What is the initial step in rapid sequence intubation?

• A. Hyperoxygenation
• B. Induction
• C. Neuromuscular blockade
• D. Intubation

Answer: (A)

Hyperoxygenation as the first step in rapid sequence intubation is all about building a safety buffer of oxygen before the brief period of apnea that follows induction and paralysis. By delivering nearly 100% oxygen with a tight mask for several breaths, you replace the nitrogen in the lungs with oxygen, creating a reservoir in the lungs and blood. That reserve buys time and helps prevent desaturation if there’s a delay or difficulty during the subsequent rapid sequence steps. This is especially crucial in patients with limited oxygen reserves due to illness, obesity, shock, or respiratory collapse. After achieving this oxygen cushion, the rapid-onset induction agent is administered, followed quickly by a fast-acting neuromuscular blocker to facilitate intubation, and then airway placement proceeds.