First step is always a quick external assessment. Is the patient agitated or sedated? Is there evidence of trauma or external facial hair that would create a challenge to intubation?
Evaluate for adequate airway diameter, temporomandibular joint mobility, and neck length. Is there reason to suspect challenges to visualization or laryngoscope placement?
Does the patient present with cervical spinal precautions that would create a challenge to laryngoscope placement? Is there history of rheumatoid arthritis or degenerative disease that would create a limitation to neck mobility?
Any evidence in patient's past medical history to suggest pulmonary fibrosis? Any occupational exposure? Evidence of aspiration, COPD, smoking history, emphysema?
"LEON MOANS" is an essential, comprehensive 9-step airway assessment that can be completed at bedside within 90 seconds, allowing the intubator to visualize the procedure and foresee any obstacles to the airway prior to beginning the intubation.