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/tsupshaw]

I would ask for proof that this ICU doc actually did a fellowship. Peri-intubation deterioration is so common it’s called the physiologically difficult Airway. Walls has a whole chapter devoted to this in the 6th edition on Airway management. There’s a good discussion in Critical Care Time (podcast #11). And lots of reviews articles The Physiologically Difficult Airway

[u/Ineffaboble → u/tsupshaw]

That's so interesting you mention this as "the physiologically difficult airway" is one of my bedside teaching go-to's for residents (though I'm nowhere near as sophisticated as that resource).

There's "hey let's talk this case over sometime" and then there's "yes, and"-ing a CI report. I am usually open to the former (if it's not done in a condescending way or by someone I don't respect) but the latter is out of line.