Title: “D.O.P.E.S. like D.O.T.T.S.”
题目：呼吸机患者紧急情况的诊断‘DOPES’和处理‘DOTTS’
Author 作者: Haney Mallemat

There are several reasons why a mechanically ventilated patient may decompensate post-intubation. Immediate action is often needed to reverse the problem, but it can be difficult to remember where to start as the vent alarm is sounding and the patient is decompensating.
机械通气患者在插管后病情加重可有几个原因，通常需要做紧急处理。但在呼吸机发出警报和患者情况恶化的状态下，应如何下手是有一定困难的。
Consider using the mnemonic “D.O.P.E.S. like D.O.T.T.S.” to assist you in first diagnosing the problem (D.O.P.E.S.) and then fixing the problem (D.O.T.T.S.).
可以考虑用助记口诀“D.O.P.E.S喜欢D.O.T.T.S”帮助你首先发现问题(D.O.P.E.S)，然后解决问题（D.O.T.T.S).
Step 1: Could this decompensation be secondary to D.O.P.E.S.?
第一步：病情加重有可能是由于D.O.P.E.S造成的？
Displaced ET tube / ET tube cuff not inflated or has a leak
气管导管位置错误／导管气囊没有充气或漏气
Obstruction of ET tube 气管导管阻塞
Pneumothorax 气胸
Equipment malfunction (disconnection of the ventilator, incorrect vent settings, etc.)
仪器故障 （连接不良，呼吸机设置条件不正确等）
Stacking (breath stacking / Auto- PEEP
叠加效应（呼吸叠加／内源性PEEP）
Step 2: Fix the problem with D.O.T.T.S.
第二步：用D.O.T.T.S解决问题
Disconnect – Disconnect patient from the ventilator
断开－解除患者与呼吸机的连接
Oxygen – Oxygenate patient with a BVM and feel for resistance as you bag
给氧－用呼吸囊活瓣面罩给氧，捏球囊时要感觉气道阻力
Tube position / function – Did the ET tube migrate? Is it kinked or is there a mucus plug?
检查导管的位置和功能－导管有无错位？是否有扭结或有粘液栓？
Tweak the vent – Are the settings correct for this patient?
调节呼吸机－呼吸机设定对这个患者是否正确？
Sonogram (ultrasound) – Sonogram to look for pneumothorax, mainstem intubation, etc. 
超声－超声检查以发现气胸，主支气管内插管等