RSI
Formal Definition
Rapid Sequence Intubation; a technique for emergency endotracheal intubation involving the near-simultaneous administration of a sedative/induction agent followed immediately by a neuromuscular blocking agent (NMBA) to achieve rapid loss of consciousness and paralysis, minimize the risk of aspiration, and secure the airway; the standard approach for intubating patients with a full stomach or at high aspiration risk.
How It's Used on the Ward
"RSI" or "rapid sequence intubation" or "we are RSI-ing this patient" — the standard emergency intubation protocol with drugs to knock out and paralyze fast.
Example
""Patient with massive GI bleed, hematemesis, unable to protect airway, SpO2 dropping to 88%: RSI planned. Pretreatment: suction at bedside, position upright. Induction: ketamine 1.5 mg/kg IV. Paralytic: succinylcholine 1.5 mg/kg IV. Cricoid pressure applied. Direct laryngoscopy: Cormack-Lehane grade 2, intubated with 7.5 ETT, CO2 confirmed.""
Clinical Context
RSI drugs: induction agents — ketamine (preferred for hemodynamically unstable; bronchodilates), etomidate (hemodynamically neutral, avoid in adrenal insufficiency), propofol (hypotension risk), midazolam (slower onset, use only as adjunct). NMBAs: succinylcholine (fast onset 45-60s, short duration, avoid in hyperkalemia risk: burns, crush, denervation, prolonged immobility); rocuronium (alternative if succinylcholine contraindicated, 1.2 mg/kg for RSI dosing; reversed with sugammadex). Cricoid pressure (Sellick maneuver): controversial — may worsen laryngoscopic view; selectively applied. Post-intubation: confirm placement with waveform capnography (gold standard), CXR. RSI is NOT delayed sequence intubation (DSI) — DSI uses ketamine for pre-oxygenation in a combative patient before paralysis.