In this episode, we dive into the RSI Trial, a groundbreaking study comparing ketamine and etomidate for rapid sequence intubation in critically ill adults. While the trial found no difference in 28-day mortality between the two drugs, it revealed that ketamine was linked to more episodes of cardiovascular collapse, largely due to increased vasopressor use. We unpack the clinical debate around this finding, exploring whether it reflects true hemodynamic instability or the effects of ketamine’s stronger analgesia. Tune in as we explore what this means for critical care practice and challenge the assumption that ketamine is always the safer choice.