A 71-year-old man presents to the emergency department with rapidly worsening respiratory failure secondary to severe bilateral pneumonia. Despite a trial of non-invasive ventilation, his oxygenation continues to decline, and the decision is made to secure his airway. Arrange the following steps of rapid sequence intubation (RSI) in the correct chronological order.
- 1Pre-oxygenate the patient with 100% oxygen.
- 2Administer an intravenous induction agent.
- 3Administer an intravenous neuromuscular blocking agent.
- 4Perform laryngoscopy to visualize the glottic opening.
- 5Insert the endotracheal tube and confirm placement with capnography.
Answer
The correct sequence is: Pre-oxygenate, administer an induction agent, administer a neuromuscular blocking agent, perform laryngoscopy, and finally insert the endotracheal tube with capnography confirmation.
Rapid sequence intubation (RSI) is the standard method for securing an airway in critically ill patients to minimize the risk of aspiration. The protocol must follow a strict chronological sequence: pre-oxygenation to maximize safe apnea time, followed by an induction agent to ensure unconsciousness. Immediately after, a paralytic agent is given to relax the airway muscles. Once paralysis is achieved, laryngoscopy is performed to visualize the vocal cords, allowing for endotracheal tube placement. Finally, placement must be confirmed using end-tidal CO2 (capnography).
Step-by-Step Solution
Key Concept
Rapid Sequence Intubation (RSI) Protocol