Ventilator alarms and the patient in distress

A ventilator alarm is the machine reporting that something has changed in the patient, the tube or the circuit, so the nurse answers it by going to the patient first — chest rise, colour, effort, saturation and the capnography waveform — rather than by silencing it, resetting it or changing settings that are never altered without a prescription or left with an alarm switched off; reads a high-pressure alarm as something resisting the breath — secretions, a tube that is kinked, bitten or has slipped down into one main bronchus, water pooled in the tubing, coughing or breathing against the ventilator, bronchospasm, a pneumothorax or lungs that are stiffening — and a low-pressure or low-volume alarm as air escaping — a disconnection, a leak in the circuit, a cuff that is leaking or underfilled so that air or the patient's voice is heard at the mouth, or a tube that has come out of the trachea; and when the ventilated patient is suddenly in distress and the cause is not found and put right at once, disconnects them from the ventilator and ventilates by hand with a manual resuscitation bag on high-concentration oxygen while calling for help, working through a tube that is displaced, a tube that is obstructed, a pneumothorax and equipment that has failed, and does not sedate or restrain a patient who is fighting the ventilator until those causes and hypoxaemia have been looked for — while the routine bedside check is kept on the patient rather than the machine: the tube at the depth recorded when it was placed and secured, the chest rising equally with breath sounds on both sides, the cuff pressure measured with a manometer rather than judged by squeezing the pilot balloon, the skin under the tube and its securing device, the humidification, the settings matched against the prescription, every alarm switched on, and a manual resuscitation bag, oxygen and suction working at the bedside.