RSI is the standard of care for airway management in EDs in the United States, and all emergency physicians should become expert in this technique. Hospitals should never limit the pharmacologic tools necessary for successful intubation in the ED. Hospitals prohibiting the use of RSI protocols in their EDs are subjecting their patients to suboptimal care?forcing physicians to use other airway techniques with lower success and higher complication rates.
 
RSI is essential in the care of many critically ill patients. Proper patient selection, anticipation of potential problems, close attention to details, and pre-established difficult airway protocols will ensure success. The introduction of newer paralytics and induction agents provide emergency physicians with even greater flexibilityin their selection of pharmacologic adjuncts.