ResusX:Podcast A Cognitive Pause
19 snips
Jan 17, 2025 
Dr. Anand Swaminathan, an emergency physician specializing in resuscitation, shares his expertise on tackling refractory shock. He emphasizes the importance of a 'cognitive pause' to reassess treatment when patients don't respond to vasopressors. The discussion delves into potential hidden causes like acidosis, hypothyroidism, and occult bleeding that can hinder effective care. Through a systematic approach, Dr. Swaminathan advocates for thorough evaluations, transforming how healthcare providers address these complex cases.
AI Snips
Chapters
Transcript
Episode notes
Cognitive Pause in Shock
- Resist adding a second vasopressor immediately if the first isn't working.
- Pause, analyze the situation, and consider underlying causes for the lack of response.
Addressing Acidosis
- Check for acidosis, a common issue in shock, which reduces vasopressor effectiveness.
- Consider isotonic bicarb as a resuscitation fluid, especially with low bicarbonate levels.
Managing Hypothyroidism
- Consider hypothyroidism, especially with low temperature, heart rate, blood pressure, and finger stick glucose ('pan lows').
- Treat empirically with T4, possibly with a small amount of T3 for faster action.