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The immediate life threats can be summarized as “DOPES”:

Displacement of the endotracheal tube (ETT)
Obstruction of the ETT
Patient — especially pneumothorax; also: pulmonary embolism, pulmonary edema, collapse, bronchospasm
Equipment — ventilator problems
‘Stacked breaths’ — a reminder about bronchospasm and ventilator settings.
Structured approach

Disconnect the ventilator and administer high-flow 100% oxygen (FiO2 1.0) using a bag-valve-mask.
Disconnection allows the release of trapped gas in the patient with severe bronchospasm — these patients usually have evidence of bronchospasm and/ or hypotension in addition to hypoxia.
Also, if the patient is easy to ventilate and re-oxygenate, then the problem probably lies with the ventilator or the circuit.
In a ventilated patient that has a problem always think: man versus machine.
Assess the patient using the MASH approach before attempting to diagnose the problem:
Movement of the chest during ventilation —
is it absent or is movement only on one side? Is the chest hyper-expanded?
Arterial saturation (SaO2) and PaO2 —
obtain an ABG sample
Skin colour of the patient (is he turning blue or pinking up?) —
the SO2 monitor lags behind the true oxygen saturation of the patient.
Hemodynamic stability
If the patient is difficult to manually ventilate, determine if the problem lies with the endotracheal tube or with the patient.
If there is little chest movement, a patient problem is still possible, but a problem with the ETT needs to be be ruled out urgently:
check ETCO2 to ensure the ETT is not in the esophagus and is patent.
pass a suction catheter and/ or a bougie to ensure the ETT is not obstructed.
check the placement of the tube visually — preferably by bronchoscopy, or alternative by by laryngoscopy from the top end (although this is far from 100% reliable).
consider a CXR to check ETT position if hypoxemia is not critical, especially if endobronchial intubation is suspected
If in doubt, and the hypoxia has not been rapidly resolved, take the tube out… and replace it.
If there is reasonable chest movement, a patient problem is most likely. Perform a focused exam and urgently seek and treat the following life-threats:
pneumothorax (look for asymmetrical chest movement)
lung collapse (look for asymmetrical chest movement)
pulmonary edema
bronchospasm (chest wall movement may be minimal — look for hyper-expansion)
pulmonary embolus
If the bag is easy to compress during manual ventilation, but there is little or no chest movement suspect either:
a circuit leak (e.g. cuff leak, disconnection, or a hole in the circuit), OR
dislodgement of the endotracheal tube — you may be ventilating the oropharynx or the stomach
If the patient is easy to ventilate with the bag and the hypoxemia rapidly resolves
Find out what happened just before the desaturation:
had suctioning been performed? (in some settings the loss of PEEP during disconnection of the circuit may lead to derecruitment and atelectasis, result in desaturation)
had there been a disconnection of the ventilator/circuit?
Otherwise, there may be a problem with the ventilator settings or there was an equipment failure.
check ventilator settings
trouble-shoot equipment failure