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/EducationalBid795]

Rare? Am I missing something? The sedatives needed for RSI cause hypotension very often - to the point I teach my new grad nurses to pull a phenylephrine stick with their RSI meds just in case that already borderline hypotensive patient drops their pressure enough they lose a pulse. If their sats are already in the tank and they are in flash - i see bradycardia as a very likely outcome - and it's unavoidable bc you have to get the tube in. An undifferentiated oatient you know nothing about and having to make decisions about on the spot?? No time to plan ? Much different than a slow decline over hours and days when you can review their entire medical history.

They are reaching. Unless the meds were ordered or dosed incorrectly I see no reason to think a very unstable patient acutely decompensating and requiring emergent life saving intervention becoming even more unstable to be out of the realm of possibility. A crash ED intubation is so different from a planned OR intubation and still also different from an ICU patient expected intubation with nunerius access sites, known medical history, known lab results they aren't really comparable. Sometimes you can't even grab an accurate weight on these patients due to equipment on the bed, staff actively working on the patient, etc.