SMACC Chicago

This year I was fortunate enough to attend the 3rd annual Social Media And Critical Care (SMACC) conference from June 23rd – 26th, 2015 in Chicago, IL. This year the conference was dubbed as SMACC Chicago and followed by the hashtag #smaccUS on twitter. I tried to keep track of all the great take home messages while at the conference for those not lucky enough to make it or who have not heard of it. For those of you who have not heard of SMACC, it is a modern, academic meeting, mixed with on-line technologies to deliver innovation in education in the fields of emergency medicine and critical care. This conference addresses important clinical issues in a format that is energetic, cutting edge, and yet reputable. If you wanna see what the conference was about last year checkout this link: smaccGOLD. So what did I learn this year? Well, a lot more than one post can give justice to, but some of the highlights are listed below.

Practical Lessons from SMACC Chicago

When on a journey choose your destination, and then enjoy whatever route it takes to get there. (“You got to be careful if you don’t know where you’re going, because you might not get there.” – Yogi Berra)
Patients and families of patients don’t care how much you know, until they know how much you care (“Nobody cares how much you know, until they know how much you care.” -Theodore Roosevelt)
Behave as you want to be remembered
Always follow up on your patients
Don’t forget when caring for your patients, that when people are desperate they need hope (“Cure sometimes, treat often, comfort always.” – Hippocrates)
If you are caring for patients at any capacity, don’t fight against religion, work with it by using the AMEN theory.
- A = Affirm you are hopeful, would love a miracle
- M = Meet the family where they are at
- E = Educate and maintain your professional opinion
- N = No matter what assure the family that you are committed and connected no matter the outcome
Failure is a fundamental part of anything worthwhile. While it can hurt, it is part of learning (“If you don’t make mistakes, you aren’t really trying.” Coleman Hawkins)
“Heirloom Knowledge” = Knowledge handed down without being challenged. Question everything. Look at original literature and make your own decisions
Train hard because in times of stress (i.e. resuscitation) we don’t rise to the occasion, we fall to the level of our training
“If your actions inspire others to dream more, learn more, do more, and become more, you are a leader.” – John Quincy Adams
Mental practice can achieve similar results to actual practice. The mental process of rehearsing or simulating a practice is widely used by athletes and coaches to help improve performance
Do we need a Social Media Impact Factor (Social Media Index)?
- Pros: Helps curate content as the number of blogs is increasing, impact factor helps authors get promotion
- Cons: Based on flawed Alexa ranking (not all blogs use this), twitter and Facebook followers can be bought, popularity does not equal quality
- My thoughts: The point of FOAMed is that the best content rises to the top organically.
Teamwork was a huge emphasis at this SMACC. Be kind to others, work as a team, and its amazing what you can accomplish. (“It is amazing what you can accomplish if you do not care who gets the credit.” – Harry S. Truman)
The concept of cross-training kept coming up during SMACC. We need to learn from other specialities, just as they can learn from us.
Mental health issues are prevalent in medicine, in providers as well as patients. Tim Leeuwenburg (@KangarooBeach) gave an excellent talk on this topic. His main points:
- Vulnerability is OK.
- Be kind to one another.
- You are never alone with FOAM.

The above lessons came from so many great talks and I want to give credit to the speakers, so instead of listing on each lesson I will list them here:

Cliff Reid @cliffreid
Liz Crowe @LizCrowe2
David Newman (Not on twitter)
Chris Hicks @HumanFact0rz
Brent Thoma @Brent_Thoma
Iain Beardsell @docib
Tim Leeuwenburg @KangarooBeach
Oli Flower @OliFlower

Clinical Lessons from SMACC Chicago

Don’t forget to think about the Aorta in your differential diagnosis. If you don’t think about it, you will miss some lethal diagnoses. (Cliff Reid @cliffreid)

Aorta

Contemporary troponins have two major issues (Rick Body @richardbody):
- It takes 6 hours from symptom onset to rule out myocardial infarction
- It doesn’t rule out unstable angina
Acute myocardial infarction can safely be ruled out at 3 hours with contemporary troponin (Rick Body @richardbody & Louise Cullen @louiseacullen)

Contemporary Troponin

Posterior STEMI is 10% of all STEMIs and the most missed STEMI for cath lab upto 30% of the time. Don’t be fooled and think this is anterior ischemia. Get a posterior ECG to confirm (Amal Mattu @amalmattu).

Posterior STEMI

Lactic Acid is a marker of physiologic stress NOT specific to sepsis, but if elevated in sepsis means a poor prognosis for patient (John Myburgh @JAMyburgh)

BP + Lactate +28d Mort

The FEAST Trial: Intravenous fluid bolus increased 48 hour mortality in critically ill children. Important to note that this was an African study, with a high incidence of malaria (Kathryn Maitland @KathMaitland).
Peripheral Vasopressors are ok in critically ill, unstable patients in a proximal peripheral IV, for <6hours until central venous catheter is established (Paul Marik – Not on Twitter).
Knowing when to stop a resuscitation is very complex, can be done, but should be done with dignity (Roger Harris @RogerRdharris)
- Human life is precious
- Very little data on when to stop
- Most of us use anecdotal data to guide us
Respiratory Rate is the one vital sign least often recorded and most frequently omitted in hospital documentation, but a raised respiratory rate is a strong and specific predictor of serious adverse events such as cardiac arrest and unplanned ICU admission. (Link Here)