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