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/DrClutch93]

As an anesthesia resident, I've already learned that sick patients are risky to induce and intubate even when they need/especially when they really need it. That's exactly why in OR we put awake arterial lines so that we catch that cardiovascular collapse early with induction and we have our pressors ready or even started already. It's definitely not unheard of for a sick patient to arrest peri-intubation. The thing is, typically by the time the patient is in our OR, the patient has already been "differentiated" so we know what to expect and consider.