Learner handout

Keep this handout beside the equipment during rehearsal. Use it with the instructions for the actual equipment.

Prepare the patient and team

Before starting, assess anatomical difficulty, aspiration risk and tolerance of apnea; choose the airway strategy, including whether an awake approach is needed. Optimize oxygenation and hemodynamics for the setting. Check suction, monitoring, waveform capnography, equipment and rescue options. Assign the operator, assistant and person watching physiology; identify who will call for help. Agree on when to stop and how to restore oxygenation using the institution's current airway algorithm.

An attempt limit is a ceiling, not a target. Declare failure earlier when needed; worsening oxygenation calls for abandoning the attempt and restoring oxygenation. Do not repeat an unsuccessful attempt without a meaningful change and an agreed plan. Escalate using the local algorithm and available expertise.

Sources: Ahmad et al. Difficult Airway Society 2025 guidelines for management of unanticipated difficult tracheal intubation in adults. DOI: 10.1016/j.bja.2025.10.006.; Apfelbaum et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology 136:31–81. DOI: 10.1097/ALN.0000000000004002.; Higgs et al. Guidelines for the management of tracheal intubation in critically ill adults. BJA, 2018. DOI: 10.1016/j.bja.2017.10.021.; Gibbs et al. Noninvasive Ventilation for Preoxygenation during Emergency Intubation. NEJM, 2024. DOI: 10.1056/NEJMoa2313680.

Use the spatial model

The primary oropharyngeal curve and secondary pharyngo-glotto-tracheal curve meet at an inflection point in the laryngeal vestibule. Greenland's model came from MRI studies of 42 normal adult volunteers. Use it to explain spatial relationships; anatomy, pathology and positioning can change the route in an individual patient.

Sources: Greenland et al. Changes in airway configuration with different head and neck positions using magnetic resonance imaging of normal airways: a new concept with possible clinical applications. BJA, 2010. DOI: 10.1093/bja/aeq239.

Guide the blade and choose a working view

Watch the mouth as the blade enters, protecting teeth and soft tissue. Change to the screen when the blade has passed the posterior tongue and use recognizable anatomy to guide further movement. Recheck the mouth whenever entry or an instrument's path is uncertain.

For the GlideScope Go 2 example, identify the epiglottis and guide the blade tip to the vallecula as its manual describes. Avoid excessive depth or lifting for a larger image. Other blades require their own instructions. There is no universal instruction to stop well before the vallecula.

Choose a recognizable laryngeal view with space for tube delivery. PAC's 50/50 cue is a coaching prompt to consider working distance and the tube approach, not a validated screen fraction or pass target. POGO describes the visible proportion of the glottic opening; it is different from where the larynx sits on the screen. A Grade 1 view or a 15-second time does not establish a successful rehearsal.

Sources: Verathon. GlideScope Go 2 Operations & Maintenance Manual. 0900-5165 REV-03, effective 13 August 2025.; Boyd and Dinsmore. Hyperangulated videolaryngoscopy. Australasian Anaesthesia, ANZCA, 2025;83–95. Edited by Yasmin Endlich.; Gu et al. A deliberately restricted laryngeal view with the GlideScope video laryngoscope is associated with faster and easier tracheal intubation. Canadian Journal of Anesthesia, 2016. DOI: 10.1007/s12630-016-0654-6.

Identify and prepare the stylet

The reusable GlideRite example is model 0803-0009, for tubes with an internal diameter of at least 6.0 mm. Its manual is 0900-4686 REV-04, effective 1 October 2025. Confirm the actual device before applying this sequence; other stylets have different instructions.

Do not bend or reshape the reusable GlideRite. Inspect for damage, confirm appropriate processing, and keep its tip contained within the tube. Clinical reprocessing follows the manufacturer's specified cleaning and high-level disinfection or sterilization process before first use and between uses.

Sources: Verathon. GlideRite Rigid Stylet Operations & Maintenance Manual. 0900-4686 REV-04, effective 1 October 2025; reusable model 0803-0009.

Enter, deliver and release

Look into the mouth as the tube enters alongside the blade, avoiding teeth and soft tissue. Then use the screen to guide its approach. Do not advance blindly through the camera's unseen entry zone.

With reusable GlideRite 0803-0009, the stylet must stay out of the glottis. When the tube engages the glottic opening, withdraw the stylet 5 cm using the thumb tab so the tip can soften; advance the tube off the stylet. Position the tube, then remove the stylet completely. Partial release and complete removal are separate events.

If the tube meets resistance, stop advancing. Reassess the view, blade depth, tube approach and likely contact point. The educator should demonstrate the smallest appropriate correction for the actual assembly. Any rotation must identify the operator's viewing perspective and its purpose; a universal clock-face instruction is insufficient. If the problem persists or physiology worsens, stop the attempt and restore oxygenation through the agreed rescue pathway.

Sources: Verathon. GlideScope Go 2 Operations & Maintenance Manual. 0900-5165 REV-03, effective 13 August 2025.; Verathon. GlideRite Rigid Stylet Operations & Maintenance Manual. 0900-4686 REV-04, effective 1 October 2025; reusable model 0803-0009.; Boyd and Dinsmore. Hyperangulated videolaryngoscopy. Australasian Anaesthesia, ANZCA, 2025;83–95. Edited by Yasmin Endlich.; Ahmad et al. Difficult Airway Society 2025 guidelines for management of unanticipated difficult tracheal intubation in adults. DOI: 10.1016/j.bja.2025.10.006.

Confirm and continue care

Observe tube passage through the vocal cords when possible and confirm sustained exhaled carbon dioxide with waveform capnography. The operator and assistant should communicate what they see. Assess tube depth separately, secure the tube and continue capnographic and physiologic monitoring. A carbon dioxide trace does not by itself exclude endobronchial placement.

An absent or doubtful sustained carbon dioxide trace requires immediate action to exclude esophageal intubation, even after a convincing visual impression. The PUMA default is tube removal and ventilation with a face mask or supraglottic airway. If immediate removal would itself be dangerous, urgently use a valid alternative confirmation method while investigating the absent trace. Remove the tube if esophageal placement cannot be excluded, sustained carbon dioxide cannot be restored, or oxygenation deteriorates. Follow the full PUMA guidance and local rescue algorithm; chest movement or auscultation alone cannot exclude esophageal placement.

Sources: Ahmad et al. Difficult Airway Society 2025 guidelines for management of unanticipated difficult tracheal intubation in adults. DOI: 10.1016/j.bja.2025.10.006.; Chrimes et al. Preventing unrecognised oesophageal intubation: a consensus guideline from PUMA and international airway societies. Anaesthesia, 2022. DOI: 10.1111/anae.15817.; Higgs et al. Guidelines for the management of tracheal intubation in critically ill adults. BJA, 2018. DOI: 10.1016/j.bja.2017.10.021.

Name what was assessed

Knowledge completion, observed simulation performance and supervised clinical transfer are different outcomes. The Studio finish line describes this rehearsal only. Repetition counts, page visits, a quiz or a certificate cannot establish independent clinical competence. Faculty should identify a specific improvement, coach it and reassess the relevant behavior; clinical progression and maintenance follow the institution's supervised process.

Sources: Bracey et al. A taxonomy of key performance errors associated with hyperangulated video laryngoscopy for emergency intubation. AJEM, 2026;101:152–158. DOI: 10.1016/j.ajem.2025.12.041.; Ott et al. Learning tracheal intubation with a hyperangulated videolaryngoscopy blade: sub-analysis of a randomised controlled trial. Anaesthesia, 2025;80(4):395–403. DOI: 10.1111/anae.16491.; Ahn et al. Mastery Learning of Video Laryngoscopy Using the Glidescope in the Emergency Department. Simulation in Healthcare, 2016. DOI: 10.1097/SIH.0000000000000164.; Elliott et al. Comparing the Video-guided Intubation Skills of Competency and Mastery-trained Staff Physicians. Simulation in Healthcare, online 25 August 2026. DOI: 10.1097/SIH.0000000000000962.

Station equipment card

Complete this card against the physical installation. Blank or unverified fields mean the setup has not been checked. A brand name alone does not establish compatibility.

Station label / location / support contact

Unverified — faculty completes locally before opening the Station.

Monitor, blade model and size

Unverified — record exact part numbers, sizes, compatible connections and applicable manual. The Go 2 manual is a teaching example, not confirmation of the installed hardware.

Stylet model and reusable / single-use status

Unverified physical device — this draft's detailed sequence applies only to reusable GlideRite 0803-0009.

Tube manufacturer, model and internal diameter

Unverified — confirm compatibility with the selected stylet and trainer; record tube size.

Trainer and permitted lubricant / accessories

Unverified — use the trainer's instructions and identify training-only equipment.

Suction, oxygenation and rescue equipment

Identify the simulated or real training components and the local algorithm used in the scenario; do not mix training equipment into patient-care stock.

Capnography scenario

Provide faculty-reviewed sustained, absent and doubtful waveform examples or a simulator; verbal cases support rehearsal but are not waveform-recognition assessment.

Local airway algorithm and emergency support

Faculty supplies the institution's current document or verified link, including its issue date, and identifies how help is summoned. No institutional pathway was supplied.

Processing and reset owner

Name the responsible person and compatible cleaning / processing instructions for each component; distinguish simulated reset from clinical reprocessing.

Faculty verification

Record reviewer, date, component compatibility, manual revision and observed sequence; verify printed instructions, physical QR destination and a cold-start walk-through before learner use.

Faculty observation rubric

Draft for local piloting, not a validated competency instrument. Observe an actual trainer attempt. For each behavior, record observed without prompting, coached, not observed, or not assessable, with a concrete example. Do not calculate a pass score from this draft.

Preparation and rescue plan

Names risks, assigns roles, checks equipment and capnography, and states the local oxygenation/rescue plan before handling the airway.

Oral entry

Watches blade and tube entry directly; protects teeth and soft tissue; changes visual field deliberately.

Blade and working view

Uses the correct landmarks for the selected blade; explains an adjustment in terms of working space and tube approach.

Device preparation

Identifies the stylet and compatible tube; inspects and contains the tip; does not reshape reusable GlideRite.

Tube delivery and release

Distinguishes partial release from final removal and follows the verified model-specific sequence without driving the stylet into the glottis.

Response to resistance or deterioration

Stops forceful advancement, names a cause and appropriate correction, and prioritizes oxygenation/rescue when the attempt should end.

Confirmation and continuing care

Calls for sustained waveform carbon dioxide, communicates with the assistant, checks depth separately and continues monitoring.

Absent or doubtful trace

Acts to exclude esophageal placement promptly using the PUMA/local pathway, including the limited exception to immediate removal; does not accept appearance alone.

Reset and targeted feedback

Restores training equipment safely and identifies one observed behavior to improve at the next coached attempt.

Correction and reassessment

Pause and correct a rehearsal when entry is blind, the rigid stylet is driven into the glottis, force continues against resistance, confirmation is accepted without adequate evidence, or deterioration fails to trigger rescue. Coach the missed behavior and reassess it before another integrated attempt. Local faculty must agree on critical behaviors and any formal assessment standard before this rubric is used for progression.

Pilot the rubric with two faculty observing the same simulation, compare their judgments, resolve disagreements and revise unclear wording. Include ED, ICU and OR scenarios. Record prompting and conditions, not just success. Practice dose, supervised clinical transfer and later maintenance should be set locally; neither three repetitions, five successes nor twelve clinical cases is a universal competence threshold.

Knowledge rehearsal

Explain each decision, then compare the feedback. These prompts do not award a score, certificate or clinical credential.

Run the rehearsal

Use the Studio instructions as the current Station cards. The equipment card must match the actual table before insertion practice. Assign an observer to the external hand and mouth view and an assistant to the monitor; compare their observations after the attempt. This supplies paired observations without claiming that an unreviewed film shows every safety event.

For ED, rehearse urgency and available help; for ICU, emphasize oxygenation and hemodynamic vulnerability; for anesthesia, include the planned difficult-airway or awake-strategy decision. Supply the current institutional algorithm in each case. These are scenario emphases, not setting-specific clinical protocols.

410 · Explain the paths and plan

411 · Trace, then explain the curves

412 · Rehearse Light. Open. Midline.

413 · Prepare, deliver and release

414 · Rehearse the complete sequence

Films and artwork retain their original files. Use the visible instructions for this revised sequence. An educator must reconcile device identity and movements before using inherited media as a procedural demonstration.