Send us Fan Mail

What happens after the pulse comes back?

In this episode, we dive into one of the most practical — and controversial — questions in post-cardiac arrest care: Which vasopressor should clinicians reach for first after ROSC? Epinephrine or norepinephrine?

Joining me is Dr. Nathalie Van Der Rijst, pulmonary and critical care physician from Philadelphia, for an energetic and evidence-driven debate exploring the physiology, pharmacology, real-world logistics, and limitations of current research surrounding post-cardiac arrest hypotension.

Together, we tackle:

• Why post-ROSC hypotension remains so deadly
• The physiologic argument for epinephrine vs. norepinephrine
• Myocardial stunning, vasoplegia, and recurrent arrest
• What observational studies and limited randomized data actually show
• Why prehospital realities matter when choosing vasopressors
• The challenges EMS agencies face with pumps, medications, and resources
• How ICU and emergency medicine perspectives sometimes differ — and where they align

Along the way, expect spirited Pittsburgh vs. Philadelphia banter, ICU vs. ER jabs, practical resuscitation pearls, and an honest discussion about the gap between ideal medicine and real-world medicine.

Whether you work in EMS, emergency medicine, critical care, anesthesia, or hospital medicine, this conversation will challenge the way you think about post-cardiac arrest shock and the critical minutes after ROSC.

As always, thank you for listening, sharing feedback, and helping grow this community focused on resuscitation, emergency medicine, critical care, and public health.

If you enjoy the episode, please share it with a colleague and send along topics you’d like covered in future episodes.

If you enjoyed this episode, please follow, subscribe, and leave a review—it helps us reach more listeners.

📱 Connect with me for more educational content, clinical pearls, podcast clips, and behind-the-scenes updates:

• Instagram: @HagahmedMD
• YouTube: @HagahmedMD

Thank you for being part of the EMERGE in EM community. Until next time, stay curious, keep learning, and continue to EMERGE.