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10/13/2026

You're looking at a CT head and the hematoma has both bright and dark areas inside it. Which one makes you pick up the phone?

Chris Reilly, MD () from ResusX:ReUnion:
🔵 Hyperdense (bright) = organized clot, proteinaceous material; expected, stable
🔴 Isodense/dark within that clot = fresh blood, acute hemorrhage mixing into the hematoma; that's an expanding bleed until proven otherwise.

When you see dark within bright on a non-contrast CT that's not a wait-and-watch finding. That's a neurosurgery call. That's a repeat imaging conversation. That's a patient whose exam you're checking every 15 minutes. Hematoma expansion is one of the strongest predictors of neurological deterioration and mortality in intracranial hemorrhage. The imaging is telling you something; the question is whether you catch it in time. What's your threshold for calling neurosurg when you see this pattern? Comment to discuss.👇

10/13/2026

Your last patient got tPA and bled. Now a new stroke alert walks in; same presentation, same window. Do you hesitate?

Sergio Zanotti, MD from ResusX:2026:
If you do, that's availability bias, and it may cost your next patient. A single bad outcome doesn't change the population-level data on tPA eligibility. But it does change how your brain weighs risk in the moment. Layer overconfidence bias on top of that, the tendency to trust your gut read of a case more than you should, and you've got a setup for a reasoning error that's hard to catch in real time.

The fix isn't just "be aware of your biases." It's building a structured decision framework before you're standing at the bedside with a family asking what you're going to do. What does your team do to pressure-test high-stakes decisions like this one? Comment below.👇

10/13/2026

You're called to intubate. Do you reach for a standard geometry or hyperangulated VL blade as your default?

Anand Swaminathan, MD () from ResusX:2026:
Standard geometry, every time. Why? Murphy's Law. Anything that can go wrong, will. By using a standard blade for every case, you're always prepared for the camera to fail or the lens to get covered. The transition to a direct view is seamless. It treats video as a powerful adjunct, not a crutch.

This mindset prepares you for the most challenging airways, not just the straightforward ones. What's the standard practice in your unit? Let's compare notes. Comment to discuss.

’sLaw

10/13/2026

You're at the bedside. The patient has transient hypotension that responds to your initial interventions, but it keeps recurring. Do you escalate to advanced therapies now?

Cheyenne Falat, MD from ResusX:2026:
This is a common clinical crossroads. The patient isn't in refractory shock... yet. But they're not stable either. They're in that gray zone of "incipient cardiopulmonary failure." The latest AHA guidelines address this directly, suggesting a benefit for patients well before they arrest.

What’s your clinical trigger to move from standard resuscitation to advanced support in these cases? Share your approach and let's discuss.

Every minute your bleeding trauma patient waits for blood products, mortality climbs 5%. Modern massive transfusion prot...
10/13/2026

Every minute your bleeding trauma patient waits for blood products, mortality climbs 5%. Modern massive transfusion protocols aren't just about what's in the cooler, they're about getting it there fast, getting it balanced, and having a direct-to-OR pathway ready before the patient hits your door. The ABC score remains the most practical prehospital activation tool (no labs, no complexity), and new data shows prehospital MTP activation with pre-thawed plasma cut mortality by 23% compared to pre-implementation. ‘Door-to-cooler’ time deserves the same quality improvement attention we give door-to-balloon. If your first cooler isn't arriving in under 10 minutes, that's your next systems project.

10/12/2026

You're moving fast through a busy shift, and your gut says you already know what's wrong with the patient in Bay 4. Do you trust that instinct?

Sergio Zanotti, MD from ResusX:2026:
10–15% of patient encounters involve a diagnostic error. A significant portion comes from how we frame the initial diagnosis, not from lack of knowledge. System 1 thinking is automatic. It's what lets you run a code without freezing. But it's also what makes you anchor on the first diagnosis that fits. System 2 is slower, deliberate. And it's what catches the zebra hiding behind the horse.

The question isn't which system to use; it's knowing when to switch. How do you force yourself to pause and reassess when the clinical picture isn't adding up? Drop your approach in the comments.👇

10/12/2026

You're at the bedside, laryngoscope in hand, and the airway fills with secretions mid-attempt. What's your move?

Anand Swaminathan, MD () from ResusX:2026 - if you're scrambling for suction at that moment, the question is: why wasn't it already in position? SALAD, Suction-Assisted Laryngoscopy for Airway Decontamination, flips the script. Instead of reacting to a contaminated airway, you build suction into every single intubation from the start.

The DuCanto catheter is the tool:
→ Rigid enough to displace debris
→ High-flow enough to clear the field fast
→ Costs not much more than a Yankauer

You don't always know what's coming. The patient who "shouldn't" have anything in their airway sometimes does. Standardizing SALAD means you're never making that call under pressure. What's your current setup at the bedside? Are you running SALAD on every intubation or only in high-risk cases? Comment below.👇

10/12/2026

You've got a PE patient in front of you. Hemodynamically borderline. Significant comorbidities. Do you call PERT now?

Cheyenne Falat, MD from ResusX:2026:
At University of Maryland, it's a one-call activation. You don't need a complete workup to get the team on the line. You call, you present, and the risk stratification happens in real time using Bova or sPESI as the framework.

The key decision point:
↳ Higher-risk score OR significant comorbidities = interventionalists and surgeons enter the conversation
↳ That's when advanced therapies are on the table

The system is designed so the right people are talking before the patient deteriorates, not after. Have you seen this workflow change a management decision in your unit? Comment below.👇

ResusNation Newsletter #182 is live! Swipe to preview this week's content.
10/12/2026

ResusNation Newsletter #182 is live! Swipe to preview this week's content.

10/12/2026

Your patient's MAP is 55 and dropping; no obvious cause. What's the first thing you grab?

Joshua Rempell, MD from ResusX:2026 - before you commit to fluids, pressors, or a workup. POCUS can pivot your entire plan in under 2 minutes. Ask yourself:
→ Obstructive? (tamponade, PE)
→ Distributive? (hyperdynamic LV, flat IVC)
→ Cardiogenic? (poor squeeze, dilated RV)
→ Hypovolemic? (collapsing IVC, empty ventricles)

The ultrasound doesn't just confirm, it redirects. What's your institution's protocol for POCUS in undifferentiated shock? Comment below.👇

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