Toughie sometimes exhibits these same charecteristics.
He will fail to start on the first try but never on the second.
I attribute this to the pressure check valve in the fuel pump.
I have experienced the rough start then an rpm rise then a return to normal.
Could that be a fuel pressure issue also?

 

Yes. A weak or failing fuel pump or faulty injectors.

 

Thanx
I will add that to my list of repairs

 

Rent a fuel pressure tester, the fuel pump pressure should be 50 to 65 psi

 

Just want to verify that Toughie does not run rough just an occasional rough start.
He runs and shifts smooth.
I'm still changing the chains, guides, seals, gaskets, water pump, spark plugs, struts, sway bar bushings, themostat and hoses at 175k.
Gotta love these trucklets.