ResusX:Podcast

When seconds count and precision matters—like during surgery—getting accurate, continuous blood pressure readings is critical. That’s where radial artery cannulation comes in. But while traditional methods rely on “feeling the pulse,” they’re not always reliable, especially in tough cases. Enter a game-changing technique: ultrasound-guided Dynamic Needle Tip Positioning (DNTP). In this episode, we dive into a powerful new study that compares old-school palpation to DNTP and the results are stunning: an 88.5% first-pass success rate, fewer attempts, less time, and reduced equipment use with the ultrasound approach. We explore why this matters for patient safety, comfort, and clinical efficiency—and how this could redefine arterial cannulation in the OR. Could this be the new gold standard for arterial access? Tune in and find out. Read the full study: "Palpation versus Ultrasound-Guided Dynamic Needle Tip Positioning Technique for Radial Artery Cannulation" by Sujan Dhakal et al. in Annals of Cardiac Anaesthesia.

When someone is critically ill, whether battling sepsis, ARDS, or severe pneumonia, corticosteroids have long been a debated topic. A massive new meta-analysis pooling data from over 10,000 ICU patients finally brings clarity. The headline: early, low-dose, prolonged steroid therapy cuts short-term mortality by roughly 15%, slashes ICU stays by 2 days, reduces time on ventilators by over 4 days, and boosts ventilator-free days—all without increasing infection or bleeding risks. Sure, there’s a slight uptick in hyperglycemia, but that’s a small price for improved survival and recovery  What does this mean for frontline clinicians? Think “early, gentle, and sustained.” Start steroids within the first 72 hours, keep them on for at least a week, and tailor doses to lower than 400 mg of hydrocortisone per day. Most surprisingly, even septic shock patients benefit most when hydrocortisone is paired with fludrocortisone Want to see the full picture? Check out the study: “Efficacy and safety of corticosteroids in critically ill patients” by Lei Cao et al. in BMC Anesthesiology (July 2025).

When seconds count in the ICU, the IV fluid you choose could literally make or break a patient’s recovery. In this episode, we’re unpacking one of the biggest debates in critical care: balanced crystalloids vs. normal saline. A massive new meta-analysis of over 35,000 patients drops a game-changing truth—your fluid choice must depend on whether the patient has a traumatic brain injury (TBI). Balanced solutions may lower mortality in most critically ill patients, but for those with TBI, they could actually do harm. Tune in to hear how this data is flipping standard practice on its head and pushing the ICU world toward smarter, personalized resuscitation. Want to dive deeper? Check out the full study “Effect of Treatment With Balanced Crystalloids Versus Normal Saline on the Mortality of Critically Ill Patients With and Without Traumatic Brain Injury” by José C. Diz et al. in Critical Care and Resuscitation.

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. While the evidence is still growing and more rigorous trials are needed, the findings raise big questions about how we manage pain and recovery in critical care. Tune in for key takeaways, clinical implications, and what this could mean for the future of ICU sedation. Want to go deeper? Read the full study: "Comparative efficacy of remifentanil and fentanyl in mechanically ventilated ICU patients: a systematic review and meta-analysis on ventilation duration and delirium incidence" by Hiromu Okano et al. in Journal of Anesthesia, Analgesia and Critical Care.

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 significantly impact 90-day mortality—and what that means for frontline ICU care today. With no meaningful differences in mortality, ICU stays, or days free from organ support, the results suggest that “usual care” oxygen strategies may already be doing the job. Key takeaways: • Conservative O₂ therapy didn’t improve survival • 90-day mortality nearly identical across groups • Usual care remains a safe and effective standard Breathe easy—this episode cuts through the noise and gives you the real clinical takeaways. Want to dig deeper? Check out the full study: "Conservative Oxygen Therapy in Mechanically Ventilated Critically Ill Adult Patients" by Daniel S. Martin et al., published in JAMA.

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—it’s changing decisions, improving outcomes, and getting organs back on track faster. From better inotropic support to quicker lactate clearance, POC echo might just be the new game-changer in critical care. Tune in and learn how this visual tool could be the lifeline in septic shock. Want the full breakdown? Check out “The association between integrating echocardiography use in the management of septic shock patients and outcomes in the intensive care unit” by Keith Killu et al., in the Journal of Ultrasound (2025). #CriticalCare #SepticShock #POCecho #UltrasoundInICU #ResusTalks #ICUpodcast #EmergencyMedicine #SepsisAwareness

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 function? Tune in as we unpack the numbers, the controversy, and what it all means for your resus playbook. Want more details? Check out the full study "Norepinephrine versus epinephrine after cardiac arrest: A systematic review and meta-analysis" by Caitlin A. Williams et al. in the American Journal of Emergency Medicine.

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 for neuro patients How to train airway newbies — VL or DL first? Whether you’re an airway nerd, trauma junkie, or just love good old-fashioned resus banter, this episode delivers clinical pearls with a side of attitude. Grab your stopwatch — the clock is ticking! Tune in now, and don’t forget to bring your strong opinions.

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.