## Rapid Sequence Induction: Core Components **Key Point:** RSI is a standardized protocol to minimize aspiration risk in emergency patients with full stomachs. The correct answer identifies what is NOT a standard RSI component. ### Standard RSI Protocol 1. **Pre-oxygenation** — 100% O₂ for 3–5 minutes or 8 vital capacity breaths to denitrogenate the lungs and extend apnea time. 2. **Cricoid pressure (Sellick maneuver)** — Applied at loss of consciousness to occlude the esophagus and prevent passive regurgitation. 3. **Avoidance of bag-mask ventilation** — Historically taught to prevent gastric insufflation; however, **modern evidence supports gentle bag-mask ventilation if SpO₂ drops**, especially in obese or pregnant patients. 4. **Rapid-acting induction agent** — Propofol, thiopental, or etomidate (NOT succinylcholine or rocuronium, which are **neuromuscular blockers**, not induction agents). 5. **Rapid-acting neuromuscular blocker** — Succinylcholine (depolarizing) or rocuronium (non-depolarizing) to facilitate intubation. ### Why Option 3 is Incorrect **High-Yield:** Succinylcholine and rocuronium are **neuromuscular blocking agents**, not induction agents. They do not induce anesthesia; they provide muscle relaxation for intubation. The induction agent (propofol, etomidate, or thiopental) must be given separately and **before** the neuromuscular blocker. **Clinical Pearl:** A common exam trap is confusing the roles of induction agents and neuromuscular blockers in RSI. Both are essential, but they serve different purposes. ### RSI Sequence (Mnemonic: CRASH-C) - **C** — Cricoid pressure - **R** — Rapid-acting induction agent - **A** — Apnea (avoid ventilation, or gentle ventilation if SpO₂ drops) - **S** — Succinylcholine or rocuronium (neuromuscular blocker) - **H** — Head-up tilt (optional, aids aspiration prevention) - **C** — Confirm tube placement **Warning:** The absolute contraindication to bag-mask ventilation in RSI has been softened in recent guidelines; gentle ventilation is now recommended if SpO₂ falls below 90% during apnea.
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.