Andrew Pirotte

EM doc w/ airway on the brain + seeker of sustainability. Opinions are my own; TweetsNotMedicalAdvice.

[Airway of the Month @AirwayOTM]

May Airway of the Month:
https://t.co/pKmvr8ti4Z

the tube misses by a millimeter — but the problem may have started before tube passage.

This month: suboptimal VL view, arytenoid engagement, and the key reset:

Back up → suction → optimize laryngoscopy → reattempt.

#FOAMed #Airway #EmergencyMedicine

[Airway of the Month @AirwayOTM]

Visible cords ≠ Ready cords. 👀

April 2026 Airway of the Month is Here!

🔥 Burn airway, Soot-stained secretions, Big suction moment
🎯 Grade 1 view
🚦 But the cords are still moving

The move:
Get to the target.
Hover.
Wait if oxygenation allows.
Then pass deliberately.
View tells you WHERE.
Paralysis tells you WHEN.
🔗 https://t.co/1Dppu0AALj

[Airway of the Month @AirwayOTM]

The March 2026 Airway of the Month is Here!

https://t.co/3ITwbxQt9c

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

[Andrew Pirotte @Apirotte]

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

[Dr. Chacón-Lozsán F .'. @franciscojlk]

💉🩺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. https://t.co/KWUfUtAMyP

[Airway of the Month @AirwayOTM]

The January 2026 Airway of the Month is here!!

https://t.co/vaho3sxnJp

🍼🚑 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. 💪

[Airway of the Month @AirwayOTM]

🎉🎊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: 👇👇👇https://t.co/ZcR44svr6L

#FOAMed #AirwayOfTheMonth #EMed #PracticeMakesExcellent #AirwayManagement #medtwitter #airway

[Airway of the Month @AirwayOTM]

🎯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 @AirwayOTM]

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.

[Andrew Pirotte @Apirotte]

@AirwayOTM Articulating bougie or switch to hyperangulated pathway!

[Airway of the Month @AirwayOTM]

🚨 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 @AirwayOTM]

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: https://t.co/Z1E3y09VrU
https://t.co/6rQh6Yz0h2

[Airway of the Month @AirwayOTM]

🚨 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:

https://t.co/Q2oprDW4zT

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 ([email protected]) directly.

[Airway of the Month @AirwayOTM]

The July 2025 AoTM is here! Pediatrics, progressive laryngoscopy, and Miller as Mac (usually we see Mac as Miller...)!

https://t.co/gQXR2jjf52

Databases:
Video only: https://t.co/ldHjTpZekR……………………
Airway of the Month Series: https://t.co/WUKaMBndIK
Hypothetical… cases: https://t.co/wlYzZePV50……………………

@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 ([email protected]) directly.

[Airway of the Month @AirwayOTM]

The June 2025 Airway of the Month is Here!
🎥👀 “See it. Scope it. Secure it.” 👀🎥

https://t.co/18Y9LCIxu1

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:  https://t.co/ldHjTpZekR…………………… Airway of the Month Series: https://t.co/WUKaMBndIK Hypothetical… cases: https://t.co/wlYzZePV50……………………
@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 ([email protected]) directly.

[The Protected Airway Collaborative @ProtectedAirway]

We're building a movement. Check it out. #protecttheairway #meded #airwaytraining https://t.co/nZe8jiI7Wa

[Andrew Pirotte @Apirotte]

@ProtectedAirway Absolutely amazing work!!!

[Airway of the Month @AirwayOTM]

The May 2025 Airway of the Month is Here!

https://t.co/WPWrmo5KJu

"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: 
https://t.co/ldHjTpZekR…………………
Airway of the Month Series:
https://t.co/WUKaMBndIK
Hypothetical… cases:
https://t.co/wlYzZePV50…………………

@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 ([email protected]) directly.

[Airway of the Month @AirwayOTM]

The April 2025 Airway of the Month is here!
https://t.co/yhBLtGlTj3

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 ([email protected]) directly.

Databases:
Video only:  https://t.co/ldHjTpZekR………………
Airway of the Month Series: https://t.co/WUKaMBndIK
Hypothetical… cases: https://t.co/wlYzZePV50………………

@jducanto@AirwayMxAcademy@dastrainees@ProtectedAirway@JohnCSakles@AirwayOnDemand@TBayEDguy@Apirotte@TriplethreatEM@FoundationsEM@AirwayOTM@KansasEM@EmoryEM 📷

[Airway of the Month @AirwayOTM]

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

https://t.co/saH6tzpD2L

Databases: Video only:  https://t.co/ldHjTpZekR………… Airway of the Month Series: https://t.co/0tBF9kdX3Q cases: https://t.co/wlYzZePV50…………
@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 ([email protected]) directly.