Step 2: Position head and neck

One of the most common reasons for failed endotracheal intubation is improper patient positioning. The correct position is with the lower part of the cervical spine flexed, and the atlanto-occipital joint extended - the so-called "sniffing position". This position aligns the axes of the mouth, pharynx and trachea, and will give the best visualization of the cords during laryngoscopy. Failure to correctly position the patient will ensure a "difficult" intubation.

Note correct technique:

  1. The lower part of the cervical spine is flexed by placing a pillow or other suitable pad under the patient's occiput.
  2. The atlanto-occipital joint is extended by tilting the head back.