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  4. Ventilation Emergencies (DOPES)

UNCONTROLLED WHEN PRINTED
Indications
  • To identify and rectify potential causes of ventilation problems in a sequential and structured manner.
Contraindications
Contraindications
Patient Factors & Considerations
  • Any ventilated patient MUST be escorted by either a doctor or nurse whom has sufficient knowledge of the operation of the ventilator and knows what to do in the case of ventilator malfunction.
  • If an officer finds themselves in a situation where a ventilator malfunctions during a transfer, they may be required to assist with the checking procedure.

Critical points for Patient Care Record Form:

  • Type of ventilator.
  • Reason for ventilating patient.
  • Patient’s main presenting problem and present condition.
  • Care given before Officer’s arrival.
Procedure

Checking for possible causes:

  • Primary attendant (e.g. doctor/nurse) to check operation of ventilator
  • Check ventilator tube for kinks.
  • Check oxygen supply:
    • Connection to outlet.
    • Switch to spare 'D' size cylinder if required.
    • Oxygen supply tube can be connected to the outlet on the front of the Oxy-Viva in place of flow-meter.
  • If unable to locate fault then ventilation will need to be provided manually using the Bag-Valve-Mask (BVM) connected to an oxygen supply flow-meter with regular oxygen tubing.
  • If on a ventilator, the patient will have an advanced airway in-situ, such as an Endotracheal Tube (ETT) or Supraglottic Airway (SGA). Medical personnel will need to secure the advanced airway before transitioning to the BVM.
  • Disconnect ventilator tubing from breathing tube and connect BVM using right-angled flexible connector if available.
  • Ventilate patient at appropriate rate; a doctor/nurse MAY ventilate, or request the officer ventilates, at rate different to those listed in the ventilation clinical skill.
  • Ensure that the doctor/nurse confirms that the advanced airway is still in-situ and ventilations are adequate.
  • Contact receiving facility to advise of ventilator malfunction.

Transport Priority 1.

D

Displacement

  • Check etCO2 value/waveform.
  • Look at tube position; does it look displaced?
  • Auscultate the chest and epigastrium. If gurgling is audible, withdraw ETT immediately
  • Assess/consider ETT cuff inflation, depth, or oesophageal intubation.
  • Check placement after any move.

O

Obstruction

P

Pneumothorax

  • Consider the signs and symptoms of pneumothorax/haemothorax.
  • Consider ventilator settings.

E

Equipment Failure

  • Consider failure of equipment starting from the oxygen cylinder straight through to the ETT and back again.

S

Secretions

  • Thick mucus might obstruct ETT.
  • Suction
Success
  • Restoration of effective ventilation/oxygenation
Discontinue
Discontinue
Additional Information
Additional information
References
References
Colour assist:

Document Control

Directorate
Clinical Services
Responsible Manager
Head of Clinical Services
Published Date
Review Date

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