A patient receiving mechanical ventilation suddenly develops hypotension. What should you check first?

When a patient receiving mechanical ventilation develops hypotension, the first priority is to verify the endotracheal tube placement. Proper tube placement is crucial for ensuring that the patient is receiving adequate ventilation. If the tube has become dislodged or is improperly positioned, it can lead to hypoventilation or inadequate oxygenation, which may result in a drop in blood pressure.

Confirming the position of the endotracheal tube involves assessing the patient's breath sounds, observing chest movement, and checking for adequate end-tidal CO2 levels. If the tube has shifted, it can cause respiratory distress and subsequently impact hemodynamics, leading to hypotension. Ensuring the airway is secure and functioning correctly is essential before investigating other potential causes of hypotension.

While blood glucose levels, ventilator settings, and medication history are important considerations in the overall management of a critically ill patient, they are secondary to confirming that the airway is secure and that the patient is being adequately ventilated.