Rapid sequence intubation (RSI)
Paediatric emergency management · Airway · Emergency
Structured emergency intubation to minimise aspiration and physiological deterioration. Work through the 7 P’s. The peri-intubation period is high risk for arrest — optimise haemodynamics first.
Preparation and pre-oxygenation
- Prepare kit (SOAP-ME): Suction, Oxygen, Airway equipment and tubes, Positioning, Monitors and Meds, End-tidal CO2.
- Pre-oxygenate with 100% oxygen for 3–5 min.
- Have fluid and a pressor ready; correct hypovolaemia before induction.
Pretreatment (case-by-case)
Induction plus paralysis
Placement and post-intubation
- Confirm with continuous waveform capnography (gold standard) plus bilateral air entry and chest rise.
- Secure the tube; depth at the lip is about the ETT internal diameter times 3.
- Post-intubation sedation, analgesia and ongoing paralysis; set the ventilator and reassess.
Common questions
What is the first step in rapid sequence intubation (rsi)?
Structured emergency intubation to minimise aspiration and physiological deterioration. Work through the 7 P’s. The peri-intubation period is high risk for arrest — optimise haemodynamics first.
What drug doses are used in rapid sequence intubation (rsi)?
Atropine (optional): 0.02 mg/kg (min 0.1 mg) in infants or when using suxamethonium. Ketamine (induction): 1–2 mg/kg IV — maintains BP, bronchodilator; good in shock/asthma. Fentanyl (adjunct): 1–2 mcg/kg IV slowly. Rocuronium (paralytic): 1–1.2 mg/kg IV, onset about 60 s. Suxamethonium (alt paralytic): 1–2 mg/kg IV; avoid in hyperkalaemia, burns, myopathy.
About this page
Compiled from standard paediatric references. Verify against a current formulary and your local protocol.
Spotted something wrong? Report an error on this page — corrections from clinicians are welcome and are reviewed before any change is published.
Last reviewed 2026-08-12.