Stage 03 · Bedside bridge · free

Bedside bridge: your first year on the unit

School teaches the ideal patient; the unit sends the other kind. This stage covers airway emergencies, reading ventilator graphics as behavior, and the handoff and escalation language that keeps you credible.

3 lessons44 min·8-question assessment
  • Work a sudden desaturation on the ventilator in a fixed order
  • Read the three graphics that change management
  • Escalate concisely enough that people act on what you say
Lesson 3.1 · 16 min

The sudden desaturation, worked in order

By the end you can

  • Run DOPE without skipping to the ventilator
  • Decide when to disconnect and bag
  • Confirm tube position with more than breath sounds

Patient first, machine second

When a ventilated patient desaturates acutely, disconnect and manually ventilate with 100% oxygen. That single act both treats the patient and splits the differential: if bagging is easy and the saturation recovers, the problem was the circuit or the settings; if bagging is hard, the problem is the patient or the tube.

DOPE keeps the order honest — Displacement, Obstruction, Pneumothorax, Equipment. Work it in that sequence because that is roughly the order of both frequency and speed of correction.

Confirmation is objective

Waveform capnography is the confirmation that holds up. Breath sounds can mislead in a noisy room and in a patient with a right mainstem intubation; a sudden loss of the capnogram with a hard-to-bag patient is a tube problem until proven otherwise.

Say it while you do it

  1. Disconnect, bag with 100%, note compliance under your hand
  2. Displacement: depth at the teeth, capnogram present
  3. Obstruction: pass a suction catheter
  4. Pneumothorax: unilateral sounds, tracheal shift, hypotension
  5. Equipment: circuit, valve, gas source

Where people lose the point

  • Suctioning first out of reflex before assessing tube position
  • Adjusting alarms instead of assessing the patient
  • Accepting bilateral breath sounds as proof of correct depth
Go deeper in the full module
Lesson 3.2 · 18 min

Graphics tell you what the patient is doing

By the end you can

  • Distinguish resistance problems from compliance problems on a pressure curve
  • Recognize air trapping on the flow curve
  • Name the dyssynchrony you are seeing

Peak versus plateau

A rising peak pressure with an unchanged plateau is a resistance problem: secretions, bronchospasm, a kinked tube, water in the circuit. A rising peak with a rising plateau is a compliance problem: pneumothorax, atelectasis, edema, abdominal distension, a stiffening lung.

That single comparison sorts most ventilator alarms into two very different actions, and it appears on every version of the exam.

Air trapping is visible

On the expiratory flow curve, if flow has not returned to zero before the next breath begins, the patient is stacking breaths. The fix is more expiratory time — a lower rate, a shorter inspiratory time, or bronchodilation — not a bigger breath.

Numbers to know cold

Resistance problem
Peak ↑, plateau unchanged
Compliance problem
Peak ↑, plateau ↑
Air trapping
Expiratory flow never reaches zero
Go deeper in the full module
Lesson 3.3 · 10 min

Escalation language that gets a response

By the end you can

  • Deliver a finding, an interpretation, and a request in under thirty seconds
  • Give the number that makes the case
  • Close the loop on what was agreed

Finding, meaning, ask

State what changed, what you believe it means, and exactly what you want. 'Her rate went from 22 to 34 over two hours, her tidal volumes are dropping, I think she is tiring, and I would like to start noninvasive ventilation and draw a gas' is a call people act on. 'She looks bad' is not.

Bring the trend, not just the current value. Two data points and a direction beat a single alarming number, because the direction is what predicts the next hour.

Where people lose the point

  • Reporting a value with no interpretation attached
  • Asking for 'orders' instead of asking for the specific intervention
  • Ending the call without repeating back what was agreed
Study guide

The whole stage on one page.

Review this the morning of a shift or the night before the assessment. Print it or save it as a PDF.

3.1

The sudden desaturation, worked in order

  • Run DOPE without skipping to the ventilator
  • Decide when to disconnect and bag
  • Confirm tube position with more than breath sounds

Say it while you do it: Disconnect, bag with 100%, note compliance under your hand → Displacement: depth at the teeth, capnogram present → Obstruction: pass a suction catheter → Pneumothorax: unilateral sounds, tracheal shift, hypotension → Equipment: circuit, valve, gas source

3.2

Graphics tell you what the patient is doing

  • Distinguish resistance problems from compliance problems on a pressure curve
  • Recognize air trapping on the flow curve
  • Name the dyssynchrony you are seeing
3.3

Escalation language that gets a response

  • Deliver a finding, an interpretation, and a request in under thirty seconds
  • Give the number that makes the case
  • Close the loop on what was agreed

Every number in this stage

Resistance problem
Peak ↑, plateau unchanged
Compliance problem
Peak ↑, plateau ↑
Air trapping
Expiratory flow never reaches zero

Traps to avoid

  • Suctioning first out of reflex before assessing tube position
  • Adjusting alarms instead of assessing the patient
  • Accepting bilateral breath sounds as proof of correct depth
  • Reporting a value with no interpretation attached
  • Asking for 'orders' instead of asking for the specific intervention
  • Ending the call without repeating back what was agreed
Flashcards

Drill the recall before the assessment.

12 cards for this stage. Tap a card to flip it, mark the ones you know, then take the assessment.

1 / 12 · 0 known
Take the assessment
Finish the stage

Now prove it on the assessment.

Eight scored questions drawn from this stage. Score 70% or better and the stage is marked passed on your path.

Take the New graduate assessmentNext stage: Practicing therapist
Back to the syllabus Airway management Ventilator monitoring & graphics Mechanical ventilation