I always say that it takes more skill to NOT intubate a patient. That is especially the case with severe CHF, where BiPAP, nitro and a couple of hours can turn them around completely. Intubation is a dangerous procedure, and I think we have come a long way in EM from the days when we had a low threshold to intubate intoxicated patients.

The TL;DR is that in patients suspected of “poisoning” (which to them means alcohol, drugs or medication), an expectant approach of “restricted intubation” led to improved outcomes of shorter ICU stay, shorter hospital stay, less pneumonia, and of course less adverse events from intubation.

Read this article and the commentary (both linked below). I thought this was too important to wait for Journal Club, but we could still cover it at JC in the near future. 20 different EDs, RCT, 225 total patients, excluded some poisonings that had easy reversal or needed antidotes. No patients died.

Here is the original research article. Here is the accompanying editorial.