RSI: The Hypoxic RSI

How not to kill your hypoxic patient.

Key Points:

  • Pre-Oxygenate with CPAP/BVM+PEEP
  • Sit up
  • Use Ap-Ox
  • Roc rocks
  • 1st pass success is critical
  • Ventilate during apnoea


Show Notes:


Preoxygenation, Reoxygenation and Deoxygenation – EMCrit

Covers Pre-oxygenation with CPAP in the hypoxic patient – watch the 2 videos

Preoxygenation and Prevention of Desaturation During Emergency Airway Management article by Scott Weingart and Rich Levitan – a must read

RebelEM – a nice summary and explanation of the above paper – LITFL’s overview

The problem with the BVM for pre-oxygenation – Nick Crimes



Levitan’s ear-to-sternal notch positioning

Find out about ramping here and here (EMUpdates)

See also the PreOx, ReOx paper by Weingart & Levitan


Apnoeic oxygenation

NO DESAT! – Rich Levitan

PulmCrit – an in-depth discussion by Josh Farkas, including the THRIVE study – LITFL’s overview


Apnoeic oxygen relies on an open airway, so we have to maintain a jaw thrust.

NCs buy you more time, in normal, obese and hypoxic patients.

High-flow NC would be even better, but are complicated because getting a BVM seal over them is not possible


DSI – Delayed Sequence Intubation

The Website – EMCrit

The Paper – no longer FOAM, but you can find it here – LITFL’s comprehensive overview


Rocuronium vs Suxamethonium

Video from Reuben Strayer from EMUpdates


Apnoeic Ventilation

Video from EMCrit

See also the PreOx, ReOx paper by Weingart & Levitan

Recent paper on using the Hamilton Ventilator for this (VAPOX)


1st Pass Intubation

The importance of 1st pass success, by Cliff Reid, and how to do it, by LITFL


Awake Intubation

Airway topicalisation and awake intubation, by EMCrit, and KSI here and here, by EMUpdates




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