RAPID SEQUENCE INDUCTION (RSI)

What is the definition of RSI?

Administration of induction agent + neuromuscular blocker to facilitate intubation.

What are the presentations of RSI?

Airway compromise, decreased LOC/GCS, inadequate ventilation/oxygenation, multi-trauma/head injury.

What are the indications for RSI?

Airway/ventilation compromise, neuroprotection (e.g. TBI), anticipated need for anaesthesia, multi-injured patient management, humanitarian reasons.

What are the contraindications for RSI?

No absolute contraindications (QAS).

What are the complications of RSI?

Oesophageal intubation, aspiration, hypoxia, laryngospasm, oropharyngeal trauma, vagal stimulation.

What precautions should be taken during RSI?

Must have failed airway plan, ensure EtCO₂ monitoring available, optimise oxygenation prior, most experienced clinician for difficult airway, limit attempts to ≤2 or ≤30 seconds, perform in controlled environment (ambulance) where possible.

What are the procedure steps for RSI?

Assign roles (Supervisor, Airway, Circulation), complete checklist + team brief, pre-oxygenate (BVM + PEEP ± adjuncts), administer induction + paralytic, apply MILS if indicated, ventilate until paralysis achieved, perform laryngoscopy, insert bougie → railroad ETT, inflate cuff + ventilate, confirm with continuous EtCO₂ (≥6 breaths), secure ETT, post-intubation sedation + ongoing care.