ICU Cases · Airway management
Hot case — collapse in the first ten minutes after intubation
A CICM Second-Part hot case — the College's hallmark real-patient bedside encounter. The candidate works through the high-risk first ten minutes after intubation, when cardiovascular collapse and the misplaced tube both declare themselves: confirm the airway with capnography, exclude oesophageal intubation and a tension pneumothorax, resuscitate the circulation, and defend a plan that ties the physiology of peri-intubation collapse to its prevention.
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Candidate brief. Mrs T, 72, intubated ten minutes ago for respiratory failure from pneumonia. She was induced with a full dose of propofol after a single fluid bolus, paralysed with rocuronium, and the tube reportedly passed on the first attempt. Since induction her blood pressure has fallen from 110/65 to 64/38 mmHg, her heart rate has slowed to 48/min, and the SpO2 trace is poor and erratic at 84%. The nurse has called you to the bedside.[1]
You have eight minutes to review the chart, examine her, and prepare a structured assessment before the examiner arrives.[2]
References3ShowHide
- [1]Russotto V, Myatra SN, Laffey JG, et al. Intubation Practices and Adverse Peri-Intubation Events in Critically Ill Patients From 29 Countries. JAMA, 2021.PMID 33755076
- [2]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [3]Marino PL The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.