Andrew Pirotte

The March 2026 Airway of the Month is Here! kumc.hosted.panopto.com/Panopto/Pages/… Rare pediatric arrest airway. CPR ongoing. Two openings in frame. Only one gets the tube. 3 reminders from this case: • Don’t intubate a dark hole — intubate landmarks • Re-center before passing plastic • Keep the view through stylet removal and confirmation

@franciscojlk @mac_eden Great work, great message. Optimized airway management is skillful resuscitation.

💉🩺Rapid sequence intubation in 2026: we are no longer “protecting the airway.” We are managing physiology under extreme stress. The latest evidence challenges one of the oldest dogmas in critical care. RSI was designed to prevent aspiration. But today, the real enemy is often hypoxemia and cardiovascular collapse. 1. Aspiration is no longer the central problem For decades, RSI was built around one fear: aspiration. But emerging data suggest: RSI may not significantly reduce aspiration It may increase hypoxemia and hemodynamic instability The paradigm is shifting: 👉 From aspiration avoidance → to physiologic optimization 2. First-pass success is everything Every additional attempt increases: Hypoxia Hemodynamic collapse Mortality Modern RSI is built around one goal: Get it right the first time. That means: Videolaryngoscopy first-line Stylet routinely Team choreography, not improvisation 3. Preoxygenation is now a therapeutic intervention Not just a step—a determinant of survival NIV > face mask HFNO as adjunct Semi-upright positioning And one key shift: 👉 Gentle ventilation is no longer taboo Done correctly, it reduces hypoxemia without increasing aspiration risk. 4. Hemodynamics matter more than ever Up to 40–50% of patients experience peri-intubation instability. The modern approach: Avoid propofol in unstable patients Favor etomidate or ketamine Consider prophylactic vasopressors Fluid loading? Not routinely beneficial. 5. Cricoid pressure: from dogma to doubt No clear benefit in preventing aspiration May worsen laryngoscopy and ventilation Current thinking: 👉 Use selectively, or not at all 6. RSI is no longer a rigid protocol It is now: Patient-specific Physiology-driven Team-dependent With tools like: Gastric ultrasound POCUS-guided decisions Structured airway protocols 7. The real determinant of success: human factors Preparation, communication, and coordination matter as much as drugs. Because in critical care: The airway is not just anatomy. It is a moment of systemic vulnerability. 🤓Final message RSI has evolved: From speed → to precision From protocol → to physiology From individual skill → to team performance And ultimately: The goal is no longer just to intubate. It is to intubate without killing the patient. 📃Reference Boulos NM et al. Anaesth Crit Care Pain Med. 2026. doi.org/10.1016/j.accp…

The January 2026 Airway of the Month is here!! kumc.hosted.panopto.com/Panopto/Pages/… 🍼🚑 Infant intubation isn’t won with fancy gadgets—it’s won before the tube moves. 3 quick reminders from a 9-month arrest clip 👇 🧯 Suction = step 1 (wet airway? park it and clear as you lift) 🪝 Lift, don’t pin (vallecula or under the epiglottis—stop “closing the door” 🚪) 🎯 No target, no tube (don’t “fish” with a styletted ETT) ⏱️ Time-box attempts. 🫁 BVM/SGA early if the view isn’t there. Back to basics > more gadgets. 💪

🎉🎊The December 2025 Airway of the Month is Here!🎊🎉 👏Huge Thanks to Dr. Reba Hodge (EM/Crit Care) for Her Excellent Teaching!!! 👩‍🏫🥇 💓🛑Bloody arrest airway. 💓🫁⚡️CPR ongoing, black material on the tongue, 🩸camera full of blood. 🛟What actually saves this tube? 🫵Parked DuCanto, double suction, and a bougie you’ve practiced with before the crisis. Full Airway of the Month case: 👇👇👇kumc.hosted.panopto.com/Panopto/Pages/… #FOAMed #AirwayOfTheMonth #EMed #PracticeMakesExcellent #AirwayManagement #medtwitter #airway

🎯November AOTM zeroes in on the moves that actually matter: 🏗️build a straight lane, 🛑stop→suction→proceed, 🌀rotate to pass (don’t force)—plus the pivot triggers I use. Dropping soon (like, it's 🔥) #FOAMed #EMTwitter #Airway

Airway of the Month — October 2025 Theme: Fail fast, oxygenate always. You’re 45 seconds in. Cords hiding. SpO₂ drifting. And your brain whispers: “Maybe if I just keep trying…” No! Abort. Readjust. Try something else. Oxygen over ego.

@AirwayOTM Articulating bougie or switch to hyperangulated pathway!

Your move: In a similar view, do you retry standard bougie, switch to articulating bougie, or pivot to SGA? Drop your approach ⬇️ Full case + VR lobby for context: bit.ly/September2025A… bit.ly/VR_September_2…

🚨 Airway of the Month — September 🚨 Bougie fails… but an articulating bougie saves the day. What’s your Plan B when first‑pass fails? (1 line answer pls) #FOAMed #AirwayManagement

🚨 Airway of the Month — September 🚨 We’re trying something new: an interactive VR airway experience you can explore + a focused case video. 👇 Check it out 👇 🕶️ VR/360° lobby with hotspots for checklists, vent setup, and Plan B/C pathways: bit.ly/VR_September_2… Why this matters: ✔️ Reinforces airway pearls in <10 minutes ✔️ Interactive checklists & algorithms ✔️ Teaching Videos for BVM and Suction Setup ✔️ Works on desktop, phone, or VR headset #AirwayManagement #FOAMed #EmergencyMedicine #MedEd #Simulation #VRinMedicine @emcrit @srrezaie @emrap_tweets @SAEM @ACEPNow @ACEP @AAEMinfo @EMRA_ACC @EMRAorg @jducanto @AirwayMxAcademy @dastrainees @ProtectedAirway @JohnCSakles @AirwayOnDemand @TBayEDguy @Apirotte @TriplethreatEM @FoundationsEM @AirwayOTM @KansasEM @EmoryEM @TTCmed @GlideScopeVL @KARLSTORZUK @AmbuEurope @VerathonInc (GlideScope) @KarlStorzEndo (C-MAC) @AmbuInc (King Vision, aScope) @Intersurgical @TeleflexInc (LMAs, Arrow) @CookMedicalUS (airway exchange / cric kits) @VyaireMed Disclaimer: This database is for your information and education only. It is intended solely for use by medical providers seeking to further understanding of airway management. All patient identifying information has been removed from the videos; however, if you believe patient information was inadvertently included or other concerns arise during your review, please email Dr. Andrew Pirotte (apirotte@kumc.edu) directly.

The July 2025 AoTM is here! Pediatrics, progressive laryngoscopy, and Miller as Mac (usually we see Mac as Miller...)! bit.ly/July2025AOTM Databases: Video only: bit.ly/Airway_Video_D……………………… Airway of the Month Series: bit.ly/AOTM_Database Hypothetical… cases: bit.ly/Hypothetical_C……………………… @jducanto @AirwayMxAcademy @dastrainees @ProtectedAirway @JohnCSakles @AirwayOnDemand @TBayEDguy @Apirotte @TriplethreatEM @FoundationsEM @AirwayOTM @KansasEM @EmoryEM Disclaimer: This database is for your information and education only. It is intended solely for use by medical providers seeking to further understanding of airway management. All patient identifying information has been removed from the videos; however, if you believe patient information was inadvertently included or other concerns arise during your review, please email Dr. Andrew Pirotte (apirotte@kumc.edu) directly.

The June 2025 Airway of the Month is Here! 🎥👀 “See it. Scope it. Secure it.” 👀🎥 bit.ly/2025_06_June_2… Bimodal! Double Vision – Twice the Tools, Half the Trouble 1. Scope Bros Unite! VL gives you the big picture. Bronchoscope says, “Hold my fiberoptic” and dives in. 2. Cannulate Like a Gentle Ninja The bronchoscope is the sneak attack. Thread the cords without the drama. 3. Placement You Can Brag About ET Tube goes in while both scopes are cheering you on. You don’t hope it’s in the trachea—you watched the whole show in 4K. Databases: Video only:  bit.ly/Airway_Video_D……………………… Airway of the Month Series: bit.ly/AOTM_Database Hypothetical… cases: bit.ly/Hypothetical_C……………………… @jducanto @AirwayMxAcademy @dastrainees @ProtectedAirway @JohnCSakles @AirwayOnDemand @TBayEDguy @Apirotte @TriplethreatEM @FoundationsEM @AirwayOTM @KansasEM @EmoryEM Disclaimer: This database is for your information and education only. It is intended solely for use by medical providers seeking to further understanding of airway management.  All patient identifying information has been removed from the videos; however, if you believe patient information was inadvertently included or other concerns arise during your review, please email Dr. Andrew Pirotte (apirotte@kumc.edu) directly.

We're building a movement. Check it out. #protecttheairway #meded #airwaytraining theprotectedairway.com/2025/05/26/the…

@ProtectedAirway Absolutely amazing work!!!

The May 2025 Airway of the Month is Here! bit.ly/2025MayAOTM "Mist"-ified by a foggy airway? Does your glottis view during CPR disappear faster than your coffee on a Night Shift? You have more Blades than a Swiss Army Knife! Which blade is the best during a code? Click the link above to learn more! Databases: Video only:  bit.ly/Airway_Video_D…………………… Airway of the Month Series: bit.ly/AOTM_Database Hypothetical… cases: bit.ly/Hypothetical_C…………………… @jducanto @AirwayMxAcademy @dastrainees @ProtectedAirway @JohnCSakles @AirwayOnDemand @TBayEDguy @Apirotte @TriplethreatEM @FoundationsEM @AirwayOTM @KansasEM @EmoryEM 📷 Disclaimer: This database is for your information and education only. It is intended solely for use by medical providers seeking to further understanding of airway management.  All patient identifying information has been removed from the videos; however, if you believe patient information was inadvertently included or other concerns arise during your review, please email Dr. Andrew Pirotte (apirotte@kumc.edu) directly.

The April 2025 Airway of the Month is here! bit.ly/April_2025_AOTM Pediatrics + pediatric bougie. 1. Know your Equipment 2. Placement of the Miller 3. Secretion Management with Suctioning Please Share in Comments: What is One Piece of Advice You wish you knew sooner about the the Pediatric Airway. Pop Quiz: What is the Smallest ET Tube that a Peds Bougie can Pass through? Disclaimer: This database is for your information and education only. It is intended solely for use by medical providers seeking to further understanding of airway management.  All patient identifying information has been removed from the videos; however, if you believe patient information was inadvertently included or other concerns arise during your review, please email Dr. Andrew Pirotte (apirotte@kumc.edu) directly. Databases: Video only:  bit.ly/Airway_Video_D………………… Airway of the Month Series: bit.ly/AOTM_Database Hypothetical… cases: bit.ly/Hypothetical_C………………… @jducanto@AirwayMxAcademy@dastrainees@ProtectedAirway@JohnCSakles@AirwayOnDemand@TBayEDguy@Apirotte@TriplethreatEM@FoundationsEM@AirwayOTM@KansasEM@EmoryEM 📷

Happy Spring Break! The March 2025 Airway of the Month is here! Scissor and Sweep, the key to the Airway! 1: Scissor: Optimizing Mandible Displacement 2: Sweep: Managing the Tongue bit.ly/March2025AOTM Databases: Video only:  bit.ly/Airway_Video_D…………… Airway of the Month Series: bit.ly/AOTM_DatabaseH… cases: bit.ly/Hypothetical_C…………… @jducanto @AirwayMxAcademy @dastrainees @ProtectedAirway @JohnCSakles @AirwayOnDemand @TBayEDguy @Apirotte @TriplethreatEM @FoundationsEM @AirwayOTM @KansasEM @EmoryEM Disclaimer: This database is for your information and education only. It is intended solely for use by medical providers seeking to further understanding of airway management.  All patient identifying information has been removed from the videos; however, if you believe patient information was inadvertently included or other concerns arise during your review, please email Dr. Andrew Pirotte (apirotte@kumc.edu) directly.

Happy SuperBowl Sunday! The February 2025 Airway of the Month is Here! Glottis or Esophagus? 1: Progressive Laryngoscopy 2: Which Hole is it? Glottis or Esophagus? 3: Stylet or Bougie? bit.ly/2025-Feb_Fonda… Go Chiefs! Databases: Video only:  bit.ly/Airway_Video_D………… Airway of the Month Series: bit.ly/AOTM_Database Hypothetical cases: bit.ly/Hypothetical_C………… @jducanto @AirwayMxAcademy @dastrainees @ProtectedAirway @JohnCSakles @AirwayOnDemand @TBayEDguy @Apirotte @TriplethreatEM @FoundationsEM @AirwayOTM Disclaimer: This database is for your information and education only. It is intended solely for use by medical providers seeking to further understanding of airway management.  All patient identifying information has been removed from the videos; however, if you believe patient information was inadvertently included or other concerns arise during your review, please email Dr. Andrew Pirotte (apirotte@kumc.edu) directly.

@AirwayOTM @AirwayMxAcademy @AirwayMxAcademy @ProtectedAirway @dasresidents @JohnCSakles @AirwayOnDemand @airwayGladiator @jducanto @KansasEM

The January 2025 Airway Of the Month is Here! bit.ly/2025JanFoundat… Large Amounts of Coffee Ground Emesis Discussion of: 1. Proper Parked Suction/SALAD Technique 2. How to Manage Tongue, Blade Seating, and Suction Catheter to Optimize ET Tube Passage 3. Review of SEAS: Sequential Exchange of Airway Stylets Databases: Video only:  bit.ly/Airway_Video_D……… Airway of the Month Series: bit.ly/AOTM_Database Hypothetical cases: bit.ly/Hypothetical_C……… Disclaimer: This database is for your information and education only. It is intended solely for use by medical providers seeking to further understanding of airway management.  All patient identifying information has been removed from the videos; however, if you believe patient information was inadvertently included or other concerns arise during your review, please email Dr. Andrew Pirotte (apirotte@kumc.edu) directly. @jducanto @AirwayMxAcademy @dastrainees @ProtectedAirway @JohnCSakles @AirwayOnDemand @TBayEDguy @Apirotte @TriplethreatEM