DOPES

What do you do when your patient on the ventilator becomes unstable?

DOPES is typically a mnemonic that is used for medical providers to systematically troubleshoot. But I can never recall the order! 

Thus, introducing... P-DOES! Or Provider-DOES!

(Hint: RT work from the vent side, physician work from the patient side and meet in the middle.)

• P: Pneumothorax

• D: Displacement (e.g. ETT tube is out, balloon cuff down)

• O: Obstruction (extensive secretions, biting ETT, kinking in vent lines)

• E: Equipment (i.e. the vent)

• S: Stacking (i.e. breath stacking, patient is not exhaling fully and air is getting trapped on each inhalation)

If the patient is unstable (e.g. hypoxic, hypotensive), think about things you can do quickly to intervene!

• Suction

• Disconnect the vent and use the BMV

• Check the ETT

• Finger or needle thoracostomy