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Rapid sequence intubation (RSI) in children

Dewesh Agrawal, MD
Section Editor
Susan B Torrey, MD
Deputy Editor
James F Wiley, II, MD, MPH


This topic will discuss evaluation of the patient requiring RSI, as well as choice of pharmacologic agents and the steps involved in performing RSI. Procedures for laryngoscopy and intubation, the difficult pediatric airway, and airway management for adults are discussed elsewhere. (See "Emergency endotracheal intubation in children" and "The difficult pediatric airway" and "Basic airway management in adults" and "Rapid sequence intubation for adults outside the operating room".)


Rapid sequence intubation (RSI) describes a sequential process of preparation, sedation, and paralysis to facilitate safe, emergent tracheal intubation. Pharmacologic sedation and paralysis are induced in rapid succession to quickly and effectively perform laryngoscopy and tracheal intubation. At the same time, careful preparation (including preoxygenation) and the use of specific techniques (such as external laryngeal manipulation and avoiding positive pressure ventilation) minimize the risks of hypoxia and aspiration.

In the emergency department (ED), RSI is generally the preferred method for emergently intubating patients who have varying levels of consciousness and are presumed to have a full stomach [1].

The success of the procedure depends upon the following:

Sedation and paralysis eliminate protective airway reflexes and spontaneous respiration. Therefore, difficulties with intubation and/or ventilation must be anticipated and contingency plans for a failed intubation developed.


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Literature review current through: Feb 2017. | This topic last updated: Tue Feb 14 00:00:00 GMT+00:00 2017.
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