Adapted from Difficult Airway Society Guidelines for the management of tracheal intubation in critically ill adults

Prepare the patient

Assess and position

• Reliable IV/IO access
• Optimise position
  • Sit-up
  • Mattress hard
• Airway assessment
  • Identify cricothyroid membrane
  • Awake intubation option?
• Allergies?

Preoxygenation

• 3 mins or ETCO₂ >85%
• Consider CPAP/NIV
• Apnoeic Nasal O₂

Optimise patient state

• Fluid/vasopressor/inotrope
• Aspirate NG tube
• Delayed sequence intubation

Prepare the equipment

Apply monitors

• SpO₂
• waveform capnography
• ECG
• Blood pressure

Check equipment

• Tracheal tubes x2 (cuffs checked)
• Direct laryngoscopes x2
• Videolaryngoscope
• Bougie/stylet
• Working suction
• Supraglottic airways
• Oropharyngeal/nasal airways
• Flexible scope/Aintree
• FONA set

Check drugs

• Consider ketamine
• Relaxant
• Pressor/inotrope
• Maintenance sedation

Prepare the team

• Allocate roles (one person may have more than one role)
  • Team leader
  • 1^st Intubator
  • 2^nd Intubator
  • Cricoid force
  • Intubators assistant
  • Drugs
  • Monitoring patient
  • Runner
  • MILS (if indicated)
  • FONA
• Who do we call for help?
• Who is noting the time?

Prepare for difficulty

• Can we wake the patient if intubation fails?
• Verbalise "the airway plan is..."
  • Plan A
    • Drugs & laryngoscopy
  • Plan B/C
    • Supraglottic airway
    • Face-mask
    • Fibreoptic intubation via supragottic airway
  • Plan D
• Does anyone have any questions or concerns?