Had a call last week — 450lb male, CHF exacerbation, sitting in a chair, couldn't lay flat. Sats dropping to 82% on 15L NRB.

Decision point: RSI or try CPAP first?

We went with CPAP + BiPAP trial first since he was still talking. Sats came up to 91% by the time we got to ED. Avoided an airway altogether.

Moral: don't rush to intubate. Non-invasive options work more often than you'd think.

Love this case. Non-invasive first, always.

Great case study. CPAP first is the right call in that scenario.