RSI is an abbreviation for rapid sequence intubation. It refers to the emergent treatment of respiratory failure by insertion of a “breathing tube” OR more correctly, an endotrachial tube in order to ensure that oxygen goes into the patients lungs (not his stomach), and enables the patient to be placed on a mechanical ventilator that will push oxygenated air in (at anywhere from 21 % to 100 % oxygen) and let toxic carbon dioxide out. It is a little different from the intubation accoplished in the operating room when patients have been fasting (empty stomach, no vomit), are relatively healthy (or else they wouldn’t be able to tolerate the surgery), there is gobs and gobs of light, there are usually no less than three MDs and frequently a Certified Registered Nurse Anesthetist (CRNA).

Many emergency medicine residents and paramedics will frequently rotate through anesthesia to practice this skill. Difficulties are introduced by various body types. Obesity, micrognathia (small jaw), and buck teeth all intoduce challenges even in a controlled setting. Now put that same patient on the floor in their bedroom after suffering a heart attack, or in the cold wet grass on the side of a road after being ejected from a car accident, or with vomit or blood actively coming out of their stomachs or lungs and you’ll start to appreciate the additional challanges faced in the prehospital setting of trying to do this procedure.

In my story from the other night, I shared the thrill of a successful intubation. I have had about 80 successful intubations. What was thrilling about that night was being the team leader, sedating and paralyzing the patient, directing his ventilations prior to the procedure, supervising the intern and giving him the opportunity to intubate despite my selfish desire to do it myself (it’s very satisfying and gives you a great chance to show off in front of everyone!). Most people (yes, even you, non medically trained reader!) can be successful at intubating given a controlled setting, but the practice of emergency medicine will require me to be able to direct a team of medical professionals during critical situations…this is what I experienced for the first time the other night. Just thought I’d clarify that!