Emergency Medicine Board Bombs
249. Clean kill: when intubation kills your pt
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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Quick takeaways
- Intubation poses significant risks for patients with cardiovascular instability, necessitating a careful assessment before proceeding with the procedure.
- Clinicians should prioritize stabilization methods over intubation in high-risk patients to mitigate potential hemodynamic collapse during critical care.
Deep dives
Intubation Risks in High-Risk Patients
Intubation can pose significant risks for certain patient populations, particularly those in respiratory distress with underlying cardiovascular instability. Patients with conditions such as acute right heart failure or massive pulmonary embolism require careful management, as intubation may lead to further declines in hemodynamic status. The introduction of positive pressure ventilation during intubation can decrease venous return and subsequently reduce cardiac output, potentially leading to cardiovascular collapse. It is critical for clinicians to recognize that for these patients, maintaining preload and optimizing oxygenation should take precedence over immediate intubation.
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