Intubation Checklist + Clinical Note Generator

Procedure Date:

Time:

Operator:

Assistant:

Supervisor:

Planning

Patient identity checked?

Yes

Patient position optimised?

Yes

Are spinal precautions required?

Yes No

Pre-oxygenation plan?

Yes

Cricoid pressure?

Yes No

Is an NG tube required?

Yes No

NG tube aspirated?

Yes N/A

Known drug allergies?

Yes No

Adequate venous access available?

Yes

Equipment & Drugs

Monitoring attached? (ECG, SpO₂, BP, EtCO₂)

Yes

Manual ventilation device available?

Yes

Suction available?

Yes

Laryngoscopes available?

Yes

Endotracheal tube(s) available?

Yes

Bougie available?

Yes

Oropharyngeal airways available?

Yes

Supraglottic airway available?

Yes

Difficult Airway Trolley location noted?

Yes

Drugs ready (induction, muscle relaxant, emergency)?

Yes

Team

Location of senior help known?

Yes N/A

Tasks allocated?

Yes

Verbal confirmation between team members before start of procedure

Yes

Difficult airway anticipated?

Yes No

If yes, plans discussed

Yes

Any other concerns about the procedure (e.g. cardiovascular instability)?

Yes No

If yes, plans discussed

Yes

Endotracheal position confirmed with CO₂ trace

Yes

Tube depth checked (bilateral air entry)

Yes

ETT secured?

Yes

Cuff pressure checked?

Yes

Ventilator settings appropriate?

Yes

Analgesia and sedation started?

Yes

Chest X-Ray required?

Yes No

Procedure documented in patient records?

Yes

Intubation Checklist + Clinical Note Generator

BEFORE THE PROCEDURE

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