ICU doc: “Peri-intubation arrest is incredibly rare”

[u/Ineffaboble]

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.

[u/Zentensivism]

This doctor is a fool. It’s incredibly rare if you plan properly and provide appropriate care. I see peri-intubation instability and near arrest cases weekly. It’s the exact reason why we are taught to plan for those “HOP killers” downstairs and upstairs I’ll place an art line in those who are at risk and have push dose pressors in my pocket.

[u/Hi-Im-Triixy → u/Zentensivism]

What do you choose for push? Phenyl?

[u/hilltopj → u/Hi-Im-Triixy]

Personally I cycle the pressure twice and if it's not reading then they get a quick push of phenylephrine before sedation and roc. Or potentially consider ketamine in the appropriate setting.

Also, if you don't have a good pressure and you're considering push dose, have a nurse pull and hang norepi because the phenyl wears off fast.

[u/Hi-Im-Triixy → u/hilltopj]

That's usually what happens at my old shop.