The critical transition comes when the right hand changes jobs. Follow the catheter from clearing ahead of the blade to a parked position that keeps drainage working during tube delivery.
Open original film ↗If playback is unavailable, use the written teaching alongside it.
The blade develops the view while suction clears its path. Parking the catheter changes who holds it without removing its drainage job. Follow that relationship through the six movements.
Rehearse with a SALAD trainer and a locally approved teaching plan. A clear view is one part of airway management; oxygenation, attempt limits, and the rescue plan still govern clinical decisions.
01
Overhand grip
Hold the rigid catheter in the right hand with an overhand grip. Align its curve with the airway so the tip can be directed as the blade advances.
With suction running, keep the catheter tip in view as you clear material. Use the rigid catheter to help displace the tongue and lower jaw, creating space for the laryngoscope. Maintain that space until the advancing blade takes control of the airway structures.
Handling cue: Keep the movement controlled and the tip visible. If visibility is lost or resistance prevents controlled movement, stop advancing and reassess.
Sweep side to side with suction running, keeping the tip just ahead of the advancing blade and under direct visualization. Once the blade controls the anatomy, clear the glottic field as needed.
Withdraw the rigid suction catheter, then reintroduce it to the left of the laryngoscope blade. Keep the glottic opening and esophageal inlet in view as you position the tip in the upper esophagus. Leave suction running to drain ongoing contamination while the right hand moves to tube delivery.
Maintain the laryngoscope position and continuing suction. Use the right hand to pass the training tube through the visible glottic opening without displacing the parked catheter.
Once the tracheal tube is positioned and its cuff inflated, clear the tube lumen with a soft suction catheter before ventilation. Withdraw the suction catheter, connect the breathing system, and begin ventilation. Confirm sustained exhaled carbon dioxide using waveform capnography, assess oxygenation and ventilation, and secure the tube.
If sustained exhaled carbon dioxide is absent, urgently exclude esophageal intubation and follow the airway rescue plan.
AFTER THE FULL SEQUENCE / SAL-F06SAL-F06 · FILM · DATE UNVERIFIED
The procedure in detail
Watch the detailed demonstration when a transition in the written sequence is unclear. Return to that movement in the trainer.
Courtesy of Bob Barrix and James DuCanto, as credited on the legacy PAC page. Full production and access details require verification.
Open original film ↗If playback is unavailable, use the written teaching alongside it.
Sequence photographs SAL-P01–P06: enhanced derivatives of the published sequence, preserved from the legacy PAC page. Used with permission confirmed by PAC. Photographer and original dates were not supplied.
Evidence & source notes →
The procedural reference. Root et al. describe how suction is integrated with laryngoscopy and maintained through tube delivery. This is the clinical anchor for the Gallery and Studio sequence.
What training studies measured. In the original 40-learner simulator report, confidence and self-perceived skill increased after training. Those self-reports did not measure clinical competence or patient outcomes.
In SATIATED, 164 paramedics were randomized to different training schedules. First-attempt success on the second manikin attempt was higher in the group already trained in SALAD. The fixed, tabletop manikin and simulated fluid limit how directly that result transfers to an emergency airway.
Results are not uniform. Fiore et al. compared three approaches in 31 residents. They found no statistically significant difference in lower-airway fluid volume or time to intubation. The study was underpowered; this does not establish that the techniques are equivalent.
Device choice within SALAD. A 2026 randomized simulation study of 200 physicians reported higher first-pass success with hyperangulated video laryngoscopy than direct laryngoscopy. Both groups used a SALAD workflow. This compares laryngoscopes in that model, not SALAD against no SALAD. It did not measure patient outcomes.
Read the sequence with its limits. This teaching sequence follows the upper-esophagus position in Root’s procedural text. The figure caption instead describes the tip seated in the hypopharynx. Both describe continuing drainage with the catheter to the blade’s left. No insertion depth is specified. Rehearse controlled placement with the clinical educator.
After tube clearance. Ventilation and confirmation belong together: assess sustained exhaled carbon dioxide using waveform capnography, alongside oxygenation and ventilation. If sustained exhaled carbon dioxide is absent, urgently exclude esophageal intubation and follow the airway rescue plan.
Root et al. also raise a potential disadvantage: continuous suction may remove oxygenated gas from the oropharynx. They did not measure that physiological effect in this paper. A usable view does not establish adequate oxygenation, and simulation success does not establish reduced aspiration, complications, or mortality in patients.
Carry forward Locate the transition where the view, drainage, or tube path is lost. Rehearse that movement with the facilitator before reconnecting the full sequence.
These films examine adjustments and extensions beyond the core sequence in Root et al. They are available when a specific problem needs closer study; they are not additional steps every SALAD attempt must include.
This demonstration explores a right-hand adjustment to blade position. Identify what problem the adjustment is intended to solve and whether the view is maintained. The film’s name does not specify a safe amount of movement or pressure.
SAL-F08 · FILM · DATE UNVERIFIED
The SALAD pinch
Observe the right-hand contact and the corresponding blade adjustment. Return to the full sequence to understand its context.
Cover scene: SAL-A08 · AI-generated SoHo architectural etching. View original scene ↗
Open original film ↗If playback is unavailable, use the written teaching alongside it.The SALAD poke →
After suction is parked, the source demonstrates using the right index finger to address crowding at the right corner of the mouth. Study the tube’s available path and the position of the blade with an educator before rehearsing the adjustment.
SAL-F09 · FILM · DATE UNVERIFIED
The SALAD poke
Follow the relationship between the right corner of the mouth, the laryngoscope position, and the tube path.
Open original film ↗If playback is unavailable, use the written teaching alongside it.Complete microskills demonstration →SAL-F10 · FILM · DATE UNVERIFIED
SALAD microskills
Use the complete demonstration to put an individual gesture back into the coordinated procedure.
Open original film ↗If playback is unavailable, use the written teaching alongside it.SAGA: the supraglottic airway extension →
SAGA adapts decontamination to supraglottic airway placement. It is a separate, device-dependent extension: evidence about the SALAD tracheal-intubation sequence cannot establish its performance. Review the device, purpose, and practice limits with an educator before adding it to a station.
SAL-F11 · FILM · DATE UNVERIFIED
SAGA rapid review
Identify how the demonstrated supraglottic device changes the sequence.
Cover scene: SAL-A11 · AI-generated Union Square station etching. View original scene ↗
The Gallery ends here. At the SALAD simulation station, find the trainer, suction system, laryngoscope, and training tube. Start by inspecting the setup and checking suction.
