There are few contraindications to RSI. A known difficult airway requires an alternative approach. A variety of other approaches may be considered in a patient known to have experienced failed laryngoscopic intubation in the past or whose anatomy or injuries preclude direct laryngoscopy. These approaches include blind techniques, fiberoptically assisted techniques, and techniques employing an LMA. (These are detailed in Chap 15 ) Invasive emergency airway management approaches are discussed below. Patients who are judged to be too ill to receive anesthetic drugs, such as those comatose, profoundly hypotensive, or without circulation, may be intubated without pharmacologic assistance. Cricoid pressure should nonetheless be applied, since regurgitation and aspiration may still occur in these patients.
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