Indiana State ENA Meeting

ARISE-FLUIDS has arrived and it's awesome 🥳 For over a decade, the Surviving Sepsis Guidelines recommended that septic patients get at least 30 cc/kg fluid. In the United States, these guidelines were weaponized into performance metrics, pressuring clinicians to prescribe arbitrary volumes to every patient. Evidence-based clinicians have LONG known that this guideline lacked evidentiary support. For example, I've attached a picture of a blog I wrote about this back in 2017. Despite the lack of evidentiary support and some evidence of harm, the Surviving Sepsis Guidelines INSISTED on perpetually recommending 30 cc/kg fluid resuscitation. We finally have a prospective RCT demonstrating that mandating early administration of 30 cc/kg fluid (as compared to early vasopressors) doesn't help and may actually cause harm. It's important to note that all of the hard endpoints in this trial were neutral (e.g., mortality, days free of organ support). I still think that 30 cc/kg fluid is a pretty reasonable volume of fluid for *most* patients. But the study does suggest that giving too much fluid may promote edema - so we should be *thoughtful* about this intervention rather than mandating it for every septic patient. Based on the subgroup analysis, the fluid-conservative strategy may have helped the subgroup of pneumonia patients the most. This is statistically nonsignificant but aligns with my expectation. ARDSy patients often don't respond well to fluid. (In contrast, I really doubt that a liter of fluids in either direction matters for most urosepsis patients.) This is a great example of the over-reach of guidelines and protocoled medicine. People get all upset about practice variation, so sometimes they try to stomp it out using guidelines and protocols. But these guidelines are highly fallible, so what may occur is that you standardize care in a way that harms everyone equally. 🤦‍♂️

Great presentation on PMCardio and OMI youtu.be/13mpiKpdmRo?is=iHYH…

Heartbreak is real 🥲

Not too shabby but need to improve my false activation rate. 🤣🤣🤣🚑🚑🚑❤️❤️❤️

ENA (Emergency Nurses Association)2026 is approaching and this year I will have two(2) styles of limited edition badge pins to give away. AND I have already started on design for 2027. This is such fun.

The week before EN26 I’ll be presenting at AAENP26 in Nashville, TN I’ll have a few #FOAMed education lapel or badge pins at AAENP and the rest will be given away at EN26. ENA (Emergency Nurses Association) American Academy of Emergency Nurse Practitioners - AAENP

Come join me on June 24

An ECG Finding Every Doctor Should Recognize — It’s More Common than You Think! — Would you activate the cath lab for both patients, neither patient, or only one of them? drsmithsecgblog.com/an-ecg-f…

Not only does @PMcardioApp Queen of Hearts diagnose Occlusion Myocardial Infarction from the ECG, but PMcardio also diagnoses low ejection fraction: “LVSense”. Does well compared to PET scan. jnm.snmjournals.org/content/…

We added 3 new algorithms to the @PMcardioApp in the last quarter. This one is currently cooking, in development and hope to add it to the app soon!

The Right Decision for the Wrong Reason? drsmithsecgblog.com/the-righ…

Pilot Custom Urushi 845 in Prussian Blue with my first broad nib.

Arterial Pulse Tapping Artifact Mimicking Acute Coronary Syndrome on Electrocardiogram | JACC: Case Reports. @drmarkhellerman jacc.org/doi/10.1016/j.jacca…

ACLS are guidelines, nothing more. Use your brain to critically assess the situation.

Dickens: It was the best of times, it was the worst of times. Schrödinger: Nice.

Learn how to avoid 14,000 unnecessary deaths in the next year? Or 29,000 in the next 5 years? Come develop new eyes in EKG evaluation for OMI at AAENP26 in Nashville or ENA (Emergency Nurses Association)26 in Phoenix, both in September. STEMI = OMI BUT OMI not always STE!

HOT TAKE: PEOPLE WHO FEEL HOT SHOULD DECIDE THE TEMPERATURE OF A ROOM. PEOPLE WHO FEEL COLD SHOULD WEAR A SWEATER.

It’s that time of year again. Happy Fuck Nazis day. Scoreboard, get shit on losers.