Crisis map

Start here if the tube is in and the patient is worse.

What is failing?Choose the visible problem.SpO₂ fallingOpen hypoxia pathway.BP/MAP fallingOpen hypotension pathway.No/low EtCO₂Tube, circulation, or equipment.Vent alarm / high pressureResistance, compliance, circuit, dyssynchrony.Abnormal vital signsTranslate vitals into a failure bucket.

First four moves

Call for help and assign roles.
Disconnect from ventilator and bag with 100% O₂/PEEP if unstable and appropriate.
Verify tube position/depth and waveform EtCO₂.
Search DOPES: displacement, obstruction, pneumothorax/patient, equipment, stacked breaths.

Do not miss

Right mainstem, esophageal tube, tube obstruction, tension pneumothorax, auto-PEEP, medication-related hypotension, RV failure.

Evidence and use limits

Last reviewed: 2026-07-23. Designed for: emergency medicine learners, clinicians, EMS, RT, and airway educators.

This is an educational cognitive aid, not a bedside order set. Confirm medications, ventilator changes, pediatric dosing, procedures, and escalation decisions against the patient’s physiology, the ventilator in use, and local ED/ICU/anesthesia/pharmacy/RT/EMS/pediatric policy.

Full references · Editorial policy · AARC 2024 ventilator assessment · ATS/ESICM/SCCM lung-protective ventilation · ATS 2024 ARDS update

About this resource

Created by: Andrew Pirotte, MD; Kyle Brown, MD; Reba Hodge, MD; Amanda Vanderwerf, PharmD, BCEMP; Morgan Kimball, PharmD, BCEMP; Joshua Mohess Clinical review: Clinical review pending: local ED, ICU, EMS, anesthesia, pharmacy, and pediatric protocol review recommended before bedside teaching rollout. Last reviewed: 2026-07-23 Next scheduled review: 2027-01-23 Designed for: EM residents, emergency physicians, EMS clinicians, airway educators, and simulation faculty Important: Educational resource and cognitive-aid guide only; not a bedside order set or substitute for local protocol, medical direction, or clinical judgment. Website contact: kybrown@kumc.edu