The first option for patient positioning is the one you would use for routine airway management, i.e. 'sniffing the morning air' (Fig 1). However, the sniffing position does not provide optimal conditions for cricothyroidotomy, where full neck extension is ideal.

In an emergency, the other options for full neck extension may be achieved by:

• Placing a pillow, sandbag or 1 litre bag of fluid under the shoulders (Fig 2)
• Dropping the head of the operating table (Fig 3)
• Pulling the patient up the bed so the head hangs off the top of the mattress (Fig 4) or over the top of the trolley

Continue to provide 100% oxygen via the upper airway during all FONA attempts, ideally using a supraglottic airway device or a tightly fitting facemask with adjuncts.