Learning objectives
- Confirm preoxygenation and apneic oxygenation plans
- Turn on and test suction
- Prepare and label RSI medications
- Address hypoxia, hypotension, and acidosis
- Confirm PPE, roles, and C-spine considerations
Step 1
Preparation
Prepare oxygenation, equipment, physiology, RSI medications, and the team before induction.
Say aloud
Preoxygenation and apneic oxygenation are planned. Suction is on. The tube, BVM, and stylet are ready. Hypoxia, hypotension, and acidosis have been addressed. Access, labeled induction and paralytic medications, PPE, roles, and the C-spine plan are confirmed. START if ready; STOP if a critical item remains unresolved.
Critical actions
Oxygenation
Equipment
Physiology
RSI options
Team
Updated checklist reference
RSI medication options
Induction options
- Ketamine
- 1-2 mg/kg
- Etomidate
- 0.2-0.3 mg/kg
- Midazolam
- 0.3 mg/kg
- Propofol
- 1-2 mg/kg
Paralytic options
- Rocuronium
- 1 mg/kg
- Succinylcholine (suxamethonium)
- 1-2 mg/kg
Dose references mirror the updated checklist. Individualize for physiology and local protocol. In patients at increased risk of peri-intubation hypotension, ACEP 2026 recommends ketamine or etomidate and advises avoiding fentanyl, midazolam, or propofol as induction/coinduction agents. ACEP 2026 policy.
Teaching pearl
Preparation is a coordinated pre-induction pause: oxygenation, equipment, physiology, medication readiness, and team roles should all be visible before the first drug is pushed.
Common pitfalls
- Suction present but not switched on
- Medication syringes unlabeled or sequence unclear
- Hypotension or severe acidosis not addressed before induction
- C-spine plan, PPE, or team roles left implicit
- Treating the listed drug doses as universal defaults rather than physiology- and protocol-dependent references
- Proceeding past the START/STOP checkpoint while a critical item remains unresolved
Watch next