Randomized Trial of Sedative Choice for Intubation

Inclusion Criteria:

* Patient is critically ill and undergoing emergency tracheal intubation with sedation in an enrolling unit
* Planned procedure is orotracheal intubation using a laryngoscope
* Planned operator is a clinician expected to routinely perform tracheal intubation in the participating unit

Exclusion Criteria:

* Patient is known to be less than 18 years old
* Patient is known to be pregnant
* Patient is known to be a prisoner
* Patient is known to have an allergy to ketamine or etomidate
* Patient is presenting to the emergency department with a primary diagnosis of trauma
* Patient or LAR declines participation during pre-enrollment opt-out conversation or by wearing opt-out bracelet for the RSI trial
* Clinician feels ketamine is required or contraindicated for the optimal care of the patient
* Clinician feels etomidate is required or contraindicated for the optimal care of the patient
* Clinician feels an induction medication other than ketamine or etomidate is required for the optimal care of the patient
* Immediate need for intubation precludes safe performance of study procedures