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/MarfanoidDroid ED Attending May 28 '25

Boo phenylephrine for push dose. Epi is my go to. 1 cc of 1:1000 in a 10cc syringe w 9cc saline. 0.1mg epi per ml

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u/obtuserecluse May 28 '25

Doesn't this just make it 1:10,000

4

u/rectal_intubation May 28 '25

Yes it is, but I dilute it one further to 1:100000 so its 10mcg/ml. I prefer it over phenylephrine as well, but I am not a physician. Canadian advanced care paramedic.

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u/sdb00913 Paramedic May 28 '25

American paramedic here, that’s what I do as well.