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EM Clerkship

Ventilator Alarms (Deep Dive R33)

EM Clerkship

Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD

Health & Fitness, Science, Education, Medicine, Life Sciences

4.9816 Ratings

🗓️ 15 May 2022

⏱️ 16 minutes

🧾️ Download transcript

Summary


DOPES



D-Displacement – endotracheal tube dislodges from trachea, or falls into right mainstem bronchus



O-Obstruction – Mucous plugging, bronchospasm, patient biting tube



P –Pneumothorax – Look out for pneumothorax, it can be subtle



E – Equipment – Disconnected/unpowered equipment, ensure everything is powered on and connected appropriately



S – Stacking – common in asthma/COPD due to inadequate expiration resulting in air trapping between breaths



Further Reading



LITFL – Post-Intubation Hypoxia



CanadiEM – Approach to the Alarming Vent

Transcript

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0:00.0

Hey everybody, this is Zach Olson and thank you for downloading this month's deep dive.

0:05.4

This episode is sponsored by Pearson Rabbit Insurance.

0:09.0

Stephanie Pearson at Pearson Rabbit is my personal disability and life insurance agent.

0:13.3

There are three reasons why you need to be buying your personal disability insurance policy while in residency.

0:19.0

Reason number one, the most obvious, it protects you in case something

0:22.4

happens to you while you are in residency. You get sick or you get injured and you can't do your

0:27.7

job. This is the insurance policy that will cover you in case something like that happens. Two,

0:33.4

you get resident discounts that will stick with you in many cases even after you graduate and once

0:39.3

you're in attending. So you graduate residency and now you've got your attending job and maybe

0:44.7

you're buying a more expensive policy or something, but that initial discount is going to stick with you

0:48.9

even after you graduate as long as you purchase it early. And reason number three and most important is

0:52.8

you get your medical underwriting done early.

0:55.3

You get to have the insurance company basically medical underwriting.

0:59.0

The insurance company will do this examination of you,

1:01.6

dig through your medical history and everything to see if they're willing to insure you.

1:06.3

And when you do this early as possible,

1:09.1

this is when you have like the fewest diagnoses on your chart. This is while you're the youngest, you have the fewest dangerous hobbies and all that kind of stuff. You get your medical underwriting done when you're young. It makes for a cheaper policy. It also makes for the strongest policy because let's say you have, you know, you're at the eye doctor and they document some weird thing related to your eyes.

1:27.6

Well, now the insurance company, who's not doctors, they're going to see that be like, oh, wow, there's some weird eye thing. Okay, we're just going to exclude everything related to eyes in the future. So now your policy is much weaker, even if it was some BS, you know, thing that just got put on your chart. So that's why you want to get this done early. Go to www.personravitz.com, fill out the contact form, get all your questions answered. Now, on to our deep dive. I'm not a huge mnemonic person, but we're going to be going through a mnemonic in this episode. It's the dopes mnemonic, D-O-P-E-S. It's the mnemonic that helps you remember kind of the differential

2:02.0

diagnosis and how to think through an alarming ventilator, which is one of the issues that Mike

2:08.1

had to deal with on the previous case. So real quick, D displacement, O obstruction, P,

2:15.8

pneumothorax, E, equipment, S stands for stacking. And again, I'm not a

2:20.7

mnemonic person, but this is one that you will hear. Let's go through each of these, though,

...

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