Put the whole system in motion
Two hands.
One fluid procedure.
The left hand creates the working view. The right hand delivers the tube. Mastery comes from making them work as one coordinated system.
Entered from the physical poster? Begin with the poster film, then move directly into the seven-phase run. Online and in-person learners share the same starting line.
- Focus
- Whole-procedure fluency
- Model
- See · build · deliver
- Finish
- Test or build
Five chapters · one coordinated act
Mastery lives in the transitions.
HAVL asks you to coordinate two curves, two visual fields, and two instruments. The laryngoscope follows one path to reveal the larynx; the tube–stylet assembly follows another to enter it.
The technical challenge is not any single move. It is knowing when to shift your gaze, when you’ve optimized the view for tracheal access, and how to manipulate the stylet so the tube can follow the tracheal axis.
Integrate
Connect the chapters
Use positioning, blade path, working view, and a tube loaded on a rigid stylet as one coordinated system.
Rehearse
Run the sequence
Rehearse seven connected phases that organize the poster’s ten actions into one controlled routine.
Diagnose
Fix the relationship
When progress stops, identify the geometric problem before adding force or repeating the same movement.
Name the movement before adding speed
Seven phases. One continuous run.
Poster 414 names ten actions. This rehearsal rail consolidates them into seven connected phases so every gaze shift and hand movement remains visible before speed is added.
- 01
Eyes
Insert the blade midline.
Look directly into the mouth as the blade enters. Find the uvula. It points the way. - 02
Blade
Hug the base of the tongue.
Transition to the screen and follow the oropharyngeal contour until the tip of the epiglottis comes into view. - 03
View
Create a useful 50/50 view.
Engage the vallecula, then pull back, lift, or tilt only as needed. - 04
Tube
Insert the tube under direct vision.
Look back into the mouth, enter from the right, then find the tip on screen. - 05
Opening
Stop. Pop. Drop.
Gently engage the glottic opening, begin withdrawing the stylet, rotate the tube to 3 o’clock, and allow its trajectory to soften. - 06
Advance
Deliver the tube.
Stabilize the tube and advance with continuous visualization. - 07
Finish
Remove the stylet.
Secure the tube against the laryngoscope handle, stabilize its depth, remove the stylet, and confirm placement before removing the laryngoscope.
A training lab you can run anywhere
Watch once. Rehearse slowly. Then repeat.
The three-pass lab
- 01
Observe the complete sequence
Watch without performing. Track gaze, blade, tube, and stylet as four separate channels.
- 02
Rehearse at teaching speed
Pause at every transition. Say what you are looking at and why the next movement is needed.
- 03
Run it without prompts
Repeat until the sequence stays organized. Then seek coaching.
Practice the transition that breaks—not just the procedure that succeeds.
Targeted support after the core run
Open only what you need to refine.
The core lesson continues at the Bottom Line. Open a tool only when you need a correction, a visual prompt, or deeper context.
Continue to the Bottom Line ↓04ACorrect one movement · five coached clipsMicroskills clinicOpen ＋
Open the part you need
Break the run into trainable moments.
These short studies isolate the key movements. Use them for targeted correction, then return to the full sequence so the skill reconnects to its neighbors.
01Own both instruments＋
Keep the blade in the left hand with a light, low grip. Hold the loaded tube high in the right hand, with the thumb ready to begin stylet withdrawal.
- Confirm the tube and stylet are correctly assembled.
- Avoid inefficient or unnecessary movements. Simplify and refine.
02Enter the mouth without losing the route＋
Open the mouth, look directly at the entry, and introduce the blade midline. Shift to the screen only after the blade is safely inside the mouth and the camera can guide the next movement.
A controlled entrance protects teeth and soft tissue and makes the screen image easier to interpret.
03Find the epiglottis progressively＋
Follow spatial relationships rather than hunting for a perfect final image. Advance along the tongue, recognize the epiglottis, and place the blade tip in the vallecula.
If the anatomy disappears, stop and pull back until the anatomy becomes recognizable again.
04Create a working view—not the closest view＋
Use small pull-back, lift, and tilt adjustments to create room for tube delivery. The goal is a useful relationship between the glottis and the tube path, not the largest possible image of the cords.
- Pull back if the view is too close or disorienting.
- Lift along the blade axis; do not lever on the teeth.
- Preserve enough space to see the approaching tube tip.
05Turn visualization into tracheal access＋
Look into the mouth as the tube enters, then recover the tube tip on screen. Stop at the glottic opening, begin withdrawing the stylet, and advance the tube only after its trajectory can change—do not add blind force.
04BDiagnose the obstacle · four fixes + safetyTroubleshootingOpen ＋
When the run stops moving
Change the relationship before you add force.
Pull back.
Re-establish the epiglottis and create space for the tube to approach the opening.
Look in the mouth.
Find the tube beside the blade, then transition back to the screen when the tip enters the camera field.
Withdraw and lift.
Back up enough to see the tip, correct the route, and try a smaller controlled movement.
Release the curve.
Begin stylet withdrawal so the tube can turn toward the tracheal axis. Rotate the tube to 3 o’clock.
04CRehearse visually · six skills cardsSkills-card atlasOpen ＋
Fast retrieval at the practice station
Flip the cards. Swipe the sequence.
Use the cards at the practice table for direct access to essential skills. Each card distills one movement into a short prompt: review, practice, repeat. The horizontal rail keeps the full set available without turning the lesson into another long vertical stack.
Swipe or scroll to review all six →
04DExplore expert context · three optional resourcesDeep CutsOpen ＋
Expert context after the core run
Compare technique. Study judgment. Stay curious.
Deep Cuts are optional. Open a resource when it answers a specific question—or continue to the Bottom Line and complete the PACscape.
Skip to the Bottom Line ↓01HAVL demonstration — Rich Levitan＋
Watch the entire sequence with attention to the moments that are easy to miss: the gaze transition at blade entry, the decision to stop optimizing the view, and the timing of stylet release.
02Hyperangulated technique pearls — Cliff Reid＋
Use this expert demonstration to compare blade depth, working-view strategy, and tube delivery with the PAC roadmap. Notice what remains consistent even when the operator’s exact movements differ.
03Expert conversation — Nicholas Chrimes＋
This extended discussion is for learners who want to explore how experts describe blade mechanics, tube delivery, and the judgment behind small corrections. Treat it as context—not a substitute for device instructions or coached practice.
Respect the transitions
See the route.
Build the view.
Deliver the tube.
Make it seamless.
Hyperangulated video laryngoscopy is not simply a sharper curve or a better look at the cords. It is a different relationship between view and delivery. Prepare deliberately, move under visualization, build a useful working view, and release the stylet before the rigid curve becomes the obstacle.
A great view becomes a successful intubation only when the tube has a safe, deliberate route.
Poster 414 // final station
You finished the PACscape. Choose what happens next.
Close the learner pathway with the HAVL Knowledge Test—or take the educator pathway and turn the posters, media, and practice sequence into a training space of your own.
Prove what you know
Take the HAVL Knowledge Test.
Complete the HAVL Knowledge Test, share feedback, and receive your certificate of completion.
Begin the HAVL Knowledge Test ↗Carry PAC into your space
Build your own HAVL training lab.
Use the setup guide to assemble the posters, equipment, digital media, and deliberate-practice workflow.
Open the setup guide ↗Return to the HAVL PACscape map to revisit any poster or repeat a chapter before choosing your next step.
References and educational-use noteOpen ＋
- Verathon. GlideRite Rigid Stylet Operations & Maintenance Manual. 0900-4686 REV-03. 2023.
- The American Society of Anesthesiologists Task Force on Management of the Difficult Airway. 2022 Practice Guidelines for Management of the Difficult Airway. Anesthesiology. 2022;136(1):31–81. PMID: 34762729.
- Eum D, Ji YJ, Kim HJ. Comparison of the success rate of tracheal intubation between stylet and bougie with a hyperangulated videolaryngoscope: a randomised controlled trial. Anaesthesia. 2024;79(6):603–610. PMID: 38114306.
- This educational page supports clinician learning and deliberate practice. It does not replace device instructions, local protocols, patient-specific assessment, supervised training, or clinical judgment.
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