intubation induced cardiac arrest

[donedeal]

The other day at the hospital we had a 49 y/o male patient come in with chest pain and SOB. He was brought back right away, still walking and talking, with obvious signs of respiratory distress. We did a whole workup on him, lines, labs, CT scan, ekg, ect....patient's breathing eventually worsened and he needed to be intubated for stabilization. At this point his BP was 60 systolic, HR around 120. The patient was still conscious and struggling to speak. It was not until the patient was given succinylcholine and etomidate that the patient went into arrest. It seemed as if the process and use of drugs to intubate actually put this man into cardiac arrest. Is this normal? Do these drugs lower blood pressure as a side effect? Perhaps cardiac arrest was inevitable, but i couldnt help but wonder if we just bagged him and pumped fluids into him if he would have stabilized. Unfortunately he did not survive. CT revealed a tear in the esophagus, Boerhaave's syndrome is suspected.

[Ridryder 911]

Well if the patient was ill enough to have to be intubated, I doubt it was the RSI that killed him. Sure Etomidate and Sux can definitely expedite things.. but, if he had esophageal tears... and Boerhaave's syndrome or esophageal varices, then he obvious has more of a hx. than one is aware of.....

I say it was consequential...

R/r 911

[AZCEP]

The Hx added to the meds would probably be co-factors. The intubation didn't make him arrest.

[ncmedic309]

I agree with the above comments. The arrest was coming, it just happened at the same time they were knocking this guy down. It seems more like a timing event than a procedure that precipitated the arrest.

[Spock]

Been there, done that and didn't like it. The patient was going to arrest no matter what. The only thing I would add in addition to all the other good comments would be with an SBP of 60 you would want to give a minimal dose of etomidate. Even though etomidate is promoted as being hemodynamically stable, if you give 40 mg you will knock down a patients BP.

Live long and prosper.

Spock

[FireMedic65]

I ran into a similar problem, pt was in severe resp distress. By the time the medic was ready to tube, pt had no pulse. Cause of death of pulmonary embolism.

I have never heard of any intubation directly causing cardiac arrest. Maybe if you take 5 minutes putting in a tube or something, i dunno

[brock8024]

I know we learned that when you intubate it can stimulate the vagus nerve causing some bradycardia.

someone please correct me if I am wrong.

What was the results of the EKG and other test done. What was the guys Hx? That can tell us alot.

I was in the ER once and had this happen. They went to tube the guy and next thing you know in the middle of it he went into arrest.

Brock

[FireMedic65]

yes, intubation does have vagal responses, but not anything that would cause asytole

[kevkei]

It's easy to blame the intubation, the RSI, or whatever else.

What about considering the fact that if nothing was done at all, he would have arrested. If you consider things that way, it makes the decision to do something a lot easier.