Links To And Excerpts From EMCrit 239 – Vent Alarms = Code Blue From Dr Weingart

Links to and excerpts from EMCrit 239 – Vent Alarms = Code Bluet [Link is to the podcast and show notes] January 26, 2019 by Dr Scott Weingart.

This EMCrit 239 is part of Dr Weingart’s minicourse [my term] EMCrit – Critical Care for Non-Intensivists during COVID19 Pandemic [Link is to his excellent post-I’m working my way through all of his resources on the post].
March 25, 2020 by Dr Scott Weingart

Here is the podcast of EMCrit 239:

And here are excerpts from the show notes:

Vent Alarms should be Regarded as Code Blue

If you cannot instill the above into your culture, patients will die

If they are crashing, do DOPES [Link is to EMCrit Podcast 16 – Coding Asthmatic, DOPES and Finger Thoracostomy
December 23, 2009 by Dr Scott Weingart]

Or if you have The Resuscitation Manual, go to Chapter 11, Crashing On the Ventilator [When you purchase the manual you will recieve a PDF copy which  you can put on your smart phone, or tablet.}

So in the show notes, Dr. Weingart goes through how we approach the alarms if the patient is not crashing meaning that:

  • the oxygen saturation is not low or falling.
  • the patient is not hypotensive
  • the patient does not have a zero end-tidal CO2
  • the patient does not look like he or she is in extremis

Note to myself: Dr Weingart’s show notes are a perfect checklist.

Resuming the excerpts:

This chart is from The Resuscitation Crisis Manual [Not an affiliate link]


Peak Only

  • Check the circuit
    • fluid pooling in circuit
    • fluid pooling in filter
    • kinking of circuit
  • Tube too small or biofilmed
  • Bronchospasm
  • Biting on ETT

Low Peak Pressure

  • Disconnected
  • ETT Cuff Deflated
  • Pt effort

Low Ve/Vt

  • Cuff Issues (See EMCrit Wee )*                                     *Wee – Avoiding Disaster – Endotracheal Tube Cuff Leaks and Tube Exchanges
    August 28, 2015 by Scott Weingart</li>            [I wasn’t able to follow this Wee. But then I watched the YouTube video that Dr. Weingart included and it was clearer to me.]
  • Bronchopleural Fistula

Low O2 Alarm

  • Not hooked Up
  • Gases Messed Up
  • Sensor Messed up

What to Do with Continued Alarms Despite Sedation, Equipment Check, Suctioning

  • Consider Bronchoscopic Assessment
  • If Patient begins to crash, consider tube exchange if bronch not available

Article On Vent Alarm Stats

Ventilator Alarms in Intensive Care Units: Frequency,
Duration, Priority, and Relationship to Ventilator
Parameters [PubMed Abstract] [Full Text PDF]                            Anesth Analg. 2018 Sep 18.

Assessing High Peak Pressures

Alarms from the ventilator: Troubleshooting high peak pressures from ALiEM Jul 30, 2013
By: Todd A. Seigel, MD





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