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09/05/2026

Your patient takes a GSW to the left chest. EMS finds them pulseless. No CPR started yet. What's your first move?

Mohamed Hagahmed, MD () from ResusX:Rounds:
The instinct is compressions. Or airway. But in penetrating chest trauma, tension pneumothorax can be the sole reason for arrest. In this case, the crew skipped both and went straight to a left thoracostomy at the wound site. Rush of air. Pulse back. Immediately.

From there:
🩸 Whole blood prehospitally
📉 Permissive SBP target of 90
📞 Trauma team notified en route
🏥 Patient arrived with vitals, went directly to OR. Survived.

Now flip it. What if they'd spent 5 minutes on scene doing compressions and managing the airway? The physiology doesn't wait. Have you managed a penetrating traumatic arrest where decompression changed everything? What's your team's protocol for sequencing interventions? Comment below.👇

Care

09/05/2026

Your trauma patient is hemorrhaging and you're running a massive transfusion protocol, but at what point does the blood itself become part of the problem?

Haney Mallemat, MD () from ResusX:2026 - even perfectly matched packed RBCs carry:
🔬 Minor allergens your host can react to
💥 Lysed cell debris releasing mitochondria → systemic inflammation
⚗️ Nitric oxide metabolites and other bioactive compounds

"Blood is a tissue transfusion" isn't just a line, it's a clinical reality that matters when you're on unit 4 of pRBCs and the patient is still tanking. Massive transfusion saves lives. But volume has consequences, and the harm isn't always from the bleeding. How does your unit balance resuscitation targets against transfusion-related risk in MTP? Drop your protocol in the comments.👇

09/05/2026

Your patient is comatose. Imaging looks devastating, but you’re unsure if they’ve cleared confounding meds. Do you withdraw support or do you wait?

Casey Albin, MD () from ResusX:2026 - here's what the evidence supports:
✅ Send a level if it exists; it changes management
✅ Call clinical toxicology or pharmacy
✅ Work with radiology to reassess whether that imaging is truly incompatible

There are documented cases, patients whose scans looked unsurvivable, who walked out. If you're not thinking about it, you're not catching it. Lean on your team for help. What's your unit's protocol when you suspect a med is confounding the clinical picture? Comment below.👇

09/05/2026

You're at the bedside. Patient is in acute respiratory distress, likely pulmonary edema. Your colleague says grab the ultrasound. Do you?

Steve Haywood, MD () from ResusX:2026:
Takotsubo? Volume overload? The treatment is the same. Positive pressure ventilation. Now. The ultrasound is a powerful tool. But it can get in the way when it delays what the patient actually needs.

Start NIV. See how they respond. If they're not improving, then work them up. Then look for what you're missing. Don't let a tool you love slow down the treatment you already know is right. Have you seen POCUS delay management in your unit? Let's talk about it.👇

09/04/2026

You're on trauma activation. 24-year-old. Multiple GSWs. Rolls in pulseless at 10 PM. Your team is looking at you. Do you run standard ACLS?

Mohamed Hagahmed, MD () from ResusX:Rounds:
Here's the problem; most of us were trained on AHA guidelines built around medical cardiac arrest. Chest compressions. Airway. Epi. Shock if shockable.

But penetrating traumatic arrest plays by different rules:
⚠️ Compressions may not be your first move.
⚠️ The reversible causes are different.
⚠️ The window to act is narrow, and the interventions are aggressive.

Knowing the difference between what the AHA says and what the evidence supports in traumatic arrest could be the call that changes the outcome. So what does your team actually do first when a penetrating trauma patient hits your bay pulseless? Comment and tell us your institution's protocol.👇

Care

09/04/2026

Your cirrhotic patient is bleeding out. Do you run the same MTP you'd use on a young trauma patient?

Haney Mallemat, MD () from ResusX:2026:
Hemorrhagic shock gets treated like a single entity. But phenotype changes everything. A young trauma patient with a GSW can often handle aggressive volume and blood product resuscitation. Their baseline physiology has reserve.

Now flip to your cirrhotic patient with a variceal bleed:
🔹 Chronic systemic inflammation
🔹 Circulating vasodilatory toxins
🔹 Baseline hemodynamic instability before the bleed even started

Or your elderly patient on CCBs with compensated CHF; can their heart actually handle what you're about to give them? Same protocol. Very different patients. Resuscitation strategy has to account for who the patient was before they hit the floor. What does your unit do differently for these phenotypes? Comment below.👇

09/04/2026

Most clinicians know the apnea test. Fewer know the hemodynamic guardrails that keep it valid and safe.

Casey Albin, MD () from ResusX:2026:
📌 Target MAP greater than 75 mmHg throughout the assessment
📌 Arterial line = real-time BP + serial ABGs (at 8, 10, and 12 min)
📌 If the patient destabilizes → test is aborted → brain death cannot be confirmed

Pre-oxygenation is what keeps most patients stable long enough to complete it. Miss the hemodynamic threshold, and you don't just have a bad test, you may have an inconclusive one that delays a family's hardest conversation.

What are your unit’s guidelines to abort the apnea test? Drop your protocol below.👇

09/04/2026

EMS rolls in with a pt who got 3 doses of naloxone and still needed continuous BVM support for 20 mins. Suspected fentanyl analog. What's your next move?

Matt Salzman, MD from ResusX:2026:
This is the clinical reality of the unregulated synthetic opioid market. High-potency analogs don't behave like the opioids older protocols were built around, and that gap can get people killed. Community programs are now distributing BVMs specifically because ventilatory support is often the intervention that keeps pts alive long enough for naloxone to work, or for the opioid to redistribute.

At the bedside:
→ Do you reach for a naloxone infusion?
→ How long do you observe before disposition?
→ What's your threshold for intubation vs. continued BVM support?

The landscape keeps shifting and there's no clean algorithm yet. What's your institution's protocol for high-potency synthetic opioid overdose? Comment below.👇

09/04/2026

Mohamed Hagahmed, MD () from July 2026 ResusX:Rounds:

Your trauma patient is pulseless. Do you start chest compressions or find the source of bleeding? For decades, we’ve been taught to follow the same algorithm, but for traumatic cardiac arrest, that algorithm is failing. Compressing an empty, bleeding heart does nothing. The key is to treat the cause, not the symptom.

In this deep-dive, we dismantle the traditional approach and show you why physiology must trump protocol. You will learn:
➡️ The "Empty Pump" problem and why standard CPR is futile.
➡️ The correct life-saving sequence: Stop the bleed, decompress the chest, give blood, then manage the airway.
➡️ Why bilateral finger thoracostomy should be done early, without waiting for tracheal deviation.
➡️ The critical role of whole blood over crystalloids.
➡️ Real-world case studies of patients who survived because providers broke from the old protocol.

This isn't about ignoring ACLS; it's about applying the right science to the right patient. Have you seen a save by prioritizing hemorrhage control over compressions? Share in the comments.

Want to watch experts from ResusX:2025? Get 4 FREE videos from the conference from Steven Haywood, Amal Mattu, Shaila Quazi, and George Willis: https://resusx2025.resusx.com/free-4-videos-page.

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Care

09/03/2026

Your trauma patient hits the bay in hemorrhagic shock. Are they already coagulopathic?

Haney Mallemat, MD () from ResusX:2026 - short answer, yes. Here's what's happening at the bedside:
❄️ They're cold from blood loss and low perfusion
🔻 Circulating volume is tanking
🌡️ Hypothermia is already driving coagulopathy

The "cold coagulopathy" isn't something you cause, it's something you inherit the moment that patient rolls in. This matters for your resuscitation strategy. If you reach for crystalloid first, you're not correcting the coagulopathy, you may be diluting what clotting factors are left. The physiology argues for blood products early. Not crystalloid.

What does your trauma bay protocol look like for the first 10 minutes of a hemorrhagic shock resuscitation? Comment and let's compare notes.👇

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