Rapid Sequence Induction (RSI)
Rapid Sequence Induction (RSI) is a structured, time‑critical technique to obtain a definitive airway quickly in patients at high risk of aspiration or who cannot maintain airway/ventilation. The aim is to minimise the interval between loss of protective airway reflexes and cuffed endotracheal tube placement, thereby reducing aspiration risk and peri‑intubation hypoxaemia.
This section summarises indications, the stepwise 7‑P approach, drug and device considerations, verification and immediate post‑intubation care, systems‑level expectations and common pitfalls. Key UK guidance includes NICE NG39 and QS166 (major trauma/timeliness), the RCEM-RCoA Emergency Airway Management joint statement (systems and governance), Resuscitation Council UK (airway in arrest/peri‑arrest) and GOV.UK material on etomidate safety (GOV.UK ACMD review).
Indications and scope
Use RSI when rapid, controlled airway protection is required and aspiration risk is significant. Typical indications include:
- Unable to maintain airway or ventilation.
- Major trauma requiring definitive airway (NICE recommends drug‑assisted RSI and aims for early performance, ideally within 45 minutes of the emergency call where feasible) (NICE NG39; QS166).
- Depressed consciousness with loss of airway reflexes (for example, severe head injury or very low Glasgow Coma Scale).
- Active airway contamination (blood, secretions, burns) or imminent airway compromise.
- Patients who are not fasted and need urgent airway instrumentation.
RSI is often preferred over procedural sedation when aspiration risk is high; local sedation policies and...
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