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.
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u/Goldy490 EM/CCM Attending May 28 '25
EM/ICU here. Guy sounds like an ass.
That said peri-intubation arrests are not ideal and I do think it’s usually worth looking at each case to see if anything could be done differently.
To say they’re incredibly rare though is incredibly false - they’re quite common in medically comorbid patients in extremis.
I have found between EM residency and ICU fellowship that in the ED we tend to intubate before we resuscitate though and often an intubation can wait for 5 minutes while the nurse hangs NE or you mix up a dirty epi drip, give a little calcium and bicarb, and do other good resuscitative things (not your case, just in general)