Rapid sequence induction (RSI, also referred to as rapid sequence intubation when performed in an Emergency Department or pre-hospital setting) is an advanced medical protocol which permits the intubation of conscious patients who require advanced airway support. Having evolved from procedures used to "induce" a coma-state in preparation for surgery, RSI is now often used in emergency settings also. This article or section needs copy editing for grammar, style, cohesion, tone and/or spelling. ...

RSI involves the use of a sedative/hypnotic medication to relax the patient followed by administration of a rapid-acting neuromuscular blocker (a paralytic) to disable the patient's involuntary reflex to fight the intubation. Sedatives typically used include thiopental, propofol, versed, or etomidate. Neuromuscular-blocking drugs typically used include succinylcholine or rocuronium. The combination enables the insertion of an endotracheal tube to ventilate patients requiring this type of advanced airway measure. Often, lidocaine is given as well if increased intracranial pressure is suspected (although there is controversy about effectiveness) and atropine is given in patients less than 2 years old to block reflex bradycardia. Sometimes fentanyl may also be used to sedate and block any pain response. Sodium thiopental (also called sodium pentothal (™ of Abbott Laboratories), thiopental (or thiopentone) sodium) is a rapid-onset, short-acting barbiturate general anesthetic. ... Propofol is a short-acting intravenous anesthetic agent used for the induction of general anesthesia in adult patients and pediatric patients older than 3 years of age; maintenance of general anesthesia in adult patients and pediatric patients older than 2 months of age; and sedation in medical contexts, such as... Midazolam, also known by the trade names Versed®, Hypnovel® and Dormicum®, is a benzodiazepine drug with an imidazole structure. ... Etomidate is a short acting intravenous anaesthetic agent used for the induction of general anaesthesia and for sedation for short procedures such as reduction of dislocated joints and cardioversion. ... Drugs can block neuromuscular transmission etiher by acting presynaptically, to inhibit ACh synthesis or release, or by acting postsynaptically, the latter being the site of action ofa ll of the clincally important drugs. ... Suxamethonium chloride (also known as succinylcholine, or scoline) is a white crystalline substance, it is odourless and highly soluble in water. ... Rocuronium is a non-depolarizing (that is, it does not cause initial stimulation of muscles before weakening them) neuromuscular blocker used in modern anaesthesia, to aid and enable endotracheal intubation, which is often necessary to assist in the controlled ventilation of unconscious patients during surgery and sometimes in intensive care. ... Diagram of an endotracheal tube (10) that has been inserted into the airway of a patient. ... Lidocaine (INN) (IPA: ) or lignocaine (former BAN) (IPA: ) is a common local anesthetic and antiarrhythmic drug. ... Atropine is a tropane alkaloid extracted from the deadly nightshade (Atropa belladonna) and other plants of the family Solanaceae. ... Bradycardia, as applied to adult medicine, is defined as a resting heart rate of under 60 beats per minute, though it is seldom symptomatic until the rate drops below 50 beat/min. ... Fentanyl is an opioid analgesic, first synthesized by Janssen Pharmaceutica (Belgium) in the late 1950s, with a potency many times that of morphine. ...

This procedure can be performed by paramedics in certain settings, especially aero-medical paramedics.

A similar procedure known as "pharmacologically assisted intubation" utilizes the sedative and hypnotic medications without the use of paralytics. This procedure is highly controversial and is usually performed where full RSI procedures are not legally allowed. RSI is the preferred procedure because it maximizes the chance of a successful intubation and reduces the chance of developing harmful increased intracranial pressure or other injuries during intubation.

External links

• emerg/938 at eMedicine
• emerg/939 at eMedicine