When you encounter a patient with shock and hypotension , the first ( instinct ) response would be to start an IV line and push fluids rapidly . This is more so if the patient is a child. This is what medicine has taught us for over a century . Now this NEJM article surprises us with its conclusion.
The accompanying editorial in NEJM reiterates a fact . . . “In medicine there is nothing called dictum” , what you perceive as life saving treatment will be doing the opposite !
Such is the fragility of present day medical facts.
Please remember , in medical science not only the drugs have expiry date even some of the break through concepts suffer from it .
This study may not have great implications for cardiologists but the filed of cardiology is also infested with many such false dictum(s ) are waiting to be damned !
In this funny world . when the scientific methods are imperfect , we have to realise two such U turns make the original path right .
Similarly , some of those who do not make the initial path correction ultimately travel in the right path !
Message to patients
Many of my patients often wonder how two diagonally opposite views are expressed by doctors for a given medical condition . My simple answer to them is do not ever try to understand your medical condition beyond a point , . . . we our-self have not yet mastered it !
Dr.S.Venkatesan MD 
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