The Airway App: Awake Intubation
International Airway Collaboration
www.airwaycollaboration.org
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Patient Gender:


 
Approximate Patient Age:


 
Approximate BMI:


 
Patient predictors of difficult intubation:


 
This awake intubation was:


 
This awake intubation took place in the:


 
Indication for awake intubation:


 
Other contextual factors:


 
Patient position:


 
Anti-sialagogues used:


 
Sedation used:


 
Approach:

Specific questions to follow for each anatomic area of topicalization  (nasal/nasopharynx, oropharyngeal, laryngeal/tracheal)

 
Vasoconstrictor used for nasal approach:


 
Topicalization delivered via:


 
Local anesthetic used for topicalization:


 
What amount of local anesthetic was used? (Feel free to record volume with percentage or dose)

 
Intubating technique(s) used on first (or only) attempt:


 
Was the awake intubation attempt abandoned?


 
Why was the awake intubation abandoned?


 
Patient management after awake intubation abandoned:


 
Number of attempts at awake intubation:


 
Modification(s) made on subsequent attempt(s) to secure the airway:


 
How would you grade the patient's overall tolerance of the procedure?


 
Complications/events during procedure:


 
During the awake intubation, what factors contributed positively to the procedure?


 
Was extra sedation needed to compensate for inadequate topicalization?

Please feel free to add comments under "Other"

 
Are there any modifications you would make in your future awake intubation procedures?

 
We appreciate any suggestions you may have to improve The Airway App. Please include them here.

 
If you would like to share the story of your case, please email airwaycollaboration@gmail.com. We can then anononymously share vignettes and continue to learn together.

Thank-you for filling out this survey! 

Was surgical airway attempted during this encounter? If so, we'd really appreciate it if you fill out this case report too.

If you would like to share more details about your case, email us at airwaycollaboration@gmail.com.
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