How Dead Birds and a Medieval Writer Created  Valentine's Day 

Think Valentine's Day is all about romance? Think again! The holiday actually traces back to not one, but possibly three different St. Valentines who were all martyred in the third century CE. These holy men shared some wild coincidences - two of them were beheaded on the same day in Rome, both supposedly cured blindness, and both may have actually been the same person. Ironically, none of them had much to do with love or romance.

The real cupid behind Valentine's Day was actually Geoffrey Chaucer, the medieval writer who gave us The Canterbury Tales. In 1382, he wrote a poem about birds choosing their mates on St. Valentine's Day to celebrate a royal engagement. The idea caught on with nobles who started writing love notes during bird-mating season, and eventually snowballed into today's billion-dollar industry of chocolate hearts and red roses. Talk about a plot twist!

Welcome to the 104th edition of ResusNation!

Stop Drowning Your Septic Patients

In my years of critical care experience, I've witnessed a concerning pattern: clinicians drowning their septic shock patients with fluid boluses before finally initiating vasopressors. While I'm not here to debate the 30cc/kg initial resuscitation (though that's probably too much), I want to emphasize a crucial point about timing. When your patient remains hypotensive after initial fluid resuscitation, it's time to start vasopressors – even if you're working with a peripheral IV.

Here's why this matters: In vasodilatory shock, what these patients primarily need are antibiotics and vasomotor tone, which you can only achieve with agents like norepinephrine. More importantly, by delaying vasopressor initiation and allowing persistent hypotension while giving bolus after bolus, you're permitting ongoing end-organ ischemia that could increase mortality.

So what's my approach? Give your initial fluid bolus, but if hypotension persists, start those pressors. You can always continue volume resuscitation alongside vasopressors if needed, but don't fall into the trap of endless fluid administration before addressing vasomotor tone.

Watch the full video here and leave a comment.

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

Dual Defib Strategies

In this episode, Dr. Tarlan Hedayati takes a deep dive into the history, science, and best practices for dual defibrillation. She explains why vector change and dual sequential shocks may improve outcomes in refractory VFib, how to properly time and place pads, and what the latest DOSE-VF trial tells us about neurological survival rates. If you manage cardiac arrests, this episode delivers game-changing insights into the future of defibrillation!

Check out this video of Dr. Tarlan Hedayati from ResusX:ReVolved now!

 Watch the Video Now!

Get A Ton Of Amazing Education For Just $1

Let's face it...everything is getting expensive. Interest rates are high, the price of eggs are insane...wouldn't it be great to catch a break during these tough economic times?

I got you covered this week with a deal that really does sound too good to be true. Right now you can join the All-Access ResusNation Membership for just one dollar! You read that right, for the first month of membership you'll pay one $1 to get access to incredible education. 

With the All-Access Pass you'll receive 5 new lectures, filled with tons of content to help you take better care of your critically ill and crashing patients. You'll also watch live grand rounds lectures each month and watch on replay. You'll also have access to our exclusive RX community where you can post cases, ask questions, and network with faculty and other like-minded individuals. We'll be adding CME and CEU credits within the next two months so you'll learn while you earn credits. Finally, you'll join our exclusive monthly hangout sessions where we talk about anything that YOU want to talk about. The All-Access Pass is only for individuals who are serious about medical education!

Sign up today and you'll only pay $1 for the first 30 days. After 30 days, you'll automatically be billed $4.99 for your membership. There are no yearly fees, no contracts, and no obligations. You can easily cancel at any time, no questions asked. 

 GET ALL-ACCESS FOR $1

Are "Routine Labs"  Harming

Your ICU Patients?"

The STRATUS trial, a stepped-wedge cluster randomized study across 25 Canadian ICUs, investigated whether switching from standard-volume to small-volume blood collection tubes could reduce red blood cell (RBC) transfusions in ICU patients. The study included over 21,000 critically ill patients and was conducted between February 2019 and January 2021.

In the primary analysis, transitioning to small-volume tubes showed a trend toward reduced RBC transfusions (9% relative reduction) though this did not reach statistical significance. However, in the larger secondary analysis including all eligible patients, the intervention achieved a significant 12% reduction in transfusions, corresponding to approximately 9.84 fewer RBC units per 100 ICU patients. Importantly, the smaller tubes did not compromise laboratory testing capabilities - specimens with insufficient volume for analysis remained extremely rare (0.03%) both before and after the transition.

This simple intervention could have substantial system-wide impacts - in this study alone, using small-volume tubes potentially saved approximately 1,500 RBC units over two years. Given that blood products are costly, limited in supply, and carry transfusion risks, this evidence supports considering small-volume tubes as a safe strategy to reduce iatrogenic blood loss and transfusion requirements in ICU patients.

Here's my Takeaway:

• Finding: 12% reduction in RBC transfusions with small-volume tubes (RR 0.88, 95% CI 0.77-1.00)

• Practice Impact: Simple switch to small-volume tubes could save ~10 RBC units per 100 ICU patients without compromising lab testing

• Population: Adult medical-surgical ICU patients admitted ≥48 hours

• Limitation: Effect was significant in secondary but not primary analysis; heterogeneity in impact across different ICUs

Want to learn more? Read the full study “Small-Volume Blood Collection Tubes to Reduce Transfusions in Intensive Care: The STRATUS Randomized Clinical Trial” Siegal DM, et al. JAMA. 2023.

Save the Date: ResusX25

Mark your calendars! We're thrilled to announce that ResusX 2025, the premier resuscitation conference of the year, is returning for its seventh spectacular year. Join us September 29 - October 1, 2025, as we take over Philadelphia's iconic Punchline Comedy Club for our most ambitious event yet.

The overwhelming interest we've received through emails and messages has shown just how exited the ResusNation is for this announcement. We're pulling out all the stops to bring you an unforgettable experience featuring the leading voices in resuscitation medicine - live and in person. Don't miss your chance to be part of this landmark event in the City of Brotherly Love. Stay tuned for more details about our world-class speakers, innovative sessions, and more.      

We're finalizing an action-packed schedule, including specialized post-conference workshops. Full CME and CEU details will be available on our website shortly.

Given the intimate venue and unprecedented interest in ResusX 2025, we anticipate tickets will sell out rapidly. As a valued newsletter subscriber, we want to ensure you have priority access to registration. So here's how to secure your spot:

If you're committed to attending ResusX 2025, simply complete our priority access form below. You'll receive immediate notification when ticket sales open, giving you first opportunity to register. Based on the overwhelming response we've already received, we expect tickets to be claimed quickly during this priority registration period.

Complete the Priority Access Form 

In this episode, Dr. Shaila Quazi demystifies resuscitative hysterotomy, the life-saving procedure formerly known as the perimortem C-section. Learn when to act, how to assemble the right teams, and the step-by-step approach that can maximize survival for both mother and baby. Packed with practical mnemonics, real-world cases, and expert insights, this is a must-listen for anyone in emergency or critical care medicine.

Because nothing says “I care” more than being ready to save lives. 💕"

Check out this video of Dr. Shaila Quazi from ResusX:ReVolved now!

Watch the Video Now! 

Watch the February 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

• Haywood on "Ventilation in Obesity"
• Hedayati on "Right Bundle - When to Be Afraid"
• McCloskey on "The Sleepwalking Resuscitationist"
• VandenBerg covering "Chest Pain and..."
• Marcolini on "What's Their Status (Epilepticus) Now?"

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.