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/hilltopj]

And that's the difference between downstairs and upstairs that the non-EM trained CC docs sometimes don't understand: upstairs they have the privilege of knowing what's coming and prepare for the worst whereas downstairs the worst sometimes just lands on our doorstep. At my shop the ICU docs aren't even in house overnight and don't respond to codes on the floor unless they happen to be around. One of the overnight ICU nurses told me- after only a year at that facility- that she'd seen me in their unit more than any of their own docs. Even in their space I'm doing more crash intubations than they are.

If I were in OP's situation I'd agree that this needs to be examined... by an EM doc.

[u/the_silent_redditor → u/hilltopj]

Had a lady arrest in the car park outside ED.

CPR and defib on the cold hard ground and managed to get ROSC and remained unstable in every which way, so ended up tubed on pressors blah blah blah.

Transferred to the brain boxes upstairs and this fella is looking at the gases. “This patient really could have done with more adequate pre-oxygenation to the tube.”

Cool. Next time we’ll call you and you can come do CPR in a puddle and then DCR with a whole waiting room watching and then tube when they remain periarrest. Dumb motherfucker.

I just said oh yeah wish we’d thought of that.

Some folk are genuinely fucking clueless, despite working immediately next door lmao.

[u/Equivalent-Lie5822 → u/the_silent_redditor]

Oh boy is that conversation relatable. Explain to the ED why I couldn’t call ahead because my hands were a bit occupied bagging the patient who arrested on me mid transport.

[u/GPStephan → u/Equivalent-Lie5822]

Holy shit I hate this. Yes, I'm supposed to call before I deliver a trainwreck, but half the time I have no coverage out in the middle of bumfuck nowhere, and the other half I'm doing patient care. I've then had one receiving professional suggest to me I should have handed the phone to the driver. Yea, sure, great idea. Cause driving lights and sirens is basically like riding the train as a passenger. Just sit down and look out the window.

To all ED docs reading this: many of you are great people that make me feel valued. But some people could use a moment to think of the circumstances we work in.