As a new SRNA or resident, the fastest path to improvement is having systems in place to ensure no basic details are missed. By minimizing the need to think about the minutiae, you can focus on the overwhelming number of physical and mental skills needed to become a functioning anesthesia provider. This brief article will provide a simple, easy to remember mnemonic device in the form of an image to cover the equipment needed to intubate a patient. No fluff here. Don’t judge me to harshly on my silly mnemonics, some are ridiculous.

The Diamond

When preparing to intubate, I run through a visual checklist to ensure I have everything in arm’s reach. This “Induction Diamond,” pictured above, allows me to systematically run through these necessities in a logical order. I progress in the order of a baseball diamond, counter-clockwise starting from the southern point of the diamond at the patient’s head, my metaphorical “Home Plate,” and continuing around to Third Base, my left-hand side.

Home Plate: Suction

The Home Plate, or southern point of the diamond, is the patient’s head. Tuck your suction (South=suction) under the pillow or mattress and make sure it’s turned on.

First Base: OPA and Eye Tape

Proceeding to First Base, at the right point of the diamond, I place an oropharyngeal airway (OPA) and tongue blade in case mask ventilation is difficult. I also keep my eye tape here to quickly grab for corneal abrasion prevention. The obligatory goofy mnemonic: OPA= Ortiz PApi = Big Papi Ortiz, a former first baseman is waiting for me there chewing on an OPA with eye tape on his eyes.

Second Base: Airway Device

As we slide into Second, we have our airway device. If using an Endotracheal Tube (ETT), ensure you have a syringe, and if desired, a stylet. If using an LMA check to see it’s properly lubricated and prepared to your liking. (Second Base= Stylet = Airway)

Third Base: Laryngoscope

Finally, Third Base; on your left side, have your laryngoscope. I prefer to have it opened and partially tucked underneath the pillow to prevent it from falling off of the bed. Obviously, if you are using an LMA you don’t need the laryngoscope placed on the bed, but have one nearby with your backup airway setup. (LEFT = Laryngoscope).

Conclusion

This is not an exhaustive list of what is needed for induction, but this system is focused on what needs to be in immediate reach to secure the patient’s airway during induction. Having medication, airway equipment, Eschmann Catheter/Elastic Gum Bougie, Video Laryngoscope, etc., are all important considerations, and should be nearby or in the room, but I feel as if the retrieval of these items can be delegated, as long as you are otherwise prepared.

The key to making this mnemonic work is making it your own. Change the diamond to a compass, alter the imagery that represents each “base,” add equipment, do whatever is necessary to make it work in your practice. For example, I keep my tape for the ETT near my reservoir bag, so when I give a squeeze to confirm breath sounds I can grab my tape to secure the tube. You may want to keep your tape on the bed, or atop the anesthesia machine. Use your judgment and experiment to find what is most logical for you. Hopefully, this less formal article has been instructive and can be put into immediate practice to get you one step closer to being slightly less incompetent.