Difficult Intubation Note Generator

Patient Demographics

Patient name

MRN / DOB

Age / Sex

Weight (kg)

Location

Date & time of intubation

Intubating provider(s)

Assisting personnel present

History of Present Illness

Reason for respiratory decompensation / indication for intubation

HPI narrative / clinical course leading to intubation

Known airway history / risk factors (if available)

Procedure Note

Pre-oxygenation

Standard face mask Non-rebreather mask High-flow nasal cannula NIV/BiPAP Apneic oxygenation (NC during apnea)

Bag-mask ventilation

Not attempted / not needed Easy Difficult Impossible / unable to ventilate

Bag-mask difficulty factors (if difficult/impossible)

Poor mask seal Obesity Upper airway obstruction Decreased lung/chest wall compliance Laryngospasm High airway resistance/bronchospasm

Adjuncts used for mask ventilation

Intubation attempts

Total number of intubation attempts

Attempt number that achieved successful intubation

Attempt	Device / technique	Cormack–Lehane view	Bougie/stylet	Ext. laryngeal manip.	Result	Complication / note
#1
#2
#3
#4

Definitive airway secured via

Orotracheal intubation Nasotracheal intubation Supraglottic airway (definitive) Surgical airway / cricothyrotomy Airway not secured

ETT size / depth at teeth or lips

Confirmation of tube placement

EtCO2 waveform capnography Bilateral breath sounds Bilateral chest rise Condensation in tube Absence of gastric sounds Esophageal detector device Post-procedure CXR confirms position Direct/video visualization through cords

Medications administered

Medications, doses, and administration times (detail)

Complications

Complication details / management

Difficult airway resources used

Recommendations for Future Intubations

Airway classification for future reference

Documented difficult airway — chart alert/flag placed Difficult bag-mask ventilation Difficult laryngoscopy/intubation Difficult supraglottic airway placement Patient/family notified Medical alert bracelet/letter recommended

Recommended approach for next intubation

Video laryngoscopy first-line Awake fiberoptic intubation Avoid RSI / maintain spontaneous ventilation ENT/surgical backup immediately available Second experienced provider present Smaller ETT should be available Extubate only in controlled setting

Specific recommendations (detail)

Follow-up needed

Difficult Intubation Note Generator

Patient Demographics

History of Present Illness

Procedure Note

Recommendations for Future Intubations

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