When a patient has hypoxia and respiratory failure while on the ventilatory a number of possible causes come to mind.  We think about air trapping, tension pneumothorax, issues related to the ventilator, etc.  But in our smallest patients pneumothorax is common as well as poor endotracheal tube placement.  Tubes can become dislodged and also easliy shot into the right mainstem bronchus.  How can you figure it out immediatly?  FOCUS ON POCUS.