Severe asthma — intubate when…
Asthma intubation indications
Mnemonic device
Silent chest + accessory + speech
Mapping
1
Silent chest — no wheezing because no airflow
2
Mental status change — CO2 narcosis, hypoxic
3
Accessory muscle use — diaphragm fatiguing
4
Speech limited — single words
5
Heart rate >120 with rising lactate
6
Exhaustion — paradoxical breathing
7
Drop in PEFR <25% predicted
Clinical note: Ketamine is the induction agent of choice — bronchodilator + maintains drive. Avoid β-blockers; permissive hypercapnia + low rate to avoid breath-stacking.