Rapid Sequence Induction (RSI) is designed to minimize aspiration risk. Which of the following are key components?

• A. Preoxygenation; continuous mask ventilation; cricoid pressure; rapid induction; prompt intubation.
• B. Preoxygenation; no or minimal mask ventilation; cricoid pressure; rapid administration of a fast-acting induction agent followed by a neuromuscular blocker; prompt tracheal intubation.
• C. Preoxygenation; no mask ventilation; no cricoid pressure; slow induction; delayed intubation.
• D. Preoxygenation; cricoid pressure; long mask ventilation; induction with slow agent; late intubation.

Answer: (B)

The main idea is to secure the airway as quickly as possible while minimizing the chance that gastric contents reach the lungs. This is achieved by preparing with oxygen beforehand, avoiding prolonged or bag-mask ventilation that could push air into the stomach, and then rapidly inducing and paralyzing so you can intubate promptly.

Preoxygenation fills the lungs with oxygen to extend the safe period of apnea if the airway takes longer to secure. Proceeding with no or minimal mask ventilation helps prevent gastric insufflation and potential regurgitation. Cricoid pressure is applied to compress the esophagus and reduce the risk of passive regurgitation during this vulnerable period, though its routine use is debated in some settings. A fast-acting induction agent is given to lose consciousness quickly, followed by a neuromuscular blocker that produces rapid, reliable paralysis so tracheal intubation can be performed without delay. The goal is immediate airway control with the endotracheal tube to protect the airway from aspiration as soon as possible.

Other options diverge from RSI by allowing ventilation before the airway is secured, using slower induction, or permitting longer periods of apnea or delayed intubation, all of which increase aspiration risk.