Why Do Bats Hang Around, Upside Down?

You want to know a secret about bats? They're basically the original Goths of the animal kingdom, always hanging out upside down! But seriously, have you ever wondered why these fascinating creatures spend their downtime defying gravity? It's not just to look cool, it's actually a brilliant strategy for a quick getaway! Unlike birds, bats can't just spring into flight from a flat surface. Their super-specialized wings and tiny legs make ground takeoffs a no-go. So, they "hangout" upside down, ready to drop and spread their wings in an instant!

And here's another quirky tidbit: bats don't have to work hard to hold themselves up! Thanks to a unique locking mechanism in their talons, their own body weight actually helps them grip their perch without any muscle effort. It's like their feet are designed to be lazy! This ingenious adaptation saves them tons of energy, letting them conserve their power for their incredible nightly aerial acrobatics. So next time you spot a bat, give a little nod to their upside-down genius. They've truly mastered the art of hanging around!

Welcome to the 126th edition of ResusNation!

Resuscitate BEFORE You Intubate

I get it, intubating a patient can feel like a powerful and essential intervention, and it's a procedure I've performed countless times throughout my career. However, after more than two decades in critical care, I've developed a profound respect—and even a healthy fear—for its potential to harm. What many don't realize is that up to 25% of critically ill patients we intubate experience post-intubation hypotension, and a concerning 3% or more can go into cardiac arrest. This isn't just an unfortunate outcome; it's often a direct consequence of the physiological cascade triggered by intubation, from the sudden loss of sympathetic drive when sedatives are pushed, to the hemodynamic impact of positive pressure ventilation.

The drugs we administer for intubation, regardless of type, cause vasodilation and venodilation, dropping blood pressure and decreasing venous return. Then, bagging and mechanical ventilation increase intrathoracic pressure, further collapsing vessels and decreasing cardiac output. Add to that the risk of acidosis from apnea and hypoxemia from prolonged intubation attempts, and you've got a recipe for disaster if not managed proactively. My clinical experience has repeatedly shown me that the key to safer intubation isn't just mastering the mechanics, but understanding and mitigating these critical hemodynamic shifts. That's why I always stress one crucial mantra: resuscitate before you intubate. Prioritize optimizing blood pressure, ensuring adequate oxygenation with non-invasive positive pressure ventilation, and using the lowest effective doses of RSI medications.

Watch the full video here and leave a comment.

Don't forget to like and follow my IG, TikTok, YT, Facebook or Linkedin accounts.

🔥 ResusX:2025 Goes VIRTUAL🔥

You've heard the buzz about ResusX:2025 happening live in Philadelphia, and now, we're thrilled to announce what so many of you have been waiting for: virtual access to ResusX:2025 is officially LIVE!

Starting today you can join us from anywhere in the world to experience three intensive days designed to sharpen your skills and elevate your critical care practice. No travel required, just pure, unadulterated resuscitation mastery delivered straight to you!

This isn't just another online conference. ResusX:2025 is a dynamic, hybrid event packed with hands-on training, essential theory, and lively discussions. Our "rockstar" faculty, true legends in resuscitation, will deliver electrifying talks, spark spirited debates, and lead live demos with incredibly realistic simulations. 

Choose Your Virtual Adventure:

Watch Live – Just $127 (Save big, usually $297!):

• Catch every moment live from Philadelphia.
• Chat with faculty and fellow attendees in real-time.
• Score some awesome prizes!

Live + Replay – Just $197 (Normally $427, huge savings!):

•  Everything in the "Watch Live" package.
• Plus, get 30-day replay access to revisit all the content.

Lifetime Access + Swag + Summaries + CME/CEU – Just $247 (An incredible deal, usually $547!):

• Includes everything from the "Live + Replay" package.
• Lifetime access to all conference content – forever!
• Rock an official ResusX:2025 T-shirt.
• Downloadable lecture summaries for quick review.
• Earn 20.0 AMA PRA Category 1 Credits™ or CEU to boost your credentials.

You're going to watch the exact same incredible content as our in-person attendees, delivered right to your screen. We even offer special discounts for non-physicians, and you can submit your burning questions for our faculty to answer live! 

Don't let this chance slip by to sharpen your skills and truly master resuscitation, all from the comfort of your home or office.

Are you ready to become a resuscitation legend? Click below to secure your virtual spot today before these early bird prices vanish!

REGISTER NOW

Your Guide to Safer Intubations: Mastering the Difficult Airway

Imagine a situation in the intensive care unit (ICU) where a patient suddenly needs to be intubated. Intubation in these patients can be incredibly challenging, especially when a patient has what's known as a "difficult airway." Despite all the amazing advances in medical technology, complications like low oxygen levels, brain injury, or even death can still occur if things don't go smoothly. This review highlights that anticipating problems, having a structured plan, and being comfortable with advanced tools are key to better outcomes.

The article emphasizes that effective "difficult airway" management isn't just about one magical device, but rather a systematic approach. Doctors now use checklists and mnemonics like "LEMON" to spot potential issues early. Tools like video laryngoscopes, which offer a much better view of the vocal cords, are becoming standard, improving success rates for even less experienced providers. When intubation proves difficult, rescue devices called supraglottic airways (like LMAs) can buy precious time by providing oxygen, even serving as a guide for eventually placing a breathing tube. And in the absolute worst-case scenarios—when an endotracheal tube cannot be placed —a surgical airway (cricothyrotomy) is a life-saving last resort. While this review is a comprehensive look at current practices, it's important to remember that real-world results can vary based on the specific hospital, available equipment, and the experience of the medical team. Still, by embracing these structured approaches and prioritizing continuous training, we can significantly improve safety for our most vulnerable patients in the ICU.

Here's my Takeaways:

• Finding: Effective difficult airway management in the ICU relies on anticipation, structured planning, and familiarity with advanced tools and algorithms to improve patient outcomes and reduce complications.

• Practice Impact: Clinicians should use systematic assessment tools (e.g., LEMON, MACOCHA score), prioritize preoxygenation, and be prepared to escalate through a stepwise algorithm (e.g., Plan A to Plan D) if initial intubation attempts are unsuccessful. 

• Population: This review focuses on critically ill adult patients in the Intensive Care Unit (ICU) and emergency settings, who often present unique challenges for airway management due to their underlying medical conditions. 

• Limitation: This is a narrative review, not a quantitative meta-analysis, meaning specific success rates or complication data for different devices and techniques may vary depending on local resources, operator experience, and individual patient anatomy.

Want to learn more? Read the full study "Difficult Airway Management in the Intensive Care Unit: A Narrative Review of Algorithms and Strategies" by Talha Liaqat et al. in Journal of Clinical Medicine.

Watch the July's Videos Now!

If you're an All-Access Member, you're in for some great content this month. We have FIVE videos hand-picked by our staff that are high-yield and our most highly watched. We're featuring

• Selman on "Brainstorming – Forgotten Causes of Delirium"
• Wydo on "Demystifying the Trauma Exploratory Laparotomy"
• Filkins on "Resus Out Loud"
• Winters on "Recent Articles in Resuscitation & Critical Care"
• Spiegel on "Finding One MAP For Everyone"

Each month we bring you fresh new content from the best of the best in resuscitation. If you're an All-Access member, go watch these videos NOW! If you're not, then sign up here.

Are you a member of ResusNation? For less than a cup of coffee, you can get even more content from CriticalCareNow. Digital teaching sessions, podcasts, free video lectures, grand rounds, and so much more can be your today. Come watch on replay all the content that CriticalCareNow does live. Check out the membership options below and decide the right one for you.

Do you want even more resus content anytime you want? For less than a cup of coffee, you can get even more content from @CriticalCareNow. Digital teaching sessions, free video lectures, grand rounds, and so much more can be your today. Come watch on replay all the content that @CriticalCareNow does live. 

Check out the membership options below and decide the right one for you.

 Get Access To The ResusNation Today!