Prolonged Casualty Care
Troubleshooting
Alarms · deterioration · equipment

When a vented casualty deteriorates, work the problem in order. The BVM is always the fallback.

DOPES — First Pass
D
Displacement. Tube migrated or out. Check depth mark and capnography waveform. No waveform means no airway until proven otherwise.
O
Obstruction. Kink, mucus plug, or biting. Pass a suction catheter; if it will not pass, the tube is obstructed.
P
Pneumothorax. Absent breath sounds, rising peak pressure, hypotension, tracheal shift. Decompress immediately.
E
Equipment. Vent, circuit, or oxygen failure. Disconnect from the vent and bag the casualty by hand while you troubleshoot the machine off the patient.
S
Stacked breaths. Auto-PEEP / breath stacking, common in obstructive lungs. Disconnect to let the casualty exhale fully, then lengthen expiratory time.
By Alarm / Problem
High peak pressure alarm+
Low pressure / low minute volume / disconnect+
Apnea alarm+
Falling SpO2+
Ventilator or power failure+
JTS Airway Management and Mechanical Ventilation CPG · JTS Acute Respiratory Failure CPG · TCCC Guidelines current edition
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