Obstruction to ventilation:

 

Causes:

Machine

·      Expiratory valve stuck closed

External tubing

·      Kink

·      Wheel

·      Foot

ETT

·      Kink

·      Bite

·      Spit

Patient

·      Dyssynchrony

·      Bronchospasm

o  Anaphylaxis

o  Histamine

o  Asthma

·      Pneumothorax

 

Response:

Diagnose

·      ↑Airway pressure with ↓tidal volume

·      Abnormal or absent capno

·      Quick check monitors for ABC

·      Quick check for pulse

Temporise

·      Announce problem

·      ±Press emergency buzzer

·      FiO2 100%

·      Man-spont

·      Squeeze bag

·      Propofol

·      Sevo

·      Relaxant (only if dyssynchrony)

Investigate & treat

·      External tubing: look

·      ETT: look + suction + laryngoscopy

·      Patient: look + listen

o  Bilateral?

o  Rise and fall?

o  Air entry?

o  Wheeze?

o  Rash?

Back-up plan

If no diagnosis and no ventilation:

·      Bag-valve mask resuscitator

·      Extubate onto guedel + facemasks