Deterioration after intubation: Difference between revisions
m (Rossdonaldson1 moved page Deterioration after intubation (DOPE) to Deterioration after intubation) |
No edit summary |
||
| Line 1: | Line 1: | ||
==Diagnosis== | ==Background== | ||
==Clinical Features== | |||
==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> | *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 - Displaced ETT | **D - Displaced ETT | ||
| Line 5: | Line 9: | ||
**P - [[Pneumothorax]] | **P - [[Pneumothorax]] | ||
**E - Equipment failure (ventilator malfunction or disconnect) | **E - Equipment failure (ventilator malfunction or disconnect) | ||
==Diagnosis== | |||
==Management== | ==Management== | ||
| Line 18: | Line 24: | ||
***Lung sounds not always reliable → get CXR if continued clinical concern | ***Lung sounds not always reliable → get CXR if continued clinical concern | ||
*Immediately disconnect from ventilator (allows for expiration of stacked breaths) | *Immediately disconnect from ventilator (allows for expiration of stacked breaths) | ||
*"DOPES like DOTTS" Mnemonic | *"DOPES like DOTTS" Mnemonic | ||
Troubleshoot | ===Troubleshoot=== | ||
*D - Displacement of tube | *D - Displacement of tube | ||
**Attach end-tidal CO2 to verify and check depth (cm at lip) | **Attach end-tidal CO2 to verify and check depth (cm at lip) | ||
| Line 42: | Line 40: | ||
**Disconnect from ventilator | **Disconnect from ventilator | ||
Fix | ===Fix=== | ||
*Disconnect vent and put light pressure on pt chest | *Disconnect vent and put light pressure on pt chest | ||
*Oxygen 100% | *Oxygen 100% | ||
| Line 53: | Line 51: | ||
*Sonography | *Sonography | ||
Auto-PEEP (Breath stacking) troubleshooting options | ===Auto-PEEP (Breath stacking) troubleshooting options=== | ||
*Bronchodilators if COPD/asthma | *Bronchodilators if COPD/asthma | ||
*Decrease RR | *Decrease RR | ||
| Line 62: | Line 60: | ||
==See Also== | ==See Also== | ||
*[[Intubation]] | |||
*[[Ventilation (Main)]] | *[[Ventilation (Main)]] | ||
==References== | |||
<references/> | |||
[[Category:Pulm]] | |||
[[Category:Critical Care]] | [[Category:Critical Care]] | ||
Revision as of 10:27, 26 August 2015
Background
Clinical Features
Differential Diagnosis
- DOPE[1][2]
- D - Displaced ETT
- O - Obstruction (anywhere along circuit)
- P - Pneumothorax
- E - 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