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What happens after the pulse comes back?
In this episode, we dive into one of the most practical — and controversial — questions in post-cardiac arrest care: Which vasopressor should clinicians reach for first after ROSC? Epinephrine or norepinephrine?
Joining me is Dr. Nathalie Van Der Rijst, pulmonary and critical care physician from Philadelphia, for an energetic and evidence-driven debate exploring the physiology, pharmacology, real-world logistics, and limitations of current research surrounding post-cardiac arrest hypotension.
Together, we tackle:
Why post-ROSC hypotension remains so deadly
The physiologic argument for epinephrine vs. norepinephrine
Myocardial stunning, vasoplegia, and recurrent arrest
What observational studies and limited randomized data actually show
Why prehospital realities matter when choosing vasopressors
The challenges EMS agencies face with pumps, medications, and resources
How ICU and emergency medicine perspectives sometimes differ — and where they align
Along the way, expect spirited Pittsburgh vs. Philadelphia banter, ICU vs. ER jabs, practical resuscitation pearls, and an honest discussion about the gap between ideal medicine and real-world medicine.
Whether you work in EMS, emergency medicine, critical care, anesthesia, or hospital medicine, this conversation will challenge the way you think about post-cardiac arrest shock and the critical minutes after ROSC.
As always, thank you for listening, sharing feedback, and helping grow this community focused on resuscitation, emergency medicine, critical care, and public health.
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