Obstruction to ventilation:

Temporise

· Announce problem

· FiO₂ 100%

· Man-spont, APL 20cmH2O, hand-ventilate, auscultate

Check delivery

· Ventilator: ±disconnect and use manual resuscitator (do this last)

· Tubing: no kink

· HME: vomit/secretions? (N.B. this has happened!)

· ETT: auscultation, laryngoscopy, suction catheter

Check patient

Look, listen, feel

· Upper airway: laryngospasm / coughing?

· Lower airway: gas trapping / bronchospasm / anaphylaxis?

· Parenchyma: APO?

· Pleura: pneumothorax?

· Abdomen: air in stomach?