Rosh Internal Medicine Boost Practice Exam

For a patient with an acute severe asthma exacerbation requiring intubation, which agent is most appropriate for induction?

1. Etomidate

2. Ketamine

3. Midazolam

4. Propofol

The correct answer is: Ketamine

In the context of a patient experiencing an acute severe asthma exacerbation requiring intubation, ketamine is the most appropriate agent for induction. Ketamine is well known for its unique properties that can be particularly beneficial in this scenario. One of the key characteristics of ketamine is its ability to provide analgesia and dissociative anesthesia while preserving respiratory drive and airway reflexes, making it advantageous in patients who may have compromised respiratory function. Unlike other induction agents, ketamine does not cause significant respiratory depression, which is crucial in patients with asthma who already have potential difficulties with ventilation. Additionally, ketamine can cause bronchodilation, which can help counteract bronchospasm in patients with asthma. This can potentially improve the patient's condition prior to intubation. The hemodynamic stability provided by ketamine is also beneficial in critical situations, allowing for safer intervention. In contrast, agents like etomidate and propofol could lead to respiratory depression, which is detrimental in a patient with existing respiratory compromise from an asthma exacerbation. Midazolam, while useful for sedation, does not provide the necessary bronchodilation and is also associated with respiratory depression. Ultimately, ketamine’s combination of analgesic, anesthetic, and bronchodil