med 610 clinical respiratory diseases & critcare med

Mechanical Ventilation

Case 6

A 65 year-old woman is intubated emergently for a severe COPD exacerbation. She underwent a rapid sequence intubation using succinylcholine for paralysis and etomidate for sedation. Shortly after intubation, she becomes hypotensive with her blood pressure dropping from 145/85 prior to intubation to 95/60 post-intubation. On exam, she has a very prolonged expiratory phase and diffuse wheezing.

What is the differential diagnosis for this patient’s hypotension?


What can you do to sort through this differential and identify the etiology of the problem?


How should you manage the most likely source of the problem?


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