In a patient with suspected difficult airway, which initial step is recommended?

• A. Perform rapid sequence intubation with no alternatives.
• B. Prepare adjuncts such as bougie and video laryngoscope for potential difficult airway.
• C. Avoid any airway maneuvers.
• D. Delay intubation until failure.

Answer: (B)

Anticipation and preparation are the most important moves when a difficult airway is suspected. The best first step is to assemble a plan and have backup airway devices ready, so you’re prepared to adapt quickly if the first attempt doesn’t go smoothly. Preparing adjuncts like a bougie and a video laryngoscope gives you practical tools to improve success on the first try or to proceed smoothly if you need to adjust your technique.

A bougie acts as a flexible guide that can be advanced into the trachea with the endotracheal tube following over it, helping when the view is limited or alignment is challenging. A video laryngoscope provides a better view of the glottic opening than direct laryngoscopy, which can reduce difficulty and time to intubation. Having these aids ready signals a deliberate, controlled approach rather than forcing a single method and risking a failed airway.

In contrast, proceeding with rapid sequence intubation with no alternatives ignores the likelihood of failure and removes backup options. Delaying airway management until failure increases the risk of hypoxia and is not aligned with safe airway practice. And avoiding airway maneuvers altogether isn’t appropriate when you’re trying to secure the airway—you still need to perform the necessary steps while being prepared to adapt.