Step 1

Preparation

Make the room, the physiology, and the rescue plan ready before medications are pushed.

Critical actions

Oxygen plan ready Suction x2 tested BVM with PEEP/filter/adjuncts Position/ramp/C-spine plan VL and DL backup ETT, stylet, syringe, bougie SGA and cric kit EtCO2 and monitoring

Pearls

Preparation is not a supply checklist. It is a failure-proofing process: oxygenation margin, clean view, first-pass mechanics, and rescue readiness.
Say aloud: Before meds: oxygen is on, suction works, BVM/rescue is ready, tube/device/bougie are ready, EtCO2 is connected, and everyone knows their role.

Pitfalls

Suction present but not turned on
Video laryngoscope not plugged in or focused
No syringe to check cuff/inflate balloon
Bougie not within reach
Cric kit “somewhere nearby” rather than staged