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Troubleshooting review

Crisis map

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

Educational review boundary: This page summarizes common patterns and published management options. It does not analyze an individual patient or generate a treatment directive. Verify the current source, local protocol, and clinical context.
Failure pattern reviewChoose 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.

Clinical review / use limits

Authored by: Airway of the Month education team. Last reviewed: July 2026. Audience: EM learners, faculty, EMS, RT, simulation educators, and airway teams.

Resources · Editorial policy · ACEP intubation policy · AARC 2024 ventilator assessment guideline · ATS 2024 ARDS guideline 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: Emergency medicine faculty review completed. Medication content reviewed by Amanda Vanderwerf, PharmD, BCEMP, and Morgan Kimball, PharmD, BCEMP. 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 clinical-reference guide only; not a bedside order set or substitute for local protocol, medical direction, or clinical judgment. Website contact: [email protected]