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.

242 Upvotes
  • permalink
  • reddit

98% Upvoted

148 comments sorted by

View all comments

2

u/Asclepiatus BSN May 28 '25 edited 7d ago

vast point sulky lunchroom intelligent narrow bike advise observation vase

This post was mass deleted and anonymized with Redact

3

u/Ineffaboble May 29 '25

Thanks. To the contrary my nurses were awesome and (like always) super supportive! My sisters from other misters and brothers from other mothers lol

My mom was an OG ER nurse and my nurse colleagues are some of my dearest friends and I’m extremely lucky that they have my back ❤️💙💜

They filed a CI report for a completely unrelated but very valid reason (the RT’s performance — it didn’t affect the outcome so I didn’t bring it into my post) and the ICU doc just tagged on to the email chain and I caught a stray 😭

And yeah you reminded me — once she was apneic we cranked the PEEP up and tried to bag her up to a higher sat but were just kind of treading water.

It was one of those very rare cases where nothing we did was working and we couldn’t buy ourselves any time. I’ve only had three intubations remotely as scary as this in my staff career.