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.
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40:26
Incidence and outcomes of out-of-hospital cardiac arrest from initial asystole: A systematic review and meta-analysis
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.
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6:14
Effect of hydrocortisone on mortality in patients with severe community-acquired pneumonia
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.
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7:54
Morning Report: Episode 1
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
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58:01
Efficacy of adjuvant use of midodrine in patients with septic shock: An open label randomized controlled trial
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.
Welcome to the ResusX:Podcast. Each episode features an amazing talk from the ResusX conference. This is a podcast dedicated to your sickest patients, and it'll all FOAMed. For more great content including our monthly grand rounds, newsletters and more go to www.ResusX.com now.
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