ResusX:Podcast

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 matters—it's that you start resuscitation fast. Tune in to find out why this could streamline emergency protocols and change how we approach prehospital care. Study: Intraosseous vs. Intravenous Access during Out-of-hospital Cardiac Arrest by Vallentin et al., Resuscitation Hit play for critical insights, clinical takeaways, and what it means for front-line care. #Resuscitation #CardiacArrest #EmergencyMedicine #Paramedics #IVaccess #IOaccess #PrehospitalCare #ROSC #Podcast

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 assumptions before spiraling deeper into the resuscitation rabbit hole. They unpack: When to switch from reflexive to reflective thinking Clues you’re treating the wrong diagnosis How to avoid cognitive traps in septic shock Swami’s go-to checklist during a pause (think: acidosis, adrenal, hypothyroid, occult bleeding, anaphylaxis, calcium, and more) Real-life cases that highlight the importance of a well-timed pause Why Hickam's Dictum > Occam’s Razor in the ED Whether you're new to the resus scene or deep in the ICU trenches, this episode will sharpen your thinking and change how you approach critically ill patients. Listen now and give your clinical brain the reboot it needs.

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 study by Dwivedi et al. in Resuscitation: Incidence and outcomes of out-of-hospital cardiac arrest from initial asystole.

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 slow roll? ⚡ Why intubating a crashing PE can be deadly (and how to avoid it) And we don’t stop there—we’re throwing down some 🔥 rapid-fire takes: Bougie every time or chill out already? Is EMS ready for blood in the field? Roc vs. Succ—who you reppin’ for neuro RSI? What actually works for intubation training in 2025? This episode is fast, fun, a little chaotic—in the best way—and packed with legit pearls for your next resus. 🎟️ Want more? Meet us at ResusX this fall → ResusX.com

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 doesn’t significantly reduce mortality. We break down what this means for clinical practice, patient care, and the future of treating severe pneumonia. Tune in for key takeaways and why more research is still needed before we rewrite the playbook.

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. While midodrine showed some impact on reducing vasopressor requirements, its effect on overall outcomes remains limited. Tune in for a quick breakdown of what this means for ICU practice and managing septic shock patients.

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 94.5% median drop in anti-factor Xa activity. But the benefit came with a trade-off—higher rates of thrombotic events, particularly ischemic stroke. We dive into the clinical implications of these findings and what they mean for balancing bleeding control with thrombotic risk. Whether you're managing ICH cases or staying updated on anticoagulation reversal strategies, this one’s for you.

Dr. Chris Doty, an emergency medicine physician and former program director, shares his insights on the recent trends in the specialty. He discusses the aftermath of a residency crisis and the notable improvement in matching spots. The conversation dives into the debate of residency lengths, the impact of burnout exacerbated by the pandemic, and the necessity for systemic changes in medical education. Doty also highlights the evolving landscape of fellowships and the importance of choosing the right residency to ensure a fulfilling career.

Join critical care expert Nick Ghionne, also known as @PulmToilet, as he delves into the complex management of refractory hypoxemia. He shares transformative strategies for optimizing ventilator settings, emphasizing the importance of driving pressure and the effective use of PEEP. Nick highlights the life-saving role of proning in ARDS and discusses the nuanced application of adjunct therapies like nitric oxide. Tune in for practical tips that can enhance patient outcomes in critical care!