By reading this article, you should be able to: •Identify the patient at risk of pulmonary aspiration during airway management. •Generate a plan to prepare a patient safely for rapid sequence induction and intubation (RSII). •Describe the Project for Universal Management of Airways (PUMA) universal principles for RSII and recall the components which are recommended, suggested and optional. •Discuss the current evidence base supporting various components of the RSII procedure. Jack Collins BSc FCAI is undertaking a fellowship in advanced airway management and simulation at St James's Hospital, Dublin. Ellen P. O'Sullivan FRCA FCAI is a consultant anaesthetist at St James's Hospital, Dublin where she specialises in difficult airway management. She has been involved in the Difficult Airway Society since its foundation and has contributed significantly to the development of several airway management guidelines. Professor O'Sullivan is the past president of the College of Anaesthetist of Ireland; she was until recently an elected council member of the Royal College of Anaesthetists and chaired their global partnership committee.