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.
60-second rescue clock
Start when deterioration is recognized
00:00
Escalation threshold: stop, oxygenate manually, and declare the failure mode.
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
Vent off. Bag with 100% O₂. PEEP valve if appropriate.
Waveform EtCO₂, depth, bilateral exam, cuff and circuit.
Hypoxia, hypotension, high pressure, no EtCO₂, dysynchrony.
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.