Short Answer 
The first step in rapid sequence intubation (RSI) is pre-oxygenation to enhance oxygen reserves and delay hypoxia. Proper medication administration is crucial, starting with sedatives followed by paralytics for patient comfort and safety. Additional techniques, like effective bag-mask ventilation and head elevation, may be considered, but do not replace the importance of pre-oxygenation.
Step 1: Pre-oxygenation
The first crucial step in drug-assisted and rapid sequence intubation (RSI) is to pre-oxygenate the patient. This process involves providing high-flow oxygen to the patient to increase their oxygen reserves. By doing this, you can significantly prolong the time to hypoxia, which is critically important during intubation, especially if the procedure takes longer than expected.
Step 2: Proper Administration of Medications
It is essential to administer medications in the correct sequence for effective intubation. Typically, the sedative should be given first to ensure the patient is adequately sedated before administering the paralytic agent. This approach helps prevent awareness during paralysis, enhancing patient safety and comfort throughout the procedure.
Step 3: Consideration of Additional Techniques
While pre-oxygenation is the primary focus, other techniques need consideration. Ventilation with a bag-mask device may be utilized only if effective; however, it should not replace pre-oxygenation. Additionally, elevating the head of the bed can be relevant for patients with spinal precautions, but this action mainly addresses spinal injury risks rather than directly impacting the intubation process.