ResusX:Podcast

In today’s episode, we’re diving into a game-changing question: Can swapping fentanyl for remifentanil help ventilated ICU patients breathe on their own sooner, and with fewer complications like delirium? This fresh meta-analysis pulls data from multiple studies and suggests remifentanil could reduce ventilation time by up to 21 hours in some cases and may lower the risk of ICU-related delirium. W...

When it comes to oxygen therapy for critically ill, ventilated patients, more isn’t always better—but is less the answer? The UK-ROX trial set out to find out, tracking over 16,000 ICU patients across 97 hospitals to test if targeting lower oxygen saturation (SpO₂ ~90%) could improve survival rates. Spoiler alert: it didn’t. In this episode, we unpack why conservative oxygen therapy didn’t signifi...

Can Ultrasound Save Lives in Septic Shock? Septic shock is a race against time, and now, there's a powerful new tool at the bedside. A recent meta-analysis of nearly 4,000 ICU patients reveals that using point-of-care echocardiography (POC echo) to guide treatment slashes mortality rates by up to 18%. In this episode, we dive into how this quick bedside ultrasound isn't just helping docs see more—...

Restarting the heart is only half the fight—what comes next could make or break recovery. In this episode, we dive into the high-stakes world of post-resuscitation shock and a game-changing debate: epinephrine or norepinephrine? New data from over 3,400 patients suggests norepi might dramatically cut the risk of a second cardiac arrest—by 63%! That’s huge. But does it impact survival? Brain functi...

In this podcast episode, resus pros Swami, Mike, and Steve go head-to-head on the hottest controversies in emergency and critical care medicine. From the great bougie vs. stylet debate to the ethics of prehospital whole blood and the eternal neuro RSI paralytic showdown — nothing is off-limits. We talk: Bougie every time? Or nah? Should every ambulance carry blood? Succinylcholine vs. rocuronium f...

In out-of-hospital cardiac arrest, time is life, and the race to restore circulation is on. But what's faster or better: intravenous (IV) or intraosseous (IO) access? A new study puts this long-standing debate to the test—and the results may surprise you. In this episode, we break down the findings from nearly 1,500 cardiac arrest cases. Spoiler: the data suggests it's not how you get access that...

You’ve given fluids, started pressors, and checked all the boxes… but your patient isn’t improving. Now what? In this episode of Talking Shift, Dr. Haney Mallemat sits down with Dr. Anand "Swami" Swaminathan to break down one of the most powerful tools in emergency medicine and critical care: The Cognitive Pause . When the usual approach fails, it's time to stop, reassess, and challenge your assum...

We talk a lot about shockable rhythms—but what about asystole? This episode dives into a global meta-analysis of over 540,000 OHCA cases and the results are rough: just 1.5% survive when asystole is the first rhythm. We break down what this means for EMS, why TOR guidelines matter more than ever, and how we need to rethink the resus game when the rhythm is flatline from the start. Based on the stu...

In this episode, we’re diving into the latest research on hydrocortisone use in critically ill patients with severe community-acquired pneumonia (CAP). It's a treatment many clinicians reach for—but does it actually make a difference in survival? According to a new study, the answer might not be as strong as we hoped. While hydrocortisone may help shorten the duration of vasopressor support, it do...

Welcome to the Morning Report —your new go-to for raw, unfiltered clinical talk. In this first episode, Dr. Haney Mallemat teams up with legends Dr. Steve Haywood, Dr. Anand Swaminathan, and Mike Abernethy to break down a wild PE case that spirals from EMS to the ED. Here’s what’s coming in hot: ⚡ Pressor stacking IRL: What, when, how? ⚡ Inhaled nitro… hero move or hype? ⚡ TPA—push it fast or s...

In this episode, we dive into a recent open-label randomized controlled trial on the adjuvant use of midodrine in patients with septic shock . Researchers investigated whether adding midodrine to norepinephrine therapy could improve survival rates. The findings? Midodrine reduced the need for vasopressors , but did not significantly lower 28-day in-hospital mortality or shorten hospital stays. Whi...

In this episode, we look at the latest study on haloperidol for ICU delirium from the New England Journal of Medicine. While haloperidol didn’t increase days alive and out of the hospital, it did show a lower risk of death—a finding that could influence how we approach treatment. Tune in for a quick breakdown of what this means for ICU care and future directions in managing delirium.

In this episode, we break down the ANNEXA-I randomized trial, which looked at patients with factor Xa inhibitor-associated intracerebral hemorrhage. The study compared andexanet alfa, a targeted reversal agent, with usual care (mainly prothrombin complex concentrate). The results? Andexanet showed better hemostatic control and more effectively reduced hematoma expansion (67% vs. 53.1%), with a 94....

In this episode of 'Talking Shift,' the host welcomes Dr. Chris Doty, an important figure in emergency medicine, to discuss his journey and the current state of the specialty. Dr. Doty reflects on a crisis from two years ago where a significant number of emergency medicine residency spots went unmatched, but more recent data shows improvement. They explore changes in residency program requirements...

In this inaugural episode of 'Talking Shift,' we dive deep into the complex world of managing refractory hypoxemia and ventilator settings with special guest Nick Ghionne, aka @PulmToilet. Explore strategies for optimizing ventilator parameters, understanding the role of driving pressure, effective use of PEEP, and the critical benefits of proning. We also discuss the nuanced use of adjuncts like...

Let’s talk about saving two hearts at once this Valentine's Day. Get 20% off and access the full ResusX: ReUnion conference—featuring this episode and over 60 expert-led lectures available for lifetime replay: Click Here . In this episode, Dr. Shaila Quazi demystifies resuscitative hysterotomy, the life-saving procedure formerly known as the perimortem C-section. Learn when to act, how to assemble...

Is dual sequential defibrillation (DSED) the key to saving shock-refractory VFib patients? Get 20% off and access the full ResusX: ReUnion conference—featuring this episode and over 60 expert-led lectures available for lifetime replay: Click Here . In this episode, Dr. Tarlan Hedayati takes a deep dive into the history, science, and best practices for dual defibrillation. She explains why vector c...

What should you really be looking for in a post-arrest ECG? In this episode, Dr. Amal Mattu unpacks the hidden dangers of misinterpreting early post-resuscitation ECGs and how making the wrong call on VTach mimics could be fatal. Learn when to repeat the ECG, when to send patients for cath, and how to recognize life-threatening hyperkalemia or sodium channel toxicity masquerading as VTach . Packed...

What happens when you need to intubate a patient, but their airway is filled with vomit, blood, or thick secretions? In this episode, Dr. Shyam Murali takes us through the SALAD (Suction-Assisted Laryngoscopy and Airway Decontamination) technique, a life-saving approach to managing contaminated airways. Learn how to optimize suction, clear the airway, and improve intubation success with game-chang...

How do you manage a patient with status epilepticus when every second counts? In this episode, Dr. Derek Isenberg outlines a step-by-step algorithm for seizure management, emphasizing high-dose benzodiazepines, evidence-based second-line agents, and the growing role of ketamine for refractory seizures. Learn why time is critical, how to identify non-convulsive status with continuous EEG, and how a...

Is it safe to administer 3% hypertonic saline through a peripheral IV during a neurologic emergency? In this episode, Dr. Salim Rezaie breaks down the evidence and challenges the need for central lines in time-sensitive cases. Learn why bolusing hypertonic saline through a peripheral line can reduce intracranial pressure more effectively while avoiding delays and central line complications. Packed...

What is auto-PEEP, and why can it lead to life-threatening complications in ventilated patients? In this episode, Dr. Anozie breaks down the physiology behind auto-PEEP, its dangerous effects like dynamic hyperinflation and cardiovascular instability, and how to spot its subtle signs on ventilator waveforms. With a focus on practical solutions, from adjusting ventilator settings to optimizing PEEP...

What do you do when a patient in shock doesn’t respond to vasopressors? In this episode, Dr. Anand Swaminathan dives into the art of the ‘cognitive pause’—a crucial step in troubleshooting refractory shock. From acidosis and hypothyroidism to occult bleeding and adrenal insufficiency, he outlines a systematic approach to uncover hidden causes that could change the course of care. If you’re ready t...

Looking to master the nuances of Airway Pressure Release Ventilation (APRV)? In this episode, Dr. Steven Haywood simplifies APRV, from setup to weaning, while uncovering the secrets to maximizing lung recruitment and oxygenation. Whether you’re optimizing care for ARDS patients or learning to avoid pitfalls like overdistension or lost ground during ventilator disconnects, this talk offers actionab...

Handling an unruly trauma patient is one of the greatest challenges in emergency medicine—but it doesn’t have to be. If you’re ready to master resuscitation and learn cutting-edge emergency techniques, get 20% off the ResusX: ReUnion conference—featuring over 60 transformative talks available for lifetime replay: Click Here . In this episode, Dr. Fred Gmora shares his expert insights into managing...