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On-shift rescue mode

On-Shift Rescue

First moves when an airway is unstable: oxygenate, call for help, confirm the tube, sort the failure mode, and change something.

Full troubleshooting Meds Vent
Immediate unstable-patient move: call for help, disconnect from ventilator, bag with 100% oxygen, verify waveform EtCO₂ and tube depth, then troubleshoot DOPES while support is coming.

60-second rescue clock

Start when deterioration is recognized

00:00

Room script

Say this out loud

“The tube is in and the patient is unstable. Disconnect the vent. Bag with 100% oxygen. Confirm waveform EtCO₂ and depth. We are running DOPES and hypotension causes now.”

Crisis map

Four moves before getting lost

1Oxygenate

Vent off. Bag with 100% O₂. PEEP valve if appropriate.

2Confirm

Waveform EtCO₂, depth, bilateral exam, cuff and circuit.

3Sort

Hypoxia, hypotension, high pressure, no EtCO₂, dysynchrony.

4Change

Fix the identified failure mode; do not repeat the same plan.

Choose the failure mode

What is failing right now?

Hypoxia Low SpO₂ / poor oxygenation
  • Manual BVM with 100% O₂.
  • Check tube depth, cuff, EtCO₂, secretions, chest rise.
  • Run DOPES and assess pneumothorax/auto-PEEP.
Hypotension MAP crashing after tube
  • Rule out tension PTX and auto-PEEP.
  • Review sedative/opioid effect and PEEP.
  • Start/resume resuscitation and pressor pathway per protocol.
No EtCO₂ No reliable waveform
  • Assume esophageal/displaced tube until proven otherwise.
  • Directly reassess tube and waveform source.
  • Reoxygenate and reintubate/rescue as indicated.
High pressure Alarm / hard to bag
  • Bag and feel compliance.
  • Suction, unkink, bronchodilate if bronchospasm.
  • Check plateau/compliance, PTX, mainstem, auto-PEEP.
Stacking Asthma/COPD auto-PEEP
  • Disconnect briefly if crashing and air-trapping suspected.
  • Lower RR / increase expiratory time.
  • Deep sedation/paralysis if dangerous dyssynchrony.
CICO Cannot intubate/oxygenate
  • Declare CICO early.
  • Use SGA/BVM rescue if possible.
  • Move to front-of-neck access per team protocol.

On-shift cockpit

Medication + ventilator quick guides

Designed for simulation, debriefing, and rapid teaching. Local protocols and pharmacy concentrations should control real orders.

RSI + post-intubation sedation

Initial vent + scenario pivot