Management (general and specific)

Steps in RSI

1. Verbalise time out
2. Ensure designation of roles intubator, drug delivery, managing equipment, monitoring patients vital signs
3. Check drugs, equipment
4. Ensure plan discussed
5. Give induction agent
6. Give paralytic agent
7. Wait 45-60 seconds after paralytic agent
8. Pass endotracheal tube
9. Move to plans B, C or D as needed
10. Confirm end-tidal CO₂, lung sounds, chest rise and misting of tube

The Difficult Airway Society, Intensive Care Society, FICM and the Royal College of Anaesthetists published a 2018 guideline on the management of tracheal intubations in critically ill adults.

As a minimum, the following personnel should be present during an intubation:

In the event of a failed or difficult airway, the following steps should be followed: