Outline the basic steps of a Rapid Sequence Intubation (RSI) protocol.

• A. Preoxygenation, induction, paralysis, laryngoscopy with tube placement, placement confirmation, and securement, with minimal or no ventilation between induction and paralysis unless needed.
• B. Induction, laryngoscopy, and immediate tube placement without preoxygenation or paralysis.
• C. Ventilate between induction and paralysis to ensure oxygenation.
• D. Preoxygenate, ventilation, then induction and RSI steps.

Answer: (A)

Rapid Sequence Intubation is designed to quickly secure the airway while minimizing aspiration risk and patient movement. The essential sequence starts with thorough preoxygenation to fill the lungs with oxygen, followed by a rapid-acting induction to render the patient unconscious. Then a neuromuscular blocker is given to achieve rapid paralysis, after which laryngoscopy is performed to place the endotracheal tube. Placement is confirmed (typically with capnography) and the tube is secured. Importantly, ventilation between induction and paralysis is kept to a minimum or avoided unless it is absolutely necessary to prevent dangerous desaturation. This combination—preoxygenation, induction, paralysis, laryngoscopy with tube placement, confirmation and securement, with minimal or no ventilation in the apnea window—reflects the RSI protocol.