ICU scenarios: it's 5:40 am. After a rapid response is called, the team is bringing to the ICU a 60 yo male pt that has been managed in the COVID-19 ward for 12 ds with NIV/steroids/tocilizumab/empiric antibiotics and anticoag. Pt pulled his mask and desated to the mid-60s...
When he arrived to the ICU, sat was in mid-80s (NIV-Fio2 100%/PEEP10), not much ⬇️ than the last few ds (it was ~90%). He is breathing in the high 20s, in mild/mod resp distress (for whatever that means!). You realize that: i) there is nothing else to offer besides intubation/MV
...and ii) he can probably "go" for a few more hrs without being intubated. You already had a brutal night. You've been up 10.5 hrs. You have no "help" (no resident/fellow/NP/PA). The am crew (MD + PA) arrive at 7 am. Your resp therapists sign-out at 6 am. What would you do next:
Would you have made a different decision if it was 10 pm? If the am team was just another attending without "help" (again: no NP/PA/fellow)? If you had a quiet night and managed to sleep a couple of hours? If the patient was on 60%? If the patient was COVID-19 (-)?
Take home message:
Many ICU decisions are patient- and context-specific. I consider intubation the procedure that requires the highest level of "situational awareness". Jumping on it or delaying it can come at great cost.
Thanks for reading and voting!
Many ICU decisions are patient- and context-specific. I consider intubation the procedure that requires the highest level of "situational awareness". Jumping on it or delaying it can come at great cost.
Thanks for reading and voting!
#FOAMed #MedEd #EMBound @MetroHealth_EM @jminardi21 @ThinkingCC @RJonesSonoEM @jaffa_md @katiewiskar @msiuba @siddharth_dugar @HeyDrNik @ICUltrasonica @khaycock2 @TaotePOCUS @apenarEM @vaszochios @nickmmark @cjosephy @critconcepts @grepmeded @RosenelliEM
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