Save a Life: Know the Precious P’s of Rapid Sequence Intubation

Photo: Wikimedia Commons

Author: Valery Victoria Rivas Cuesta, MSVI
Medical Student
Universidad Iberoamericana (UNIBE) School of Medicine

An emergency physician’s failure to secure the airway can rapidly lead to death or disability. In the emergency setting, patients are assumed to have a full stomach and be at risk for aspiration. Often, rapid-sequence intubation (RSI) represents the preferred method to secure the airway in the ED setting, as it results in unconsciousness (induction) and neuromuscular blockade (paralysis) rapidly thereafter.[1]

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The procedure has the following main goals: prevention of hypoxia, shortening the time between induction and intubation, minimizing aspiration risk, and improving first pass success.[1] This is achieved by the “ritual of the P’s”:[2]

RSI is often the preferred method of managing the airway in the emergency setting. Multiple studies report that the implementation of RSI has resulted in improved success and decreased complication rates for emergency intubations.[5] Therefore, the ability to perform a proper RSI is a core skill for any emergency physician to acquire. Know these “Precious P’s” and how to use them; you will undoubtedly help save a life.


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