Ketamine May Aid in Prehospital Management of Severe Asthma

An ALS unit that has a 60-year-old female on board in severe respiratory distress. On arrival, you find your patient altered in the back of the ambulance. She's hypoxic, with oxygen saturation (SpO2) in the upper 60s, and has audible wheezing. She will not keep the non-rebreather mask on. Initially she was found unresponsive by the ALS crew, who first attempted intubation, but had difficulty doing so as they don't carry paralytics. An 18-gauge IV had been established in the left antecubital area, and she received 125 mg of solumedrol IV. The first arriving ALS crew has treated her before and indicates she has a history of severe asthma and has been intubated before in the past. You have a 25-minute air transport over a mountain range that's 9,000 feet above sea level to the nearest hospital with the appropriate level of care available. You and your partner decide that despite the difficulty in managing asthma patients on a ventilator, the patient will need intubation for airway control and to help further treat her asthma. Setup for intubation with paralytics is begun to increase the success of intubation. The patient continues to be non-cooperative and combative from her hypoxia. You plan to give her a sedation dose of ketamine, both to get control of the patient, and to better pre-oxygenate her prior to the intubation attempt. The setup is for a delayed sequence intubation (DSI) using ketamine and rocuronium. Plans are going well until the patient, in her altered state, pul...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Airway & Respiratory Columns Source Type: news