Episode 127. RSI Trial: Ketamine vs Etomidate

In Episode 127 of The Pharm So Hard Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, breaks down the long-awaited RSI Trial comparing ketamine versus etomidate for rapid sequence intubation in critically ill patients. Challenging more than two decades of dogma, Jimmy explores why ketamine was associated with more early cardiovascular collapse—including higher rates of vasopressor escalation and significant blood pressure drops—despite its reputation as the “safer” agent in shock. Using real-world scenarios from the ED and ICU, this episode unpacks the concept of the ketamine hemodynamic paradox, catecholamine depletion, dosing considerations, and how these findings should change your airway preparation strategy. If you care about making intubations as boring—and as safe—as possible, this is a must-listen.