All right, so welcome back to the Internet Book of Critical Care podcast.

I'm here with Adam Thomas and we took a short break for the ESICM conference, but we're back.

It was an emotional week, Josh.

It was an emotional week for me.

I know.

Today crashing asthmatic, we're talking about ICU level asthma. We'll allude to the phenotypes

here, but again, we're going to give the foundation and the dramatic approach all in one.

So today, diagnosis, we'll talk about the non-intubated crashing asthmatic, we'll give you

pearls around intubation if you have to, we'll talk about sedation strategies, we'll

talk about post-intubation stabilization, and all things vent. We'll talk about sedation strategies. We'll talk about post-intubation stabilization

and all things vent. We'll even trick a little ECMO in there to make you guys happy.

Yeah, I think we're going to irritate all people equally with this one.

That's our forte, isn't it, Josh? It's a rebellion, we rebel. So Josh, let's get straight

into it. Diagnosis and initial assessment of that asthma patient.

Just basic stuff here.

Obviously don't assume that every asthmatic patient has an asthma exacerbation.

So there's a table here with differential diagnoses.

Common things to consider are anaphylaxis, which can certainly look a lot like asthma.

Vocal cord dysfunction or upper airway obstruction.

Key clues there are if you can hear the wheezing across the roomal cord dysfunction or upper airway obstruction. Key clues

there are if you can hear the wheezing across the room, that's an upper airway problem.

That's not asthma super important. And then other things like pneumothorax pneumonia, heart failure.

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