Medical

Septic shock / peri-arrest airway

Before / During / After / Pitfalls

Before

• Resuscitate first when possible: fluids/blood when indicated, vasopressor ready/running, source control pathway.
• Choose induction strategy with hypotension in mind; dose reduction/titration per local protocol.
• Have push-dose/infusion pressor, arterial monitoring plan, and post-intubation sedation ready.

During

• Minimize apnea; avoid excessive PEEP/vent pressures early if preload-dependent.
• Assign BP watcher and pressor nurse.
• Confirm tube, then immediately reassess MAP, EtCO2, perfusion, and sedation effect.

After

• Treat post-intubation hypotension aggressively.
• Use lung-protective ventilator strategy if ARDS/sepsis lung injury present.
• Debrief whether airway timing/resuscitation sequence worked.

Pitfalls

• Paralyzing before pressor/resuscitation plan is ready.
• Over-sedation immediately after tube.
• Excessive intrathoracic pressure in preload-dependent shock.