Ketamine can be very useful especially in septic shock patients who refuse to cooperate to allow me to pre-oxygenate with nasal cannula with facemask or even with the newer device, the SuperNova.

At baseline patient confused from dementia, and slightly more from sepsis with ongoing metabolic acidosis from lactic acidosis. Ketamine was my friend today when I used it correctly. I wanted to avoid the 8hrs post adrenal suppression if intubation was done with etomidate.

Gave Ketamine 1mg/kg and then once preoxygenated with the SuperNova device, Succinylcholine was given since the patient had no absolute contraindications.

Read up on this Weingart link for more FOAMED on Delayed Sequence Intubation or Weingart and Levitan's collaboration on DSI for preoxygenation link.

If that is not enough go to

http://emcrit.org/dsi/

https://www.acep.org/Clinical---Practice-Management/Upstairs-Care-Downstairs--Delayed-Sequence-Intubation-(DSI)/

http://lifeinthefastlane.com/ccc/delayed-sequence-intubation/