The Cognitive Pause

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.