What is Rapid Sequence Induction?

T. Broderick

Rapid sequence induction, also known as RSI, is an advanced medical procedure for endotracheal intubation. Though the goal of rapid sequence induction is no different from normal intubation, a physician performs RSI exclusively on patients who may expel his or her stomach contents during the process of intubation. To reduce this risk, RSI focuses on temporarily paralyzing the patient during the procedure. As anesthetic drugs are part of the procedure, a physician administering RSI must have extensive training in the procedure or have an anesthesiologist administer the drugs. Paramedics or nurses can perform RSI during emergency conditions.

Rapid sequence induction is an advanced medical procedure for endotracheal intubation.
Rapid sequence induction is an advanced medical procedure for endotracheal intubation.

Intubation is necessary in a variety of medical situations, from post-surgery recovery to assisting patient breathing during the end stages of a terminal illness. Rapid sequence induction has the same overall goal, but is necessary in emergency situations when a patient may vomit during intubation. For example, if a patient has a stroke right after eating, vomiting during intubation poses a significant risk of choking, acidosis and hypoxia. As these risk factors can become fatal, RSI is the preferred method in these situations.

Paramedics are trained to perform a rapid sequence induction when it is necessary to save the life of a critically injured patient.
Paramedics are trained to perform a rapid sequence induction when it is necessary to save the life of a critically injured patient.

Rapid sequence induction is a multi-step process that a physician or other medical professional must be able to complete in less than two minutes. After confirming that all necessary materials are present, a physician administers pure oxygen to raise blood oxygen levels. The patient then receives any appropriate premedication before the anesthetic. The physician then inserts the tube between the vocal chords. The last two steps involve checking that air is reaching the lungs and securing the tube to a portable or hospital ventilator.

Rapid sequence induction requires a much higher level of skill compared to normal intubation. Though a single physician is able to carry out the entire procedure, the safest method involves two medical personnel. One person intubates the patient while the other administers the anesthetic. This safeguard lowers the chance that the patient receives too little or too much anesthetic. Either mistake can have fatal results.

A physician or anesthesiologist is not always available to perform rapid sequence induction. For example, paramedics rushing a patient to the hospital sometimes have no choice but to perform RSI in order to save the patient's life. Though RSI carries more risk for the patient in this situation, delaying treatment can mean patient death. The potential benefit outweighs the potential risk.

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