In rapid sequence intubation (RSI), which is the first step?

• A. Hyper-oxygenate patient
• B. Perform intubation
• C. Assess for color change
• D. Assess for bilateral breath sounds

Answer: (A)

Preoxygenation with high-concentration oxygen is the first move in rapid sequence intubation. Giving the patient 100% oxygen before anesthesia creates an oxygen reserve in the lungs, which buys time if there’s a brief period of apnea during induction and paralysis. This helps prevent hypoxemia during the critical moment of airway securing. The other steps come after you’ve built that oxygen reservoir: induction and rapid paralysis followed by the intubation attempt, and then confirming placement with lung sounds or other monitors. Assessing a color change or bilateral breath sounds isn’t the initial action in RSI, and those checks are done after airway control is established.