Outline the steps typically involved in rapid sequence induction (RSI).

• A. Preoxygenate, apply cricoid pressure if indicated, induce with IV agent, administer a rapid-onset neuromuscular blocker, perform secure airway with intubation; be prepared for alternative airway.
• B. Preoxygenate, apply cricoid pressure for all patients, induce with inhaled agent, perform slow-blind airway.
• C. Induce with IV agent, avoid airway instrumentation, wait for spontaneous breathing.
• D. Preoxygenate, perform awake fiberoptic intubation in all cases.

Answer: (A)

Rapid sequence induction is about securing a safe airway quickly while minimizing the risk of aspiration through a tightly coordinated, rapid sequence of steps. Begin with preoxygenation to maximize the oxygen reserves and extend the safe apnea window. If indicated, apply cricoid pressure to compress the esophagus and reduce the chance of regurgitated contents during induction. Then induce with a rapid-acting intravenous anesthetic so consciousness and protective reflexes are lost promptly. Immediately give a rapid-onset neuromuscular blocker to achieve quick, complete muscle relaxation and facilitate fast endotracheal intubation. Once the airway is secured, ventilation is controlled, and the team remains ready to move to an alternative airway if intubation fails (for example, a supraglottic device or emergency airway access). The emphasis is on speed, a clear plan for securing the airway, and readiness for contingencies. The other approaches described don’t align with RSI because they involve slower induction methods, avoiding airway instrumentation, or performing awake or fiberoptic techniques in all cases, which defeats the goal of rapid airway control.