According to an article in JEMS, paramedics can consider using ketamine with other standard asthma medications to manage a severe asthma patient needing intubation in prehospital settings. The article includes a case study of a severe asthmatic needing endotracheal intubation in which ketamine was used as a sedative.
Ketamine is well known for its rapid onset of behavioral control with preservation of airway reflexes, and can be given IV, intramuscular, and intranasal. It’s a drug that’s not commonly thought of as an adjunct in the case of severe asthma exacerbations, which served two very important functions in the management of this patient’s severe asthma exacerbation.
This case highlights the advantages ketamine gave the crew in this including: behavioral control, bronchodilation, optimize pre-oxygenation and continued sedation for comfort. In conjunction with appropriate ventilator settings, an in-line DuoNeb and magnesium, ketamine provided an effective and comfortable patient transport on the ventilator that might otherwise have been difficult to obtain.