Fab

ROSALÍA revela lo que piensa sobre la selección argentina: — “argentinos triplehijueputas”, manifestó la motomami.

@pepistolera1 Yo sabia que los argentinos eran retrasados pero nunca tanto 😭

La cancelación a la Rosalia me parece una estupidez grande como una casa

Quiroz destruyendo Chile, menos mal yo solo tengo gatos, uds tienen hijos y están hasta el pico.

Oye no sean malos con el Presidente Kast, no ven que les regaló un cupón para comprar gas.

La única emergencia real para este gobierno era bajarle los impuestos a los ricos.

Imagina ser argentino, gastar hasta lo que no tienes para ir a la final y ver a tu país perder 😭

justin bieber, madonna and shakira

Csm que mal

🫀Macrocirculation is only the beginning. For decades, haemodynamic resuscitation has focused on restoring blood pressure, cardiac output, and oxygen delivery. These variables remain essential, but they do not guarantee that oxygen actually reaches the cells that need it. Tissue oxygenation is a sequential physiological process with three interconnected levels. First, the macrocirculation transports oxygenated blood through the heart and large vessels. Second, the microcirculation distributes that oxygen according to local metabolic demand through arterioles, capillaries, and venules. Finally, the mitochondria use oxygen as the final electron acceptor in oxidative phosphorylation to generate ATP. Organ function depends on the integrity of every step in this cascade, not simply on blood pressure or cardiac output. This explains why a patient with a mean arterial pressure of 70 mmHg and a normal cardiac output may still develop tissue hypoxia and multiple organ dysfunction. Oxygen delivery can appear adequate while microvascular flow is severely impaired, a phenomenon known as loss of haemodynamic coherence. This is particularly relevant in sepsis, major trauma, burns, and acute pancreatitis, where optimization of macrocirculatory variables alone frequently fails to restore tissue perfusion. The determinants of oxygen delivery are also worth remembering. Oxygen delivery (DO₂) is the product of cardiac output and arterial oxygen content (CaO₂). Arterial oxygen content depends predominantly on haemoglobin concentration and arterial oxygen saturation, while dissolved oxygen contributes only minimally under physiological conditions. Increasing FiO₂ without correcting anaemia or low cardiac output often has far less impact than expected. Even when oxygen reaches the tissues, the final determinant of survival is mitochondrial function. If mitochondria cannot utilise oxygen efficiently because of inflammation or metabolic dysfunction, ATP production falls dramatically and cells switch toward anaerobic metabolism with lactate generation. Cellular oxygen utilisation is therefore as important as oxygen delivery itself. The clinical implication is profound. Modern haemodynamic management should move beyond treating numbers. Mean arterial pressure, cardiac output, haemoglobin, tissue perfusion, lactate, venous oxygen saturation, and, increasingly, microcirculatory assessment should all be interpreted together. The goal is not simply restoring circulation but ensuring that oxygen successfully completes its journey from the lungs to the mitochondria. This shift from macrocirculation to cellular oxygenation represents one of the most important physiological concepts in perioperative and critical care medicine. Reference 📚 Meier, J. British Journal of Anaesthesia, 136(6), 1761–1775. doi.org/10.1016/j.bja.…

These people will say shit like “trans people are mentally ill”

Así me imagino al wolf parkinson white

@mcb030594 Yo pensando esto después de 28 horas en el hospital

Yo levantándome 5 am todos los días para ir a la pega y hay gente que no le trabaja un día a nadie u.u

Se debería estar discutiendo el aborto libre y no esta mierda de escuchar los latidos.

【Durations of Therapy for Diabetic Foot Infections】 Let's remember the typical durations of therapy for DFI! (of course case by case) Level: Intermediate @CIDJournal @Cortes_Penfield @JonathanRyderMD @DGArmstrong @TzeWoeiTan @limbsandlungs @IDSAMedEdCOP

Mientras casi todo Chile está bajo alerta meteorológica nos metieron por la raja la peor reforma en la historia del país

@carlos_hansen @lamarce_harr Quienes?

@lamarce_harr También hay varios de izquierda investigados por delitos varios

Con 3 Senadores investigados por CORRUPCIÓN la derecha gana tranquilamente las votaciones. Y nadie cuestiona nada. Increíble!!

La megarreforma ganó por 2 votos. 3 de ellos fueron votos de senadores de derecha PROCESADOS por corrupción.

Critical Physiology Series #5 Pulse Pressure in Critical Care: The Hidden Story Between Two Numbers Pulse pressure is simply the difference between systolic and diastolic blood pressure. Although it is one of the easiest variables to calculate, it is often one of the most overlooked at the bedside. Pulse pressure reflects the interaction between stroke volume and the properties of the arterial system. A large stroke volume ejected into compliant arteries produces a wider pulse pressure. A small stroke volume or a marked reduction in arterial compliance changes this relationship. A narrow pulse pressure is frequently a sign that stroke volume has fallen. This may occur in hypovolemic shock, cardiogenic shock, cardiac tamponade or massive pulmonary embolism. In these situations, the heart ejects less blood with each beat, resulting in a smaller difference between systolic and diastolic pressure. A wide pulse pressure tells a different physiological story. It may be seen in distributive shock, where profound vasodilation lowers diastolic pressure while stroke volume is initially preserved or even increased. It can also occur in conditions such as severe aortic regurgitation, hyperthyroidism or advanced arterial stiffness. Pulse pressure should never be interpreted alone. A patient with a pulse pressure of 20 mmHg may be experiencing severe circulatory failure, but the underlying mechanism could be hypovolemia, pump failure or obstructive shock. Clinical examination, echocardiography and the overall hemodynamic profile remain essential to identify the cause. Changes in pulse pressure over time are often more informative than a single measurement. Progressive narrowing despite fluid resuscitation or vasopressor therapy may indicate worsening cardiac function or persistent hypovolemia. Conversely, widening of pulse pressure after appropriate treatment often reflects improved stroke volume and cardiovascular performance. Pulse pressure also forms the basis of dynamic indices such as pulse pressure variation, which can help identify preload responsiveness in selected mechanically ventilated patients. However, these indices are only reliable under specific physiological conditions and should not be applied indiscriminately. At the bedside, pulse pressure is much more than the distance between two numbers. It is a physiological clue that helps us understand the relationship between ventricular ejection, vascular tone and arterial function. Recommend readings 📚 Michard, 2000, DOI: 10.1164/ajrccm.162.1.9903035 Cecconi, 2014, DOI: 10.1016/S0140-6736(14)60626-5

He pensado hace días a quién podría llevar y no se me ocurre, ojalá alguien como Fran Valenzuela

i’m the second biggest procrastinator behind george r r martin