Airway Glossary • LITFL

The LITFL Airway Glossary provides a common language for describing video laryngoscopy, airway anatomy, equipment, procedural techniques and performance errors. Terms are linked to relevant airway cases and expanded as the video library develops.

Use the search table for keywords and the hyperlink to find the section on this page for further details

Category	Term	Definition	Video relevance	Related terms	Relevant errors	Reference	Search terms / synonyms
Anatomy	Vallecula	Depression between the base of the tongue and the epiglottis.	Identify the midline vallecula before applying lift. Incomplete, lateral or lost seating can impair glottic exposure.	Median glossoepiglottic fold; hyoepiglottic ligament; vallecular engagement	Failure to engage midline; not fully seated; lost seating; too much force; inadequate lifting force	Weingart et al. 2023; doi:10.1016/j.ajem.2023.08.035	vallecula; valleculoscopy; blade seating; Mac blade
Technique	Hyperangulated video laryngoscopy	Video laryngoscopy using a more acutely curved blade that provides an indirect glottic view and requires technique-specific microskills.	Blade geometry and indirect viewing alter insertion, vallecular engagement and especially tube delivery with a shaped rigid stylet.	Hyperangulated blade; rigid stylet; video laryngoscopy	Bracey HAVL taxonomy (20 performance errors)	Bracey et al. 2026; doi:10.1016/j.ajem.2025.12.041	HAVL; hyperangulated; hyper-angulated; GlideScope
Performance error	Failure to engage midline of vallecula	Blade tip fails to engage the median glossoepiglottic fold, resulting in inadequate epiglottic translation.	Assess whether the blade is centred in the vallecula before increasing lifting force.	Median glossoepiglottic fold; vallecula; epiglottis	Failure to engage midline of vallecula	Weingart et al. 2023; Bracey et al. 2026	failure engage midline; off centre vallecula; MGEF
Anatomical variant	Omega epiglottis	Epiglottis with curled lateral margins producing an omega (Ω)-shaped appearance.	May narrow the visible laryngeal inlet or alter the approach to vallecular engagement.	Epiglottis; floppy epiglottis; anatomical variant		LITFL Airway Glossary draft	omega epiglottis; omega-shaped epiglottis; curled epiglottis
Technique	Standard geometry video laryngoscopy	Video laryngoscopy using a Macintosh-like blade geometry that can support screen-guided laryngoscopy and, in some devices, direct laryngoscopy.	Uses a distinct set of microskills centred on structure recognition, vallecular engagement and device delivery.	Video laryngoscopy; Macintosh blade; bougie; direct laryngoscopy	Weingart SGVL taxonomy (13 performance errors)	Weingart et al. 2023; doi:10.1016/j.ajem.2023.08.035	SGVL; standard geometry VL; Macintosh video laryngoscopy; video Mac
Anatomy	Arytenoid cartilage	Paired posterior laryngeal cartilages forming part of the posterior glottic framework.	Visible posterior landmarks around the glottic inlet; the endotracheal tube may impinge on an arytenoid during delivery.	Glottis; vocal cords; posterior impingement	Tube delivery issues	Weingart et al. 2023; doi:10.1016/j.ajem.2023.08.035	arytenoid; arytenoids; posterior glottis; tube hang-up
Anatomy	Hyoepiglottic ligament	Ligament connecting the epiglottis to the hyoid bone; tension through this structure contributes to epiglottic elevation during vallecular lift.	Not normally visible directly, but its engagement helps explain why correct midline vallecular seating elevates the epiglottis.	Vallecula; median glossoepiglottic fold; epiglottis	Failure to engage midline of vallecula	LITFL Airway Glossary draft	hyoepiglottic ligament; hyo-epiglottic ligament; vallecular lift
Manoeuvre	BURP manoeuvre	Backward, upward and rightward pressure applied externally to the larynx to alter glottic exposure.	A view-optimisation manoeuvre; distinguish it from generic external laryngeal manipulation.	External laryngeal manipulation; glottic exposure		LITFL Airway Glossary draft	BURP; backward upward rightward pressure; laryngeal pressure, Maneuver
Technique	Mac-as-Miller	Deliberate use of a curved Macintosh-style blade to directly elevate the epiglottis rather than seating the tip in the vallecula.	May be used intentionally as a rescue manoeuvre; accidental epiglottic override should be distinguished from deliberate technique.	Macintosh blade; Miller blade; epiglottis; vallecula	Overriding the epiglottis (HAVL when not used as rescue)	Weingart et al. 2023; Bracey et al. 2026	Mac as Miller; Mac-as-Miller; direct epiglottis lift; epiglottic override
View / classification	Cormack-Lehane Grade	Classification system describing glottic view during laryngoscopy (Grades I–IV).				Cormack, Lehance, Cormack-Lehane
View / classification	POGO	Percentage of glottic opening [POGO] score
View / classification	Yentis–Lee
Performance error	Missed anatomical structure recognition	Glottic structures are visible to the reviewer but are not recognised by the operator, who does not make an appropriate positional correction or attempt device passage.	Separate failure to recognise visible landmarks from off-midline or overly deep insertion that progresses toward the oesophagus.	Structure recognition; epiglottis; glottis; vallecula	Missed anatomical structure recognition	Weingart et al. 2023	missed anatomy; structure recognition; unrecognized glottis
Performance error	Overly deep insertion leading to oesophageal visualization	A midline insertion is advanced too rapidly or too far, overrunning glottic structures and reaching the oesophageal view.	Watch for skipped landmarks during advancement and whether withdrawal restores epiglottic or glottic anatomy.	Structure recognition; epiglottis; oesophagus	Overly deep insertion	Weingart et al. 2023	too deep; overly deep; esophageal visualization; oesophageal visualisation
Performance error	Tube delivery issues	Endotracheal tube passage is delayed or prevented by impingement on laryngeal structures, commonly an arytenoid.	Observe where the tube tip arrests and whether rotation or repositioning relieves the obstruction.	Endotracheal tube; arytenoid cartilage; tube rotation	Tube delivery issues	Weingart et al. 2023	tube delivery; arytenoid hang-up; ETT impingement
Performance error	Over-rotated insertion (Kovacs Sign)	The glottis occupies more than half of the screen with anterior tracheal structures visible, creating poor geometry for device passage.	A very close glottic image may represent excessive blade rotation or depth rather than an optimal delivery position.	Glottic exposure; blade depth; tube delivery	Over-rotated insertion	Weingart et al. 2023	Kovacs sign; over rotated; over-rotation; glottis >50%
Performance error	Bougie delivery issue	The bougie cannot be manipulated through the vocal cords or hangs on anterior tracheal rings without effective correction.	Assess bougie tip control, trajectory through the glottis and response to resistance after cord passage.	Bougie; anterior tracheal rings; vocal cords	Bougie delivery issue	Weingart et al. 2023	bougie issue; bougie delivery; anterior ring hang-up
Performance error	Too much force in vallecula	Excess pressure or over-insertion in the vallecula moves the epiglottis caudally and worsens glottic visualisation.	Recognise an iatrogenically worsened view caused by excessive blade pressure rather than insufficient lift.	Vallecula; epiglottis; blade force	Too much force in vallecula	Weingart et al. 2023; Bracey et al. 2026	too much force; over insertion vallecula; excessive pressure
Performance error	Not fully seated in vallecula	Blade tip is midline in the vallecula but has not advanced sufficiently to translate the epiglottis.	Look for a centred blade with inadequate forward seating and limited epiglottic elevation.	Vallecula; median glossoepiglottic fold; epiglottis	Not fully seated in vallecula	Weingart et al. 2023; Bracey et al. 2026	not fully seated; shallow vallecula; incomplete seating
Performance error	Inadequate suction	Tube or bougie delivery is attempted despite inadequate visualisation from secretions, blood or debris and without sufficient suction.	Identify contamination that meaningfully obscures landmarks and whether suction was used before proceeding with device delivery.	Suction; SALAD; blood; emesis; secretions	Inadequate suction	Weingart et al. 2023; Bracey et al. 2026	inadequate suction; poor suction; secretions; blood; debris
Performance error	Premature camera withdrawal	The laryngoscope is withdrawn before passage of the endotracheal tube through the glottis has been visually confirmed.	Maintain the camera view until tube passage is secure, including during bougie or stylet removal when relevant.	Tube passage; vocal cords; bougie; stylet	Premature withdrawal of camera	Weingart et al. 2023; Bracey et al. 2026	camera withdrawal; scope removed early; premature blade withdrawal
Performance error	Lost vallecular seating	Vallecular engagement is lost during the attempt, causing deterioration or loss of glottic visualisation.	Observe whether an initially good view worsens when the blade tip slips out of its effective vallecular position.	Vallecula; blade seating; glottic exposure	Lost seating in vallecula	Weingart et al. 2023	lost seating; lost vallecula; blade slips
Performance error	Inadequate lifting force	Blade tip is appropriately engaging the vallecula but insufficient lift produces inadequate glottic exposure.	Look for correct vallecular seating with limited epiglottic translation or an unnecessarily restricted glottic view.	Vallecula; lifting force; glottic exposure	Inadequate lifting force	Weingart et al. 2023; Bracey et al. 2026	poor lift; inadequate lift; lifting force
Performance error	Insertion off midline	Blade tip is inserted lateral to the glottic structures and further advancement leads toward oesophageal visualisation.	Track whether the operator maintains midline orientation during blade advancement and recognises lateral landmarks before over-advancing.	Midline insertion; structure recognition; oesophagus	Insertion off midline	Weingart et al. 2023; doi:10.1016/j.ajem.2023.08.035	off midline; lateral insertion; esophageal visualization; oesophageal visualisation
Manoeuvre	Tube rotation	Rotation of the endotracheal tube to redirect the tip and relieve impingement during passage.	Useful when the tube tip catches on arytenoid cartilage or other laryngeal structures.	Posterior impingement; arytenoid cartilage; tube delivery	Tube delivery issues	Airway Case 001; Weingart et al. 2023	tube rotation; rotate ETT; 90 degree rotation; arytenoid hang-up
Manoeuvre	External laryngeal manipulation	External manipulation of the larynx to improve glottic exposure or tube-delivery geometry.	Assess whether external manipulation improves the view or facilitates device passage without destabilising blade position.	Glottic exposure; BURP manoeuvre; laryngoscopy	Inadequate glottic exposure	LITFL Airway Glossary draft	ELM; external laryngeal manipulation; external manipulation
Manoeuvre	SALAD	Suction-Assisted Laryngoscopy and Airway Decontamination: a technique for managing heavily contaminated airways during laryngoscopy.	Suction may lead blade insertion and can be positioned to provide ongoing clearance while laryngoscopy and tube delivery proceed.	Suction; emesis; blood; contaminated airway	Inadequate suction	DuCanto, Serrano & Thompson 2017; Airway Case 001	SALAD; suction assisted laryngoscopy airway decontamination; contaminated airway
Equipment	Rigid stylet (e.g., GlideRite)	Pre-shaped rigid stylet used to match the curvature of a hyperangulated laryngoscope blade.	Tube delivery depends on controlled rotation, release from anterior-ring hang-up and stable tube position during stylet withdrawal.	Hyperangulated video laryngoscopy; hyperangulated blade; endotracheal tube	Translation not rotation; anterior tracheal ring hang-up; dislodged ETT during stylet removal	Bracey et al. 2026	rigid stylet; GlideRite; hyperangulated stylet; shaped stylet
Equipment	Stylet	Rigid or semi-rigid insert placed inside an endotracheal tube to shape and control it during intubation.	The chosen curvature should match the laryngoscopy technique and permit controlled delivery through the glottis.	Rigid stylet; endotracheal tube; hyperangulated video laryngoscopy	Device delivery errors	LITFL Airway Glossary draft	stylet; ETT stylet; tube stylet
Equipment	Bougie	Tracheal introducer passed through the glottis to guide subsequent endotracheal tube placement.	Observe control of the tip, passage through the cords and correction of anterior tracheal-ring hold-up before railroading the tube.	Endotracheal tube; standard-geometry video laryngoscopy; coudé tip	Bougie delivery issue; tube delivery issues	Weingart et al. 2023	bougie; tracheal introducer; gum elastic bougie; introducer
Equipment	Miller blade	Straight laryngoscope blade commonly used to lift the epiglottis directly.	The blade tip is advanced beneath the epiglottis rather than seated in the vallecula.	Epiglottis; Mac-as-Miller; straight blade		LITFL Airway Glossary draft	Miller; Miller blade; straight blade
Equipment	Macintosh blade	Curved laryngoscope blade designed to seat in the vallecula and indirectly elevate the epiglottis.	Correct midline seating and lifting direction are central to efficient glottic exposure.	Vallecula; median glossoepiglottic fold; Mac-as-Miller	Vallecular manipulation errors	LITFL Airway Glossary draft	Macintosh; Mac blade; curved blade
Equipment	Hyperangulated blade	Sharply curved video laryngoscope blade designed for an indirect camera view.	Improves glottic visualisation without requiring direct line-of-sight alignment, but tube delivery usually requires a matching shaped stylet.	Hyperangulated video laryngoscopy; rigid stylet	HAVL performance errors	Bracey et al. 2026; doi:10.1016/j.ajem.2025.12.041	hyperangulated blade; hyper-angulated blade; GlideScope blade
Equipment	Standard geometry blade	Video laryngoscope blade with Macintosh-like geometry.	Allows a familiar vallecular approach and may permit both direct and video-assisted viewing depending on the device.	Standard-geometry video laryngoscopy; Macintosh blade	SGVL performance errors	Weingart et al. 2023	standard geometry blade; SG blade; Macintosh video blade
Technique	First pass success	Successful tracheal intubation on the first intubation attempt.	Record separately from technical performance: a first-pass success may still contain correctable performance errors.	Attempt; performance error; procedural outcome		Weingart et al. 2023; Bracey et al. 2026	FPS; first pass success; first-pass success
Technique	Video laryngoscopy (VL)	Laryngoscopy using a camera-equipped blade that displays airway structures on a screen.	Provides a recordable view that supports procedural teaching, review and quality improvement.	Standard-geometry video laryngoscopy; hyperangulated video laryngoscopy		Weingart et al. 2023; Bracey et al. 2026	VL; video laryngoscopy; videolaryngoscopy
Technique	Direct laryngoscopy (DL)	Laryngoscopy in which the operator directly visualises the larynx through the mouth rather than relying on a camera screen.	Relevant when a video laryngoscope with standard geometry is used for direct viewing or when direct and screen views are compared.	Video laryngoscopy; standard-geometry video laryngoscopy		LITFL Airway Glossary draft	DL; direct laryngoscopy; direct view
Complication	Posterior impingement	ETT tip catches on arytenoids or posterior structures.
Anatomy	Anterior airway	Glottis positioned more anteriorly requiring steep blade angle.
Anatomy	Vocal cords	Paired vocal folds forming the margins of the glottic opening.	Visualisation of the folds defines the glottic inlet and allows confirmation that the bougie or tube passes between them.	Glottis; arytenoid cartilage; subglottis	Missed anatomical structure recognition; tube delivery issues; premature withdrawal of camera	LITFL Airway Glossary draft	vocal cords; vocal folds; cords
Anatomy	Subglottis	Airway immediately below the vocal folds, extending toward the cricoid cartilage.	Visual passage of the tube beyond the cords confirms progression into the subglottic airway before camera withdrawal.	Glottis; vocal cords; cricoid cartilage	Premature withdrawal of camera	LITFL Airway Glossary draft	subglottis; subglottic airway; below cords
Anatomy	Glottis	Opening between the vocal folds leading into the trachea.	The target for bougie or endotracheal tube passage; assess both view and delivery geometry rather than view alone.	Vocal cords; arytenoid cartilage; subglottis	Missed anatomical structure recognition; device delivery errors	LITFL Airway Glossary draft	glottis; glottic opening; glottic inlet
Anatomy	Median glossoepiglottic fold	Midline mucosal fold connecting the tongue base to the epiglottis; a target for midline vallecular blade placement.	Engaging the midline fold helps centre the blade in the vallecula and translate the epiglottis during Macintosh-style laryngoscopy.	Vallecula; hyoepiglottic ligament; vallecular engagement	Failure to engage midline of vallecula	Weingart et al. 2023; doi:10.1016/j.ajem.2023.08.035	median glossoepiglottic fold; median vallecular fold; MGEF; vallecula midline
Anatomy	Epiglottis	Leaf-shaped supraglottic cartilage that guards the laryngeal inlet and is elevated during laryngoscopy.	A key orientation landmark. Identify the epiglottis before advancing to the vallecula or deliberately lifting it directly.	Vallecula; hyoepiglottic ligament; omega-shaped epiglottis; floppy epiglottis	Missed anatomical structure recognition; overly deep insertion	LITFL Airway Glossary draft	epiglottis; epiglottoscopy; supraglottis
Anatomical variant	Floppy epiglottis	Epiglottis that prolapses posteriorly and may obscure the laryngeal inlet.	May require altered blade positioning or deliberate direct elevation when vallecular lifting does not expose the glottis.	Epiglottis; Mac-as-Miller; Miller blade	Missed anatomical structure recognition	LITFL Airway Glossary draft	floppy epiglottis; prolapsing epiglottis
Airway condition / video finding	Foreign body	Material within the upper airway that may obstruct airflow, obscure landmarks or impede blade and device passage.	Identify location and relationship to the laryngeal inlet before advancing the blade or tube.	Airway obstruction; suction; removal device	Missed anatomical structure recognition	LITFL Airway Glossary draft	foreign body; FB; airway obstruction; object
Airway condition / video finding	Airway oedema	Swelling of upper-airway or laryngeal tissues that may distort normal landmarks and narrow the glottic inlet.	Expect altered anatomy, reduced working space and potentially more difficult structure recognition or device passage.	Epiglottis; glottis; anatomical distortion	Missed anatomical structure recognition; tube delivery issues	LITFL Airway Glossary draft	airway oedema; edema; swollen airway; laryngeal oedema
Airway condition / video finding	Emesis in airway	Gastric contents present in the upper airway during laryngoscopy.	Requires active decontamination and suction while maintaining orientation and camera visibility.	SALAD; suction; aspiration; contaminated airway	Inadequate suction	Airway Case 001; DuCanto et al. 2017	emesis; vomit; vomiting; gastric contents; contaminated airway
Airway condition / video finding	Secretions in airway	Saliva, mucus or other secretions that obscure airway landmarks or the camera view.	Suction should restore landmark recognition before bougie or tube passage when visibility is impaired.	Blood; emesis; suction; SALAD	Inadequate suction	Weingart et al. 2023; doi:10.1016/j.ajem.2023.08.035	secretions; mucus; saliva; schmutz; contaminated airway
Airway condition / video finding	Blood in airway	Blood within the pharynx or laryngeal field that may obscure airway structures or contaminate the camera.	Recognise early and suction before attempting device delivery if the laryngeal view is inadequate.	Secretions; emesis; SALAD; suction	Inadequate suction	Weingart et al. 2023; doi:10.1016/j.ajem.2023.08.035	blood; haemorrhage; hemorrhage; contaminated airway

Glossary of terms

Airway oedema

AIRWAY CONDITION ∘ VIDEO FINDING

Swelling of upper-airway or laryngeal tissues that may distort normal landmarks and narrow the glottic inlet.

Video relevance: Expect altered anatomy, reduced working space and potentially more difficult structure recognition or device passage.
Related terms: Epiglottis, glottis, anatomical distortion
Relevant errors: Missed anatomical structure recognition, tube delivery issues
Reference:

Anterior airway

ANATOMY

Glottis positioned more anteriorly requiring steep blade angle.

Video relevance:
Related terms:
Relevant errors:
Reference:

Arytenoid cartilage

ANATOMY

Paired posterior laryngeal cartilages forming part of the posterior glottic framework.

Video relevance: Visible posterior landmarks around the glottic inlet; the endotracheal tube may impinge on an arytenoid during delivery.
Related terms: Glottis; vocal cords; posterior impingement
Relevant errors: Tube delivery issues
Reference:

Blood in Airway

AIRWAY CONDITION ∘ VIDEO FINDING

Blood within the pharynx or laryngeal field that may obscure airway structures or contaminate the camera.

Video relevance: Recognise early and suction before attempting device delivery if the laryngeal view is inadequate.
Related terms: Secretions, emesis, SALAD, suction
Relevant errors: Inadequate suction
Reference:

Bougie

EQUIPMENT

Tracheal introducer passed through the glottis to guide subsequent endotracheal tube placement.

Video relevance: Observe control of the tip, passage through the cords and correction of anterior tracheal-ring hold-up before railroading the tube.
Related terms: Endotracheal tube, standard-geometry video laryngoscopy, coudé tip
Relevant errors: Bougie delivery issue, tube delivery issues
Reference:

Bougie Delivery Issue

PERFORMANCE ERROR

The bougie cannot be manipulated through the vocal cords or hangs on anterior tracheal rings without effective correction.

Video relevance: Assess bougie tip control, trajectory through the glottis and response to resistance after cord passage.
Related terms: Bougie, anterior tracheal rings, vocal cords
Relevant errors: Bougie delivery issue
Reference: Weingart et al. 2023

BURP Manoeuvre

MANOEUVRE

Backward, upward and rightward pressure applied externally to the larynx to alter glottic exposure.

Video relevance: A view-optimisation manoeuvre; distinguish it from generic external laryngeal manipulation.
Related terms: External laryngeal manipulation, glottic exposure
Reference:

Cormack-Lehane Grade

CLASSIFICATION

Classification system describing glottic view during laryngoscopy (Grades I–IV).

Video relevance:
Related terms:
Reference:

Direct Laryngoscopy (DL)

TECHNIQUE

Laryngoscopy in which the operator directly visualises the larynx through the mouth rather than relying on a camera screen.

Video relevance: Relevant when a video laryngoscope with standard geometry is used for direct viewing or when direct and screen views are compared.
Related terms: Video laryngoscopy; standard-geometry video laryngoscopy
Reference:

Emesis in Airway

AIRWAY CONDITION ∘ VIDEO FINDING

Gastric contents present in the upper airway during laryngoscopy.

Video relevance: Requires active decontamination and suction while maintaining orientation and camera visibility.
Related terms: SALAD, suction, aspiration, contaminated airway
Relevant errors: Inadequate suction
Cases: 001
Reference: SALAD (CCC)

Epiglottis

ANATOMY

Leaf-shaped supraglottic cartilage that guards the laryngeal inlet and is elevated during laryngoscopy.

Video relevance: A key orientation landmark. Identify the epiglottis before advancing to the vallecula or deliberately lifting it directly.
Related terms: Vallecula; hyoepiglottic ligament; omega-shaped epiglottis; floppy epiglottis
Relevant errors: Missed anatomical structure recognition, overly deep insertion
Reference:

External laryngeal manipulation

MANOEUVRE

External manipulation of the larynx to improve glottic exposure or tube-delivery geometry.

Video relevance: Assess whether external manipulation improves the view or facilitates device passage without destabilising blade position.
Related terms: Glottic exposure; BURP manoeuvre; laryngoscopy
Relevant errors: Inadequate glottic exposure
Reference:

Failure to Engage Midline of Vallecula

PERFORMANCE ERROR

Blade tip fails to engage the median glossoepiglottic fold, resulting in inadequate epiglottic translation.

Video relevance: Assess whether the blade is centred in the vallecula before increasing lifting force.
Related terms: Median glossoepiglottic fold; vallecula; epiglottis
Relevant errors: Failure to engage midline of vallecula
Reference: Weingart et al. 2023; Bracey et al. 2026

First pass Success

OUTCOME

Successful tracheal intubation on the first intubation attempt.

Video relevance: Record separately from technical performance: a first-pass success may still contain correctable performance errors.
Related terms: Attempt; performance error; procedural outcome
Reference: Weingart et al. 2023; Bracey et al. 2026

Floppy Epiglottis

ANATOMICAL VARIANT

Epiglottis that prolapses posteriorly and may obscure the laryngeal inlet.

Video relevance: May require altered blade positioning or deliberate direct elevation when vallecular lifting does not expose the glottis.
Related terms: Epiglottis; Mac-as-Miller; Miller blade
Relevant errors: Missed anatomical structure recognition
Reference:

Foreign body

AIRWAY CONDITION ∘ VIDEO FINDING

Material within the upper airway that may obstruct airflow, obscure landmarks or impede blade and device passage.

Video relevance: Identify location and relationship to the laryngeal inlet before advancing the blade or tube.
Related terms: Airway obstruction; suction; removal device
Relevant errors: Missed anatomical structure recognition
Reference:

Glottis

ANATOMY

Opening between the vocal folds leading into the trachea.

Video relevance: The target for bougie or endotracheal tube passage; assess both view and delivery geometry rather than view alone.
Related terms: Vocal cords; arytenoid cartilage; subglottis
Relevant errors: Missed anatomical structure recognition; device delivery errors
Reference:

Hyoepiglottic ligament

ANATOMY

Ligament connecting the epiglottis to the hyoid bone; tension through this structure contributes to epiglottic elevation during vallecular lift.

Video relevance: Not normally visible directly, but its engagement helps explain why correct midline vallecular seating elevates the epiglottis.
Related terms: Vallecula; median glossoepiglottic fold; epiglottis
Relevant errors: Failure to engage midline of vallecula
Reference:

Hyperangulated Blade

EQUIPMENT

Sharply curved video laryngoscope blade designed for an indirect camera view.

Video relevance: Improves glottic visualisation without requiring direct line-of-sight alignment, but tube delivery usually requires a matching shaped stylet.
Related terms: Hyperangulated video laryngoscopy; rigid stylet
Relevant errors: HAVL performance errors
Reference: Bracey et al. 2026; doi:10.1016/j.ajem.2025.12.041

Hyperangulated video laryngoscopy

TECHNIQUE

Video laryngoscopy using a more acutely curved blade that provides an indirect glottic view and requires technique-specific microskills.

Video relevance: Blade geometry and indirect viewing alter insertion, vallecular engagement and especially tube delivery with a shaped rigid stylet.
Related terms: Hyperangulated blade; rigid stylet; video laryngoscopy
Relevant errors: Bracey HAVL taxonomy (20 performance errors)
Reference: Bracey et al. 2026; doi:10.1016/j.ajem.2025.12.041

Inadequate lifting force

PERFORMANCE ERROR

Blade tip is appropriately engaging the vallecula but insufficient lift produces inadequate glottic exposure.

Video relevance: Look for correct vallecular seating with limited epiglottic translation or an unnecessarily restricted glottic view.
Related terms: Vallecula; lifting force; glottic exposure
Relevant errors: Inadequate lifting force
Reference: Weingart et al. 2023; Bracey et al. 2026

Inadequate Suction

PERFORMANCE ERROR

Tube or bougie delivery is attempted despite inadequate visualisation from secretions, blood or debris and without sufficient suction.

Video relevance: Identify contamination that meaningfully obscures landmarks and whether suction was used before proceeding with device delivery.
Related terms: Suction; SALAD; blood; emesis; secretions
Relevant errors: Inadequate suction
Reference: Weingart et al. 2023; Bracey et al. 2026

Insertion off midline

PERFORMANCE ERROR

Blade tip is inserted lateral to the glottic structures and further advancement leads toward oesophageal visualisation.

Video relevance: Track whether the operator maintains midline orientation during blade advancement and recognises lateral landmarks before over-advancing.
Related terms: Midline insertion; structure recognition; oesophagus
Relevant errors: Insertion off midline
Reference: Weingart et al. 2023; doi:10.1016/j.ajem.2023.08.035

Lost vallecular seating

PERFORMANCE ERROR

Vallecular engagement is lost during the attempt, causing deterioration or loss of glottic visualisation.

Video relevance: Observe whether an initially good view worsens when the blade tip slips out of its effective vallecular position.
Related terms: Vallecula; blade seating; glottic exposure
Relevant errors: Lost seating in vallecula
Reference: Weingart et al. 2023

Mac-as-Miller

TECHNIQUE

Deliberate use of a curved Macintosh-style blade to directly elevate the epiglottis rather than seating the tip in the vallecula.

Video relevance: May be used intentionally as a rescue manoeuvre; accidental epiglottic override should be distinguished from deliberate technique.
Related terms: Macintosh blade; Miller blade; epiglottis; vallecula
Relevant errors: Overriding the epiglottis (HAVL when not used as rescue)
Reference: Weingart et al. 2023; Bracey et al. 2026

Macintosh Blade

EQUIPMENT

Curved laryngoscope blade designed to seat in the vallecula and indirectly elevate the epiglottis.

Video relevance: Correct midline seating and lifting direction are central to efficient glottic exposure.
Related terms: Vallecula; median glossoepiglottic fold; Mac-as-Miller
Relevant errors: Vallecular manipulation errors
Reference: Macintosh laryngoscope,

Median glossoepiglottic fold

ANATOMY

Midline mucosal fold connecting the tongue base to the epiglottis; a target for midline vallecular blade placement.

Video relevance: Engaging the midline fold helps centre the blade in the vallecula and translate the epiglottis during Macintosh-style laryngoscopy.
Related terms: Vallecula; hyoepiglottic ligament; vallecular engagement
Relevant errors: Failure to engage midline of vallecula
Reference: Weingart et al. 2023; doi:10.1016/j.ajem.2023.08.035

Miller Blade

EQUIPMENT

Straight laryngoscope blade commonly used to lift the epiglottis directly.

Video relevance: The blade tip is advanced beneath the epiglottis rather than seated in the vallecula.
Related terms: Epiglottis; Mac-as-Miller; straight blade
Reference: Miller laryngoscope

Missed Anatomical Structure Recognition

PERFORMANCE ERROR

Glottic structures are visible to the reviewer but are not recognised by the operator, who does not make an appropriate positional correction or attempt device passage.

Video relevance: Separate failure to recognise visible landmarks from off-midline or overly deep insertion that progresses toward the oesophagus.
Related terms: Structure recognition; epiglottis; glottis; vallecula
Relevant errors: Missed anatomical structure recognition
Reference: Weingart et al. 2023

Not Fully Seated in Vallecula

PERFORMANCE ERROR

Blade tip is midline in the vallecula but has not advanced sufficiently to translate the epiglottis.

Video relevance: Look for a centred blade with inadequate forward seating and limited epiglottic elevation.
Related terms: Vallecula; median glossoepiglottic fold; epiglottis
Relevant errors: Not fully seated in vallecula
Reference: Weingart et al. 2023; Bracey et al. 2026

Omega Epiglottis

ANATOMICAL VARIANT

Epiglottis with curled lateral margins producing an omega (Ω)-shaped appearance.

Video relevance: May narrow the visible laryngeal inlet or alter the approach to vallecular engagement.
Related terms: Epiglottis; floppy epiglottis
Reference:

Over-Rotated Insertion (Kovacs Sign)

PERFORMANCE ERROR

The glottis occupies more than half of the screen with anterior tracheal structures visible, creating poor geometry for device passage.

Video relevance: A very close glottic image may represent excessive blade rotation or depth rather than an optimal delivery position.
Related terms: Glottic exposure; blade depth; tube delivery
Relevant errors: Over-rotated insertion
Reference: Weingart et al. 2023

Overly Deep Insertion Leading to Oesophageal Visualization

PERFORMANCE ERROR

A midline insertion is advanced too rapidly or too far, overrunning glottic structures and reaching the oesophageal view.

Video relevance: Watch for skipped landmarks during advancement and whether withdrawal restores epiglottic or glottic anatomy.
Related terms: Structure recognition; epiglottis; oesophagus
Relevant errors: Overly deep insertion
Reference: Weingart et al. 2023

POGO

CLASSIFICATION

Percentage of glottic opening [POGO] score

Video relevance:
Related terms:
Relevant errors:
Reference: Levitan et al. 2002,

Posterior Impingement

COMPLICATION

ETT tip catches on arytenoids or posterior structures.

Video relevance:
Related terms:
Relevant errors:
Reference:

Premature camera withdrawal

PERFORMANCE ERROR

The laryngoscope is withdrawn before passage of the endotracheal tube through the glottis has been visually confirmed.

Video relevance: Maintain the camera view until tube passage is secure, including during bougie or stylet removal when relevant.
Related terms: Tube passage; vocal cords; bougie; stylet
Relevant errors: Premature withdrawal of camera
Reference: Weingart et al. 2023; Bracey et al. 2026

Rigid Stylet (e.g., GlideRite)

EQUIPMENT

Pre-shaped rigid stylet used to match the curvature of a hyperangulated laryngoscope blade.

Video relevance: Tube delivery depends on controlled rotation, release from anterior-ring hang-up and stable tube position during stylet withdrawal.
Related terms: Hyperangulated video laryngoscopy; hyperangulated blade; endotracheal tube
Relevant errors: Translation not rotation; anterior tracheal ring hang-up; dislodged ETT during stylet removal
Reference: Bracey et al. 2026

SALAD

MANOEUVRE

Suction-Assisted Laryngoscopy and Airway Decontamination: a technique for managing heavily contaminated airways during laryngoscopy.

Video relevance: Suction may lead blade insertion and can be positioned to provide ongoing clearance while laryngoscopy and tube delivery proceed.
Related terms: Suction; emesis; blood; contaminated airway
Relevant errors: Inadequate suction
Cases: Airway Case 001,
Reference: DuCanto, Serrano & Thompson 2017

Secretions in Airway

AIRWAY CONDITION ∘ VIDEO FINDING

Saliva, mucus or other secretions that obscure airway landmarks or the camera view.

Video relevance: Suction should restore landmark recognition before bougie or tube passage when visibility is impaired.
Related terms: Blood; emesis; suction; SALAD
Relevant errors: Inadequate suction
Reference: Weingart et al. 2023; doi:10.1016/j.ajem.2023.08.035

Standard Geometry Blade

EQUIPMENT

Video laryngoscope blade with Macintosh-like geometry.

Video relevance: Allows a familiar vallecular approach and may permit both direct and video-assisted viewing depending on the device.
Related terms: Standard-geometry video laryngoscopy; Macintosh blade
Relevant errors: SGVL performance errors
Reference: Weingart et al. 2023

Standard geometry video laryngoscopy (SGVL)

TECHNIQUE

Video laryngoscopy using a Macintosh-like blade geometry that can support screen-guided laryngoscopy and, in some devices, direct laryngoscopy.

Video relevance: Uses a distinct set of microskills centred on structure recognition, vallecular engagement and device delivery.
Related terms: Video laryngoscopy; Macintosh blade; bougie; direct laryngoscopy
Relevant errors: Weingart SGVL taxonomy (13 performance errors)
Reference: Weingart et al. 2023; doi:10.1016/j.ajem.2023.08.035

Stylet

EQUIPMENT

Rigid or semi-rigid insert placed inside an endotracheal tube to shape and control it during intubation.

Video relevance: The chosen curvature should match the laryngoscopy technique and permit controlled delivery through the glottis.
Related terms: Rigid stylet; endotracheal tube; hyperangulated video laryngoscopy
Relevant errors: Device delivery errors
Reference:

Subglottis

ANATOMY

Airway immediately below the vocal folds, extending toward the cricoid cartilage.

Video relevance: Visual passage of the tube beyond the cords confirms progression into the subglottic airway before camera withdrawal.
Related terms: Glottis; vocal cords; cricoid cartilage
Relevant errors: Premature withdrawal of camera
Reference:

Too much force in vallecula

PERFORMANCE ERROR

Excess pressure or over-insertion in the vallecula moves the epiglottis caudally and worsens glottic visualisation.

Video relevance: Recognise an iatrogenically worsened view caused by excessive blade pressure rather than insufficient lift.
Related terms: Vallecula; epiglottis; blade force
Relevant errors: Too much force in vallecula
Reference: Weingart et al. 2023; Bracey et al. 2026

Tube delivery issues

PERFORMANCE ERROR

Endotracheal tube passage is delayed or prevented by impingement on laryngeal structures, commonly an arytenoid.

Video relevance: Observe where the tube tip arrests and whether rotation or repositioning relieves the obstruction.
Related terms: Endotracheal tube; arytenoid cartilage; tube rotation
Relevant errors: Tube delivery issues
Reference: Weingart et al. 2023

Tube rotation

MANOEUVRE

Rotation of the endotracheal tube to redirect the tip and relieve impingement during passage.

Video relevance: Useful when the tube tip catches on arytenoid cartilage or other laryngeal structures.
Related terms: Posterior impingement; arytenoid cartilage; tube delivery
Relevant errors: Tube delivery issues
Reference: Airway Case 001; Weingart et al. 2023

Vallecula

ANATOMY

The depression between the base of the tongue and the epiglottis. During Macintosh-style laryngoscopy, appropriate placement of the blade tip within the vallecula permits indirect elevation of the epiglottis.

Video relevance: Identify the midline vallecula before applying lift. Incomplete, lateral or lost seating can impair glottic exposure.
Related terms: Median glossoepiglottic fold · Hyoepiglottic ligament · Vallecular engagement
Performance errors: Failure to engage midline · Not fully seated · Lost seating
Cases:
Reference: Weingart et al., 2023

Video Laryngoscopy (VL)

TECHNIQUE

Laryngoscopy using a camera-equipped blade that displays airway structures on a screen.

Video relevance: Provides a recordable view that supports procedural teaching, review and quality improvement.
Related terms: Standard-geometry video laryngoscopy, hyperangulated video laryngoscopy
Reference: Weingart et al. 2023; Bracey et al. 2026

Vocal folds

ANATOMY

Paired vocal folds forming the margins of the glottic opening.

Video relevance: Visualisation of the folds defines the glottic inlet and allows confirmation that the bougie or tube passes between them.
Related terms: Glottis; arytenoid cartilage; subglottis, vocal cords
Relevant errors: Missed anatomical structure recognition; tube delivery issues; premature withdrawal of camera
Reference:

Yentis–Lee

CLASSIFICATION

Video relevance:
Related terms:
Relevant errors:
Reference: Cormack-Lehane scoring system

References

Workshops and courses

Nelson B. Advanced Airway Management. Medmastery course

Video laryngoscopy library

Airway Glossary
Stepwise Approach to Video Laryngoscopy
Performance Errors in Video Laryngoscopy
How to Review a Laryngoscopy Video
Laryngoscopic Airway Anatomy
Airway Video Cases

FOAMed

Long N. Adult Intubation Checklist. LITFL
Long N. Paediatric Intubation Checklist. LITFL
Weingart S. EMCrit 176 – Updated EMCrit Rapid Sequence Intubation Checklist
Weingart S. EMCrit 300 – Airway Continuous Quality Improvement and the Resus Airway Bundle
Weingart S. EMCrit 360 – A Taxonomy of Key Performance Errors for Emergency Intubation (Primer)

Journal articles

Weingart SD, Barnicle RN, Janke A, Bhagwan SD, Tanzi M, McKenna PJ, Bracey A; Resuscitationists Research Group. A taxonomy of key performance errors for emergency intubation. Am J Emerg Med. 2023 Nov;73:137-144.
Bryan A, Feltes J, Sweetser PW, Winsten S, Hunter I, Yamane D. Hyperangulated video laryngoscopy in the emergency department: An analysis of errors and factors leading to prolonged apnea time. Am J Emerg Med. 2025 Sep;95:153-158.
Weingart SD et al. The Airway Lead and the Creation of a Comprehensive Emergency Airway Quality Program. J Emerg Med. 2025 May;72:104-111.
Bracey A, Lacy AJ, Weingart SD, Ata A, Giuliano AS, Lewis JC, Mantas J, Bayly B, Doyle M, Barnicle RN. A taxonomy of key performance errors associated with hyperangulated video laryngoscopy for emergency intubation. Am J Emerg Med. 2026 Mar;101:152-158.

Video Laryngoscopy
LIBRARY

Tim Friedmann

Dr. Tim Friedmann, MD is an Assistant Professor in the Department of Emergency Medicine at the Icahn School of Medicine at Mount Sinai. He is an Assistant Program Director for the residency program and works clinically at Mount Sinai Hospital and Elmhurst Hospital | Sinai EM |

Mike Cadogan

BA MA (Oxon) MBChB (Edin) FACEM FFSEM. Emergency physician, Sir Charles Gairdner Hospital. Passion for rugby, medical history, medical education, and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | On Call: Principles and Protocols 4e| Eponyms | Books | Horology