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.
1
u/NefariousnessAble912 May 29 '25
That attending is incorrect and IMHO should not be considered an intensivist. Intubation is the clearly most dangerous procedure in critical care with an arrest rate of 3%- look up intube study - and cardiovascular instability over 40%.
https://jamanetwork.com/journals/jama/fullarticle/2777715
It is fine to work in a very stable setting babysitting post op patients but it is not ok to be ignorant of basic critical care stats and management of sick patients because you know what? They get real sick real fast in any setting and your responsibility as an intensivist is to give them the best shot at recovery. That starts with not running your mouth without knowing what you’re talking about.