Pre-intubation Checklists

Big thanks to Lev Veniaminov who offered the following comments on this concept when I sent him a copy of George Douros' (Austin Health FACEM) airway checklist card. This post is packed with links for the airway obsessed reader.


The first thing that struck me when I started the anaesthetic rotation was how anaesthetists approach airway, regardless of gender, experience, amount of intestinal fortitude and size of ego.

There always is heightened sense and awareness of disaster lurking around the corner when it comes to airway. EVERY intubation comes with consideration of possible ways, presence of airway adjuncts ready to go. Even in elective cases.
If there is a slightest hint of possible difficult ETT a plan is always discussed should things go out of quilter. Even if it is just "not able to pass the ETT on the first go"... in an uncomplicated AW...

There is interesting podcast on EMCrit.org (EMCrit 49, "amateurs discuss strategy; experts discuss logistics") where Scott talks about approaching various situations... This can be easily applied to AW management.

There also is a very interesting article in BJA in a way echoing this podcast:

Complications and failure of airway management T. M. Cook* and S. R. MacDougall-Davis
Br. J. Anaesth. (2012) 109 (suppl 1): i68-i85.

It can be accessed through your www.clinicians.vic.gov.au access via OpenAthens

This guy, Tim Cook is like Elvis Presley on the anaesthesia circuit and is heavily involved in NAP works (NAP 4 talks about AW disasters in EM too)...


The Difficult Airway Society (DAS) also offer airway mangagment algorithms that should be a part of the paintwork design of every resus cubicle in ED...

Also of interest is the podcast of Scott with Cliff Reid (he is a retrieval specialist in NSW and with HEMS in UK) on retrievals where Cliff mentions how they approach EVERY intubation. Meticulously planned ETT, stereotypically planned and set up as a result, he mentioned - in the five years of running the protocol they had ZERO failure rate.

Just to add to the importance of having a card like that...