Adult Critical Care Specialty (ACCS) Practice Exam

What action should be taken when there is a low pressure alarm on a ventilated patient with diminished breath sounds?

1. Apply supplemental oxygen

2. Use a bag-valve mask for ventilation

3. Use a tube exchanger to replace the ET tube

4. Increase the respiratory rate on the ventilator

The correct answer is: Use a tube exchanger to replace the ET tube

When faced with a low pressure alarm on a ventilated patient who also exhibits diminished breath sounds, the appropriate action involves using a tube exchanger to replace the endotracheal (ET) tube. This situation often indicates a potential issue with the airway, such as a dislodged or obstructed ET tube, or a significant reduction in lung inflation capability due to underlying pathology like a pneumothorax or severe atelectasis. Using a tube exchanger is critical because it allows for the rapid replacement of the ET tube while minimizing the risk of losing the airway entirely. It provides a means to ensure that mechanical ventilation can continue without interruption and that the patient's oxygenation and ventilation needs are met effectively. Rapid assessment and intervention in this scenario help prevent respiratory distress or further complications for the patient. While other actions such as applying supplemental oxygen, using a bag-valve mask, or increasing the respiratory rate might seem helpful, they do not directly address the potential underlying airway problem. Supplemental oxygen may provide temporary improvement but does not resolve the issue of obstructed or ineffective ventilation. Bag-valve mask ventilation could be indicated if immediate rescue is necessary, but it is not a sustainable solution for the identified problem. Increasing the respiratory rate could also fail to correct the underlying cause