hypoxemia rapidly resolves
check ventilator settings
trouble-shoot equipment failure
Acute Respiratory distress syndrome (ARDS)
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