Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science


Emergency Medicine


Dr. Clair, Dr. Buttler


Purpose: Endotracheal intubation is a fairly common procedure practiced in emergency medicine and is a required skill of emergency medicine providers including physicians and advanced practice providers. Rapid sequence intubation is the most common means of performing endotracheal intubation (RSI) in the emergency department (ED). However, there is some evidence that in certain situations RSI may not be the most appropriate process and that a different algorithm of delayed sequence intubation (DSI) once reserved primarily for anesthesia may have a place in the ED.

Methods: The research for this scholarly article was performed by doing a literature review for relevant peer-reviewed journal articles related to DSI. Several search engines were used including GoogleScholar.com, PubMed.gov, and the academic search bar on the University of Lynchburg Library’s website. UpToDate.com was also consulted to gain practical knowledge of the subject. To ensure that only relevant and credible articles where accessed the search was limited to articles published within the last ten years and only those that were peer-reviewed.

Results: Through the literature review it is apparent that DSI likely has a place in emergency medicine. However, it is also apparent that DSI is likely only indicated in specific instances when the intubation is suspected to be difficult as laid out in this paper. As of now most of the available evidence for DSI is case reviews though there are a few randomized control studies available through the cohort sizes are fairly small.

Conclusion: DSI has some indications in EM including some pediatric patients and adult patients where a difficult airway is suspected. Emergency medicine providers should be knowledgeable of both DSI and RSI.


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