Which sequence correctly lists the general steps of rapid sequence intubation (RSI)?

Which sequence correctly lists the general steps of rapid sequence intubation (RSI)?

• A. Hyperoxygenate, prep equipment and position patient, induction and neuromuscular blocking agent administration, intubate, confirm placement
• B. Hyperoxygenate; prep equipment and position patient; intubate; induction and neuromuscular blocking agent administration; confirm placement
• C. Hyperoxygenate, prep equipment and position patient, intubate, induction and neuromuscular blocking agent administration, confirm placement
• D. Prep equipment and position patient, hyperoxygenate, induction and neuromuscular blocking agent administration, intubate, confirm placement

Answer: (A)

Rapid sequence intubation hinges on keeping the patient well oxygenated while creating the best conditions for a quick, controlled airway. Start with hyperoxygenation to build a safety margin against desaturation during the brief apnea that follows. Then get the essential equipment ready and position the patient properly so you can move immediately to the next steps without delay. Administer the induction agent and the neuromuscular blocker in quick succession to achieve rapid loss of consciousness and complete muscle relaxation, which allows a smoother and faster intubation with fewer movements. Perform the intubation once the patient is paralyzed, and finally confirm endotracheal tube placement with reliable methods such as waveform capnography (and then auscultation as adjunct). Other sequences disrupt this flow by delaying preoxygenation, or by attempting intubation before paralysis, which can worsen the view, increase hemodynamic instability, or increase the risk of aspiration.

Rapid sequence intubation hinges on keeping the patient well oxygenated while creating the best conditions for a quick, controlled airway. Start with hyperoxygenation to build a safety margin against desaturation during the brief apnea that follows. Then get the essential equipment ready and position the patient properly so you can move immediately to the next steps without delay. Administer the induction agent and the neuromuscular blocker in quick succession to achieve rapid loss of consciousness and complete muscle relaxation, which allows a smoother and faster intubation with fewer movements. Perform the intubation once the patient is paralyzed, and finally confirm endotracheal tube placement with reliable methods such as waveform capnography (and then auscultation as adjunct).

Other sequences disrupt this flow by delaying preoxygenation, or by attempting intubation before paralysis, which can worsen the view, increase hemodynamic instability, or increase the risk of aspiration.