Rapid sequence intubation for adults outside the operating room
- Calvin A Brown, III, MD, FAAEM
Calvin A Brown, III, MD, FAAEM
- Assistant Professor of Emergency Medicine
- Harvard Medical School
- John C Sakles, MD
John C Sakles, MD
- Professor of Emergency Medicine
- University of Arizona College of Medicine
- Section Editor
- Ron M Walls, MD, FRCPC, FAAEM
Ron M Walls, MD, FRCPC, FAAEM
- Editor-in-Chief — Adult and Pediatric Emergency Medicine
- Section Editor — Adult Resuscitation
- Neskey Family Professor of Emergency Medicine
- Harvard Medical School
- Brigham and Women's Hospital
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Emergency Medicine (Adult and Pediatric)
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
One of the most important tasks of any clinician managing an acutely unstable patient is to secure the airway. In most circumstances, emergency clinicians use rapid sequence intubation (RSI) to accomplish this task. RSI involves the administration of an induction agent and a neuromuscular blocking agent to create optimal intubating conditions and minimize the time the airway is unprotected. RSI presupposes the patient is at risk for aspiration of stomach contents and incorporates medications and techniques to minimize this risk. Use of RSI also helps to mitigate the potential adverse effects of airway manipulation.
This topic reviews the central concepts and techniques needed to perform RSI in adults in the emergency setting outside the operating room. RSI for anesthesia, RSI in children, the medications used for emergency RSI, and other subjects related to emergency airway management are reviewed separately:
●For medications used for RSI in adults: (See "Induction agents for rapid sequence intubation in adults outside the operating room" and "Neuromuscular blocking agents (NMBAs) for rapid sequence intubation in adults outside of the operating room".)
●For RSI in children: (See "Rapid sequence intubation (RSI) outside the operating room in children: Approach" and "Rapid sequence intubation (RSI) outside of the operating room in children: Medications for sedation and paralysis".)
●For basic and advanced airway management: (See "Basic airway management in adults" and "Extraglottic devices for emergency airway management in adults" and "Direct laryngoscopy and endotracheal intubation in adults" and "Video laryngoscopes and optical stylets for airway management for anesthesia in adults".)
Subscribers log in hereLiterature review current through: Nov 2017. | This topic last updated: Nov 16, 2017.References
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- CONTRAINDICATIONS AND PRECAUTIONS
- DESCRIPTION OF THE TECHNIQUE
- - General guidelines and common scenarios
- - Right-to-left intrapulmonary shunting
- - Delayed sequence intubation
- - Adjunct strategies
- Preintubation optimization
- Paralysis with induction
- - Induction agents
- - Neuromuscular blocking agents
- Placement with proof
- Postintubation management
- SUMMARY AND RECOMMENDATIONS