Critically ill physiology combined with endotracheal intubation can be a recipe for disaster. Focusing only on the mechanics of intubation and failing to prepare for the effects it will have is heading down a dangerous road. The HOV mnemonic -- Hemodynamics, Oxygenation, Ventilation (pH) is a simple way to organize key concepts and skills needed to intubate a sick patient safely. So be prepared, and next shift ask yourself, "is my patient in the HOV lane?"