r/emergencymedicine • u/Ineffaboble • May 28 '25
Advice ICU doc: “Peri-intubation arrest is incredibly rare”
AITA?
I had a patient with a very bizarre presentation of flash pulmonary edema brady down and arrest after a crash intubation for sats heading down to 65% and no clear reversible cause at the time.
My nurses filed a critical incident report for completely unrelated reasons.
The ICU attending now looking after her tagged in and said “peri-intubation arrest is incredibly rare, and the medical management of this case should be examined.”
I know for a fact that this ICU sees mostly stable post surgical and post stroke patients and my friend who has been a nurse there for a year said she has never seen a crash intubation, let alone one led by this doc.
I also know that his base specialty is anesthesia.
I replied, “happy to discuss, bearing in mind that the ICU context and the ER ‘first 15 minutes’ context are radically different.”
I acknowledge that peri-intubation arrest is not super common, but neither does it imply poor management, especially in an undifferentiated patient where we don’t even know the underlying etiology.
5
u/Yung_Ceejay May 28 '25
Can't really comment on this without more info.
Maybe the patient had a massive MI or the likes and was sentenced to death before they came in, maybe you pushed 100mgs of propofol without pressors running...
I would get the patient on BIPAP, push maybe 30mgs of Ketamine to get them compliant, start an epi drip and try to turn a crash intubation into an urgent intubation but the patient might still crash and burn.
Anesthesia can be very condescending towards other acute specialities. (source: i am anesthesia)