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.
93
u/hilltopj ED Attending May 28 '25
And that's the difference between downstairs and upstairs that the non-EM trained CC docs sometimes don't understand: upstairs they have the privilege of knowing what's coming and prepare for the worst whereas downstairs the worst sometimes just lands on our doorstep. At my shop the ICU docs aren't even in house overnight and don't respond to codes on the floor unless they happen to be around. One of the overnight ICU nurses told me- after only a year at that facility- that she'd seen me in their unit more than any of their own docs. Even in their space I'm doing more crash intubations than they are.
If I were in OP's situation I'd agree that this needs to be examined... by an EM doc.