Not many aspects of Emergency Medicine define our specialty better than resuscitation, and few concepts exemplify resuscitation better than shock and intubation. Yet few words together strike greater fear in the minds of savvy resuscitationists. Not because we cannot deftly manage shock, or because we are anything but hardy intubators, but because the swiftest way to transform a living patient into a dying patient or a dying patient into a dead patient is to brazenly intubate someone who is in shock. These are often called “clean kills” for good reason. What are the root causes of endotracheal intubation’s (ETI) hemodynamic effects and, most importantly, how do we circumnavigate them? Fundamentally, how do we safely intubate a patient in shock?

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