Rapid Sequence Intubation — 7 P's
RSI sequence + drug doses
Mnemonic device
Preparation · Preoxygenation · Pretreatment · Paralysis with induction · Positioning · Placement · Postintubation
Mapping
Prep
Equipment: ETT × 2 sizes + cuff check, working laryngoscope + backup, suction yankauer ON, BVM ready, drugs drawn
Preoxygenate
100% FiO2 × 3 min OR 8 vital-capacity breaths; nasal cannula 15 L during attempt = apneic oxygenation
Pretreat
Optional: lidocaine 1.5 mg/kg (head injury), fentanyl 1-3 mcg/kg (HTN/IHD response blunting). Atropine 0.02 mg/kg in peds <1 yr only.
Paralyze + induce
Induction (pick by hemodynamics): etomidate 0.3, propofol 1.5-2.5, ketamine 1-2; THEN paralytic — succ 1.5 mg/kg or roc 1.2 mg/kg
Position
Sniffing position (ear-to-sternal-notch); ramp obese; head-up 25° (apneic oxygenation + reduce reflux)
Place
Laryngoscopy at 60s post-paralytic (succ) or 90s (roc); ETT through cords; verify ETCO2 × 6 breaths + BBS + chest rise
Postintubation
Secure ETT, depth check (lip 21 cm M / 19 cm F), ventilator settings (TV 6-8 mL/kg PBW, PEEP 5, RR 10-12), sedation/analgesia continued
Clinical note: Cricoid pressure controversial — modern evidence mixed. NG tube decompression preop if full stomach. Have plan B (LMA) and plan C (cricothyrotomy) before plan A starts.