What do you do when a patient in shock doesn’t respond to vasopressors? In this episode, Dr. Anand Swaminathan dives into the art of the ‘cognitive pause’—a crucial step in troubleshooting refractory shock. From acidosis and hypothyroidism to occult bleeding and adrenal insufficiency, he outlines a systematic approach to uncover hidden causes that could change the course of care. If you’re ready to sharpen your resuscitation skills and tackle the toughest cases, this episode is for you!