POSTER 410 / Introduction to HAVL
Great views are only the beginning.
The camera can reveal the larynx while the tube still has a curve to negotiate. Begin with the relationship between the view, the blade, and tube delivery.
At the physical station? Go directly to the Practice Studio.
410 / ROOM 01
The curve changes the task
A hyperangulated blade carries the camera around the tongue. A clear image and successful tube delivery are separate achievements. The evidence also depends on the device, setting and comparator.
In DEVICE, 1,417 ED/ICU adults were randomized to video or direct laryngoscopy: first-attempt success was 85.1% versus 70.8%. Of 705 patients assigned video, 607 received standard-geometry blades and 98 hyperangulated blades. Severe complications were similar (21.4% versus 20.9%); this is not a GlideScope-specific effect.
In Ruetzler's single-center operating-room trial, GlideScope hyperangulated video laryngoscopy was compared with direct laryngoscopy in 8,429 procedures. More than one attempt was needed in 1.7% versus 7.6%; airway/dental injury did not differ significantly. Most procedures were elective, in selected surgical services.
Trace the camera and tube paths. Which comparison supports a claim about GlideScope, and which supports video laryngoscopy more broadly?
Compare your explanation +
Ruetzler directly studied GlideScope versus direct laryngoscopy in that OR population. DEVICE supports video versus direct laryngoscopy in ED/ICU care; its blade distribution does not establish a hyperangulated advantage. Neither establishes a reduction in serious complications for every patient.
TAKE THIS FORWARDA recognizable glottis is a location. Tube delivery is the next task.
410 / ROOM 02
See the connected system
The mental model, blade and tube-delivery adjunct work within a patient and team plan. Hyperangulated and standard-geometry video blades are distinct options. Pooled perioperative studies favor several video designs over direct laryngoscopy; they do not establish one universal best design. A 2025 emergency-care review found a small association favoring standard-geometry video blades for first-pass success, but low-certainty comparisons and selection bias limit causal interpretation.
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.
Name the job of each component. For your ED, ICU or anesthesia setting, what must be ready before the first attempt?
Compare your explanation +
Include the tube route, physiological preparation, named team roles, waveform capnography and a rescue plan. Choose equipment for the patient, operator and setting; do not infer a universal blade winner from a VL-versus-DL trial.
TAKE THIS FORWARDPlan the view, delivery and recovery together.
FROM THE GALLERY TO YOUR HANDS
Explain the paths and plan
HAVL diagram; a colleague or educator; your setting's current airway algorithm.
First action: Find the blade and tube on the diagram.
SOURCE CABINET
References & boundaries
Use the current local device instructions and educator-reviewed practice. Study findings apply to their stated settings and comparators.
OPTIONAL STUDY
Read the comparisons separately
Cochrane 2022 found fewer failed intubations with hyperangulated VL than with direct laryngoscopy (RR 0.51, 95% CI 0.34–0.76), with imprecise hypoxemia effects. The 2025 anesthesia network meta-analysis and emergency-care review address different settings and comparators. Use the full evidence register for denominators, certainty and limitations.
410 / PRACTICE STUDIO · Cognitive rehearsal
Explain the paths and plan
Explain both instrument paths and name the team's preparation and rescue plan.
YOU NEED HAVL diagram; a colleague or educator; your setting's current airway algorithm.
START HERE / WITH YOUR COLLEAGUE
Find the blade and tube on the diagram.
Use the diagram to explain the two paths, then brief your team’s plan. This Studio begins with the task.
Begin the planning rehearsal ↓BEFORE YOU BEGIN
Check your setup.
HAVL diagram; a colleague or educator; your setting's current airway algorithm.
If equipment or instructions do not match, stop and ask the responsible educator. The equipment card identifies the local support and reset owner before the Station opens.
Equipment and support card →DO / STEP 01
Trace the two paths.
Explain how the camera can find the larynx while the tube still needs a delivery route.
Review the related Gallery Room →DO / STEP 02
Brief the team for one setting.
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.
Review the related Gallery Room →DO / STEP 03
Name the stopping decision.
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.
Review the related Gallery Room →AFTER YOUR FIRST REHEARSAL
Choose one improvement.
If the plan is unclear, name the missing role or resource and clarify it with the educator before proceeding.
Rehearse according to what you and your educator observe. Repetition counts do not establish proficiency.
BEFORE YOU LEAVE / THIS REHEARSAL
Show and explain.
Explain both paths and have your colleague repeat the preparation and rescue plan. This completes the cognitive rehearsal; it does not assess intubation performance.
Reset for the next learner
Return the model and teaching materials to their starting arrangement.
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.
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