If a video or fiberoptic laryngoscope is to be used, it is turned on and image quality is verified. Pharmacologic agents are drawn up in properly The patient has at least one, and preferably two, secure, well-functioning intravenous (IV) lines. Continuous capnography provides additional valuable monitoring information, particularly after intubation. Cardiac monitoring, BP monitoring, and pulse oximetry should be used in all cases. The patient is in an area of the emergency department that is organized and equipped for resuscitation. Fallback plans in the event of failed intubation are established, and the necessary equipment is located. We no longer recommend routine use of this maneuver during emergency intubation.Д«efore initiating the sequence, the patient is thoroughly assessed for difficulty of intubation (see Chapter 2). Sellick maneuver (posterior pressure on the cricoid cartilage to occlude the esophagus and prevent passive regurgitation) formerly was recommended, but it has been shown to impair glottic visualization in some cases, and the evidence supporting its use is dubious, at best. In other words, the purpose of RSI is to render the patient unconscious and paralyzed and then to intubate the trachea without the use of bag-mask ventilation, which may cause gastric distention and increase the risk of aspiration. The preoxygenation phase begins before drug administration and permits a period of apnea to occur safely between the administration of the drugs and intubation of the trachea, without the need for positive-pressure ventilation. The technique is predicated on the fact that the patient has not fasted before intubation and, therefore, is at risk for aspiration of gastric contents. Rapid sequence intubation (RSI) is the administration, after preoxygenation, of a potent induction agent followed immediately by a rapidly acting neuromuscular blocking agent (NMBA) to induce unconsciousness and motor paralysis for tracheal intubation.