I was on call last night with a senior resident and an attending and we all agreed we would do a "modified" rapid sequence induction for a case we were about to put on. Turns out, though, that we had different ideas of how to do a modified rapid. Here was my understanding of a "modified" RSI (learned from other attendings)- 1. Preoxygenate 2. Induce unconsciousness, apply cricoid pressure 3. Prove ability to ventilate by bag mask 4. Paralyze (sux) 5. +/- gentle ventilation with waiting for sux to circulate My attending's version- 1. Preoxygenate 2. Push induction agent and wait 10-15 seconds prior to pushing relaxant (to avoid patients having the sensation of weakness prior to unconsciousness) 3. cricoid pressure 4. gentle ventilation while waiting for sux to circulate Her critique of my version: what do most people do if they can't really ventilate? Push sux. Now you've wasted ~30 seconds of your preoxygenation waiting for your induction drug to hit and trying to ventilate. If it hits the fan, you might want that time back. In support of my version, if you can't ventilate and they have a mediocre airway exam, maybe you'd abort your modified RSI and go for awake fiberoptic. It was a little humbling, I felt like I should know this by now. But in trying to investigate I've found only a few papers and chapters and no good answer to the question. I'm wondering if there really is a "right" answer? What does modified rapid sequence mean to everyone, especially those in practice? Or do you think of "modified" as a more general descriptor, meaning you modify a classic RSI in different ways depending on the situation? Also, does anybody have a reference?