Endotracheal Intubation Process – an overview 
 
1. Indications for Intubation: 
– Airway protection (reduced GCS, aspiration risk) 
– Respiratory failure (hypoxia or hypercapnia) 
– Airway obstruction 
– Requirement for controlled ventilation 
 
2. Pre‑Intubation Airway Assessment – LOCSSIP (and complete the LOCSSIP checklist) 
 
L – Look externally: 
• Facial trauma, obesity, beard, large tongue 
 
O – Obstruction: 
• Tumour, foreign body, stridor, infection 
 
C – Cervical spine mobility: 
• Trauma, arthritis, immobilisation 
 
S – Size (mouth opening): 
• Inter‑incisor distance (<3 fingers suggests difficulty) 
 
S – Shape: 
• High‑arched palate, Mallampati score 
 
I – Incisors: 
• Prominent, loose, capped, false or buck teeth 
 
P – Previous intubation: 
• History of difficult airway or airway surgery 
 
3. Preparation 
– Check equipment: laryngoscope, ET tubes, suction, oxygen, capnography 
– Position patient (sniffing position unless C‑spine injury) 
– Pre‑oxygenate with 100% oxygen for 3–5 minutes 
– Apply monitoring (ECG, SpO₂, BP) 
 
4. Medications (Rapid Sequence Induction) 
– Induction agent: Etomidate, Propofol or Ketamine 
– Neuromuscular blocker: Atracurium or Rocuronium (rare occasions Suxamethonium) 
-Medication to support blood pressure (such as meteraminol) 
 
5. Intubation Procedure 
*must be undertaken by a suitably qualified Healthcare professional 
– apply cricoid pressure 
– Insert laryngoscope and visualise vocal cords 
– Pass endotracheal tube through cords 
– Inflate cuff and ventilate 
 
6. Confirmation of Tube Placement 
– End‑tidal CO₂ (gold standard) 
– Bilateral chest rise and breath sounds 
– Chest X‑ray for tube depth 
 
7. Post‑Intubation Care 
– Secure tube 
– Start ventilation 
– Provide sedation and analgesia 
– Continuous monitoring 
– arterial blood gas 
– Chest X-ray (usual practice outside of theatres)