Here is the link to the 2006 PALS case studies. There are four respiratory core cases, four core shock cases, and four core cardiac cases. The case studies were on the 2006 PALS dvd. What follows is from that dvd.
Causes Of Acute Deterioration In An Intubated Patient (The DOPE Mneumonic) [p 169 of 2016 Pediatric Advanced Life Support Provider Manual]
Sudden deterioration in an intubated patient may be caused by one of several complications. Use the mneumonic DOPE to help remember these.
Displacement of the tube The tube may be displacedf out of the trachea or advanced into the right or left mainstem bronchus Obstruction of the tube Obstruction may be caused by
- Secretions, blood, pus, or foreign body
- Kinking of the tube
Pneumothorax Simple pneumothorax usually results in a sudden deterioration in oxygenation (reflected by a sudden decrease in SpO2) and decreased chest expension and breath sounds on the involved side.
Tension pneumothorax may result in the above plus evidence of hypotension and a decrease in cardiac output. The trachea is usually shifted away from the involved side.
Equipment Failure Equipment may fail for a number of reasons, such as:
- Disconnection of the O2 supply from the ventilation system
- Leak in the ventilator circuit
- Failure of the power supply to the ventilator
- Malfunction of the valves in the bag or circuit
Evaluating the patient’s Status
If the condition of an intubated patient deteriorates, the first priority is to support oxygenation and ventilation. While attempting this support, rapidly assess the child and attempt to determine and correct the cause of deterioration. If the child is being mechanically ventilated, hand ventilate with a bag while you assess the patient’s airway, ventilation, and oxygenation . . .
Your initial assessment will determine the urgency of the required response. If you cannot verify that the ET tube is in the airway, direct visualization of the tube passing through the glottis is advised. If the child’s dondition is deteriorating and you strongly suspect that the tube is no longer in the trachea, you may need to remove it and ventilate with a bag-mask device.
For an outstanding brief review of DOPE [including what can cause deterioration in an asthmatic on the ventilator] see Dr. Weingart’s podcast and show notes, EMCrit Podcast 16 – Coding Asthmatic, DOPES and Finger Thoracostomy December 23, 2009, from EMCrit.