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/ProgrammerMean3412]

Many if not most peri-intubation arrests are from a failure to resucitate the patient prior to intubation, unrecognized esophageal intubation or a daft induction. They're mostly, but completely, preventable.

[u/Ineffaboble → u/ProgrammerMean3412]

Source?

[u/ProgrammerMean3412 → u/Ineffaboble]

The most "reddit reaponse" imaginable. Take a look at your own practice, your colleagues, and heck ask someone who's been practicing longer. We have ourselves to blame in most instances when they code peri intubation. Someone mentioned the HOP killers above, I welcome you to review exactly why that term was coined. Its because bad medicine often takes a tenuous patient and promptly kills them.