Your patient is suddenly bleeding from every line site. You suspect DIC. Mark Ramzy, DO (@mramzydo) from ResusX:ReUnion: Beyond replacing factors, what is your absolute first priority to shut down the cascade? Let's see your approach in the comments.

Your patient has a UTI, platelets of 90, an AKI, and the smear just came back with helmet cells. Mark Ramzy, DO (@mramzydo) from ResusX:ReUnion: Do you treat the infection and move on — or does this change your entire management? Comment with your approach.👇

Fever. AKI. Thrombocytopenia. Altered mental status. Rash. Mark Ramzy, DO (@mramzydo) from ResusX:ReUnion: C. diff is on the list — but what diagnosis can you NOT afford to miss here? Drop your answer.👇

Your patient's ICD keeps firing. Is this just another episode of VT, or the start of an electrical storm? Amal Mattu, MD (@amalmattu) from ResusX:2025: Recognizing this pattern early is key. What are your first-line interventions at the bedside? Let's debate in the comments.

Your patient has a fever, confusion, AKI, and plummeting platelets. Mark Ramzy, DO (@mramzydo) from ResusX:ReUnion: What's the diagnosis and underlying mechanism? Let's discuss your approach.

Amio is running, patient is still in VT, and you need a second agent NOW. Amal Mattu, MD (@amalmattu) from ResusX:2025: Do you grab lidocaine, procainamide, or a beta blocker — and how fast can your team actually get it to the bedside? Comment with what you'd do.👇

Your pt with pancreatitis is bleeding through his central line dressing. Not anticoagulated. DIC confirmed. Mark Ramzy, DO (@mramzydo) from ResusX:ReUnion: Do you replace products aggressively or treat the trigger first? What's your bedside threshold — comment and discuss.👇

Patient cycling in and out of monomorphic VT, stable each time — are you reaching for amiodarone? Amal Mattu, MD (@amalmattu) from ResusX:2025: What's your bedside approach? Comment to discuss.👇

Refractory hypotension, sky-high lipase, fever — and a rash. Mark Ramzy, DO (@mramzydo) from ResusX:ReUnion: What's the unifying diagnosis here? Drop your answer and let's discuss.👇

Patient with recurrent VT/VF gets a 3rd shock in an hour. You suspect electrical storm. Amal Mattu, MD (@amalmattu) from ResusX:2025: Beyond ACLS, what's your immediate next move? We're all seeing this more often in the unit. Share your protocol in the comments.

You place a Foley and get back frank hematuria. Mark Ramzy, DO (@mramzydo) from ResusX:ReUnion: Patient is febrile, agitated, and has a rash you've seen before. FAST is negative. What's your next move at the bedside? Let's hear your approach.👇

Your patient's been shocked by his ICD 5 times tonight. Amal Mattu, MD (@amalmattu) from ResusX:2025: Electrical storm is on the table — what's your first move at the bedside? Comment with your approach.👇

Your patient has lightheadedness, gross hematuria, and a vague bleeding history. He just returned from Madagascar. Mark Ramzy, DO (@mramzydo) from ResusX:ReUnion: What's your first diagnostic step at the bedside? Share your approach in the comments.

Your patient is in recurrent VT despite shocks and amiodarone. Amal Mattu, MD (@amalmattu) from ResusX:2025: What's your next move to stop the storm? Lidocaine? Beta-blockade? Deep sedation? What actually works at the bedside for you? Comment to discuss.

ICP is rising and you push osmotherapy — but are you actually targeting the right compartment? Brian Wright, MD (@brianjwrightmd) from ResusX:2025: The Monro-Kellie Doctrine gives you 4 levers. Which one are you pulling and why? Comment to discuss.👇

She's on HFNC, still dropping her sats, and she told you clearly: no intubation. Mark Ramzy, DO (@mramzydo) from ResusX:ReUnion: Now she’s tachy and hypotensive — what's your next move? Walk me through your approach in the comments.👇

Patient cycling in and out of stable V-Tach — you're not shocking them. So which drug? Amal Mattu, MD (@amalmattu) from ResusX:2025: 1 episode = procainamide. Keeps firing = amiodarone, for its anti-adrenergic effect. How does your unit handle this? Comment below.👇

Your patient needs 3% HTS now, but you only have a PIV. Brian Wright, MD (@brianjwrightmd) from ResusX:2025: Do you push it or delay treatment waiting for a central line? What’s your move at the bedside? Comment your approach.

She's on BiPAP, refusing intubation, and now her platelets are falling as you pull back on vasopressors. Mark Ramzy, DO (@mramzydo) from ResusX:ReUnion: What's your next move at the bedside? Comment and tell us how you'd work this up.

Electrical storm, amio is running, arrhythmia keeps breaking through — do you reach for propranolol or metoprolol next, and does it matter? Amal Mattu, MD (@amalmattu) from ResusX:2025: The pharmacology might change your answer. What's your go-to at the bedside? Comment below.

The Monro-Kellie Doctrine describes 3 intracranial compartments — name them and explain what happens when one expands. Brian Wright, MD (@brianjwrightmd) from ResusX:2025: Can you answer this without looking it up? Comment your answer.👇

EMS is holding him down. Wife says he's "not himself." Week of diarrhea, no eating. Mark Ramzy, DO (@mramzydo) from ResusX:ReUnion: Do you reach for a sedative first — or does something else hit your list before that? Tell us your approach.👇

Your VT patient is already on flecainide at home doses and now has electrical storm. Amal Mattu, MD (@amalmattu) from ResusX:2025: Do you blame the drug or hunt for another trigger first? Hypokalemia, ischemia, myocarditis — where do you start? Comment to discuss.👇

Your patient’s ICP is up. You're ordering osmotherapy NOW. Brian Wright, MD (@brianjwrightmd) from ResusX:2025: Mannitol or hypertonic saline? Bicarb? What patient factor makes you choose one over the other at the bedside? Share your approach.

Your patient with a low EF and an ICD is experiencing recurrent shocks and is near-syncope. Amal Mattu, MD (@amalmattu) from ResusX:2025: What is your absolute first priority at the bedside? Let's hear your approach in the comments.

Highest osmolality of all osmotic agents — and pushing it too fast causes the one thing you're trying to prevent. Brian Wright, MD (@brianjwrightmd) from ResusX:2025: What's the correct rate for 23.4% HTS? Drop your answer and let's discuss.

Refractory V-Fib. You're setting up for DSD with two defibrillators. Amal Mattu, MD (@amalmattu) from ResusX:2025: Do you shock simultaneously or sequentially? And where exactly should that lateral pad go for the best vector? What's your unit's protocol? Comment to discuss.

At what osmolar gap does mannitol lose its ICP benefit and start adding risk? Brian Wright, MD (@brianjwrightmd) from ResusX:2025 If you said ~20 mOsm/kg, you're correct! Know why? Drop your answer below👇

Your pt is in refractory V-Fib — amio on board, 3 shocks in, nothing converting. Do you reach for dual sequential now or wait? Amal Mattu, MD (@amalmattu) from ResusX:2025: Real case, real decision. What would you do at the bedside? Comment to discuss. 👇

ICP is climbing and HTS isn't readily available — would you reach for sodium bicarb? Brian Wright, MD (@brianjwrightmd) from ResusX:2025: Two small trials say it works, possibly with a more sustained response than 5% HTS. What's your move? Comment to discuss.

You've shocked three times. VF persists. Your team reaches for epi. Do you let them push it? Amal Mattu, MD (@amalmattu) from ResusX:2025: Catecholamines may be driving the storm — not fixing it. What's your bedside move here? Comment to discuss.

Elevated ICP at the bedside — you have mannitol and HTS. Which do you grab if you need sustained reduction AND better cerebral perfusion pressure? Brian Wright, MD (@brianjwrightmd) from ResusX:2025: The data might surprise you. What's your unit's protocol? Comment below.

Refractory VF, multiple shocks, still in the storm — what's your next move? Amal Mattu, MD (@amalmattu) from ResusX:2025: Stopping epi, layering beta blockers, dual sequential defibrillation? What does your team reach for first? Drop your approach in the comments.

ICP is climbing and your central line isn't in yet. Do you wait or push 23% HTS peripherally? Brian Wright, MD (@brianjwrightmd) from ResusX:2025: Data shows no extravasation injury and equivalent outcomes. Hypotension w/ speed of delivery. What do you do? Share your approach.

Electrical storm, emergent intubation. You're reaching for ketamine — should you stop? Amal Mattu, MD (@amalmattu) from ResusX:2025: In catecholamine-driven crises, that choice can make things worse. What's your go-to sedative in this scenario? Comment to discuss. 👇

Your patient’s ICP is climbing!! Brian Wright, MD (@brianjwrightmd) from ResusX:2025: Monro-Kellie gives us three targets to lower ICP: brain, blood, and CSF. Which do you go after first, and what's your go-to intervention? Comment to discuss.

Third shock. Still in VF. More epi on the way — but what if epi is making it worse? Amal Mattu, MD (@amalmattu) from ResusX:2025: Would you stop it and push a beta blocker instead? Tell me what you'd actually do at the bedside. 👇

ICP is climbing and you need osmotherapy. Brian Wright, MD (@brianjwrightmd) from ResusX:2025: Do you reach for mannitol or hypertonic saline — and does your answer change based on volume status? Tell us what your unit does. 👇

You've shocked three times and V-Fib keeps returning. ⚡ Amal Mattu, MD (@amalmattu) from ResusX:2025: The team wants more epi — but could that catecholamine surge be the reason it won't break? What's your next move at the bedside? Comment and share your approach.

ICP is up. Mannitol or hypertonic saline — you have to decide fast. Brian Wright, MD (@brianjwrightmd) from ResusX:2025: The evidence won't save you here; neither drug has shown a clear mortality benefit in TBI. What's actually driving your choice at the bedside? Comment below.

Your pt is in electrical storm and getting multiple ICD shocks. Why might the shocks be making things worse? Amal Mattu, MD (@amalmattu) from ResusX:2025: They drive the sympathetic surge that perpetuates arrhythmias. What's your first move to break this cycle? Comment below.

Your SAH patient has rising ICP and you can't let them go hypovolemic — mannitol or hypertonic saline? Brian Wright, MD (@brianjwrightmd) from ResusX:2025: Neurointensivists are increasingly choosing HTS. What's your bedside go-to? Drop it in the comments 👇

You're at the bedside, 30 seconds to intubate — Roc or Sux? Reuben Strayer, MD (@emupdates) from ResusX:2025: Roc rocks, but what's the clinical picture in front of you? Tell us how you decide 👇

45 minutes of V-Fib. Standard shocks failing. Amal Mattu, MD (@amalmattu) from ResusX:2025: Would you call for double or triple sequential defibrillation at your institution?! Does your unit even have a protocol for this? Drop your approach below 👇

What's the most feared complication of mannitol? Brian Wright, MD (@brianjwrightmd) from ResusX:2025: It’s rebound elevated ICP from mannitol leaking across a damaged BBB, reversing the osmotic gradient. Did you know this mechanism? Comment to discuss.

Your crashing patient needs a tube NOW. You have etomidate and ketamine in your hand. Reuben Strayer, MD (@emupdates) from ResusX:2025: Which one are you pushing, and what's the most important factor driving your decision? Let's see your clinical reasoning in the comments.

Which osmotic agent has ~2,000 mOsm osmolality, zero chloride, and won't cause a non-anion gap metabolic acidosis? Brian Wright, MD (@brianjwrightmd) from ResusX:2025: Hint: it's already in your crash cart. Drop your answer — let's see who knows this one. 👇

The patient is intubated and paralyzed. Are you 100% certain they're sedated? Reuben Strayer, MD (@emupdates) from ResusX:2025: Forgetting this step is a true nightmare scenario. What’s your immediate sedation strategy post-RSI? Let's see your approach in the comments.

ICP is rising — do you reach for osmotherapy first? Brian Wright, MD (@brianjwrightmd) from ResusX:2025: The tier system places basic critical care first (Tier 0). Osmotherapy is early Tier 1, not your opening move. What's your unit's escalation protocol? Let's discuss 👇

You reach for midazolam to induce for RSI. Do you push the paralytic right after — or wait? Reuben Strayer, MD (@emupdates) from ResusX:2025: The timing here is different from other induction agents. What would you do? Comment below 👇