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/MarfanoidDroid]

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

[u/obtuserecluse → u/MarfanoidDroid]

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

[u/MarfanoidDroid → u/obtuserecluse]

Yeah but I don't have that in my code cart. Sometimes I inject into a 100cc bag of NS and draw into a 10cc to make 0.01mg per ml for my push dose depending on the scenario, but it's a quicker process to grab a pre loaded saline syringe and draw up 1ml

[u/robertdoleagainlol3 → u/MarfanoidDroid]

You don’t have code dose epi in your code cart? Am I understanding this math right????

[u/Purple_Opposite5464 → u/robertdoleagainlol3]

They probably just have 1mg/ml epi they use instead of, not everywhere carries the 1mg/10ml stuff