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/SpoofedFinger May 28 '25

I mean, what they said is technically true, IF you're counting every more routine intubation. It's not uncommon at all in crash intubations for respiratory failure that are already domino-ing into shock. You'd think an ICU doc that worked through covid, where these kinds of intubations were far more common, would know that. They only thing I could think of that would get my docs pissy like this is if you opted not to try bipap or something while setting up to RSI.

You're not the asshole, they're being a fuckwit.

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u/Ineffaboble May 28 '25

Thanks. She was on HHHFNC. No way was she going to tolerate BIPAP without heavy sedation (which could've made matters worse), and her sats dropped so quickly I don't think we could've gotten the mask on her in time. It was truly a minutes-to-seconds kind of crash. I don't intubate just for bragging rights.