In this episode, Dr. Haney Mallemat recounts a harrowing experience faced by a former resident who grappled with a life-threatening asthma exacerbation. Detailing the critical decisions made in a small, understaffed hospital, Dr. Mallemat underscores the complexities of managing severe asthma cases. From the crucial importance of avoiding premature intubation to navigating medication choices like epinephrine and heliox therapy, listeners gain insights into the nuanced approach required in such emergencies. Dr. Mallemat emphasizes the significance of calming anxious patients, employing ketamine, and utilizing non-invasive ventilation to alleviate distress. With practical advice on when to consider intubation, optimizing ventilation strategies, and managing post-intubation care, this episode offers invaluable guidance for healthcare professionals confronting life-threatening asthma scenarios.