Emergency Medicine Board Bombs 249. Clean kill: when intubation kills your pt
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Feb 2, 2025 Intubation is a high-stakes gamble that can lead to catastrophic outcomes, including the dreaded 'clean kill.' A harrowing case study of a critically ill patient illustrates the delicate balance required in emergency medicine. Important discussions focus on the risks of sedation and paralytics, highlighting three vulnerable patient demographics. Listeners also explore non-invasive alternatives that can enhance patient safety. This deep dive into critical care exposes the nuances of decision-making that can mean life or death.
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Initial Management of Respiratory Distress
- Consider BiPAP with vasopressor support for hypotensive, tachycardic patients in respiratory distress.
- Avoid immediate intubation, even if it seems intuitive, as it can lead to cardiovascular collapse.
Clean Kill Phenomenon
- Intubation can sometimes be a "clean kill," leading to cardiovascular collapse and death.
- Some patients cannot tolerate the physiological changes induced by ventilation.
Physiology of Intubation Collapse
- Positive pressure ventilation decreases venous return, lowering cardiac output.
- Sedation and paralytics eliminate compensatory mechanisms against shock, like vascular tone.