Gustavo Calderón V. 𒉭

@UChileEM @monkeyem monkeyem.com , blog de Medicina de Urgencia d Chile para el mundo! Está empezando pero vamos c/todo! #FOAMed

Webinar “Hantavirus Cardiopulmonary Syndrome: Lessons Learned from Chile”. 🗓️ Lunes 11 de Mayo 2026 ⏰ 10:00 horas, (GMT-4) Modalidad: Online, Gratuita. Inscripciones: forms.gle/H6pJWVPm4j3MCd…

🍽️ ICU nutrition: we’ve been doing it wrong for years? More calories More protein Earlier feeding Sounds logical But physiology disagrees ⚠️ The key update High-quality RCTs now show: ❌ Early full-dose nutrition → NO benefit → Potential harm Especially in: • Shock • Multiorgan failure • High metabolic stress 👉 This is not neutral 👉 This is dangerous practice 🧠 Critical illness is not static It evolves through metabolic phases: 1. Acute catabolic phase 2. Stabilization phase 3. Recovery phase 👉 Feeding must follow physiology Not protocols 🔥 Phase 1: Acute catabolic • High inflammation • Insulin resistance • Endogenous substrate mobilization 👉 The body is NOT ready for full nutrition 💡 Strategy: ✔️ Permissive underfeeding ✔️ Low protein Why? Because early overload leads to: • Hyperglycemia • Hepatic dysfunction • Renal stress • Impaired autophagy 👉 You are feeding dysfunction, not recovery ⚖️ Phase 2: Stabilization • Inflammation decreasing • Organ function improving 👉 Now metabolism starts to tolerate nutrition 💡 Strategy: ✔️ Slow escalation ✔️ Daily reassessment ⚠️ Red flags: • Hypophosphatemia • Hyperglycemia → Patient is NOT ready 💪 Phase 3: Recovery • Anabolism returns • Mobility improves 👉 NOW nutrition matters most 💡 Strategy: ✔️ Higher calories ✔️ Higher protein ✔️ Combine with rehab 👉 This is where you rebuild muscle and function 📊 The real takeaway Nutrition is NOT: ❌ A fixed prescription ❌ A calorie target It is: ✔️ A dynamic therapy ✔️ A metabolic intervention 🎯 The new principle “Start low Advance judiciously Individualize throughout” 👉 Precision ICU nutrition ⚠️ Final thought Overfeeding early harms Underfeeding late harms 👉 Timing is everything 📚 Stoppe C et al. Curr Opin Clin Nutr Metab Care 2026 DOI: 10.1097/MCO.0000000000001186

Saher Alghorra (NYT) has won the Pulitzer Prize for Breaking News Photography for "his haunting, sensitive series showing the devastation and starvation in Gaza"

🇮🇱 "ESTAMOS MATANDO COMO NO LO HACÍAMOS DESDE 1967": Israel se jacta de su agresiva doctrina en Cisjordania sn-esp.site/cx6v

Marjan Yeshayayi, a member of the Tehran Jewish community, asked rescue workers not to use machinery [to clear the rubble] in order to preserve the scriptures. “When I made the request, I did not believe they would accept it, but instead they said, ‘OK, we will remove it manually,’ and they really did. Each brick was removed by hand, and the scrolls came out safely and were handed over to the Jewish community. rt.com/news/639415-te…

The lack of news on Gaza isn’t because the genocide is over. It’s because Israel slaughtered the journalists and Western media pretends there’s a ceasefire.

Lebanon is the second most-documented genocide in history after Palestine, yet the most denied.

🇦🇶🇨🇱 | Puerto Williams es la Ciudad mas Austral del Mundo, no Ushuaia

The level of complicity of the @BBC in the ethnic cleansing of southern Lebanon is shocking. I am listening to their Jerusalem correspondent report that the ‘IDF are striking Hezbollah targets’ while I’m on the ground in the middle of it watching men, women and children being killed on a daily basis. My colleagues are being executed. Paramedics are being systematically murdered. All of this is happening in plain sight and the BBC correspondent here in Lebanon knows it. May you all be put on trial for your deadly propaganda when the time comes. Shame on all of you, especially those on the ground who are too cowardly to speak out.

🔴El Ejército israelí arrasa un convento y una escuela católica en el Líbano abc.es/internacional/…

Mientras tanto en Cunco, Chile, las cabras usan las garitas para protegerse de la lluvia 😀😀😀

Respuesta Metabólica al Estrés en la Enfermedad Crítica 💥🏥 🔰📚Annals of Intensive Care 2025 doi.org/10.1186/s13613… Enlace a Artículo Completo👇🏻🆓✅ t.me/SoMELaguna

Ciudadano palestino: "Tengo documentos que prueban que esta es mi casa." Ben Gvir: "Me da igual. En 2 horas se van o morirán." Un día cualquiera en Cisjordania.

🫀⚠️ Post-resuscitation vasoplegic shock: are we targeting the right physiology? After ROSC, we often focus on blood pressure. But the problem is much more complex. 🧠 What is really happening? Post-resuscitation shock is not a single entity: 👉 Myocardial dysfunction 👉 Vasoplegia 👉 Relative hypovolemia ➡️ And their contribution changes over time in the same patient 📌 Current standard ✔️ MAP target: ≥ 60-65 mmHg ❌ No strong evidence supporting higher targets (>70 mmHg) 👉 Higher MAP may improve myocardial injury and cerebral oxygenation 👉 But no clear outcome benefit 💉 Vasopressor reality • Norepinephrine = first-line • Epinephrine → ↑ mortality, arrhythmias (observational data) • Dopamine → ↑ arrhythmias ➡️ Catecholamines are necessary… but not harmless 🔥 The hidden problem: vasoplegia Driven by: • Ischemia-reperfusion injury • Cytokine surge • Nitric oxide overproduction • Vasopressin deficiency ➡️ Leading to loss of vascular tone and responsiveness ⚖️ Are we overusing catecholamines? High adrenergic load may cause: • Myocardial injury • Arrhythmias • Immune dysregulation • Receptor desensitization ➡️ This is why catecholamine-sparing strategies are emerging 🧩 What about vasopressin? ✔️ Physiological rationale exists ✔️ May reduce catecholamine exposure ❌ No strong evidence for routine use post-ROSC ❌ Possible ischemic risks 📊 Key concept: hemodynamic phenotype Not all patients are the same: • Early phase → low CO + high SVR • Later phase → high CO + low SVR ➡️ Same MAP ≠ same perfusion 👉 This is where multimodal monitoring becomes essential 🚨 Critical insight Optimizing MAP alone: ❌ Does NOT guarantee microcirculatory perfusion ❌ Does NOT ensure organ protection 🔥 Take-home message Post-resuscitation shock is: 👉 Dynamic 👉 Heterogeneous 👉 Frequently oversimplified And: ➡️ Vasopressor therapy should be individualized, not protocolized 📚 Jendoubi A. et al. (2026) Critical Care doi.org/10.1186/s13054…

Aprovechando el #DiaDelNiño Recordar el concepto de #BabyLung. del ya finado L Gattinoni. 👶🫁 El pulmón en SDRA NO es "rígido" sino es pequeño (poco distensible) pues el área ventilada correspondería al de un #niño entre 5-6 años. -El área ventilada no es un sitio anatómico. Es una zona funcional, cambiante (Zona dependiente y no dependiente).

🔴🔴🔴The detainees of the Freedom Flotilla, who were kidnapped and taken to the Greek island of Crete, have been released... After being subjected to brutal beatings and severe abuse, resulting in deep wounds and serious fractures at the hands of the oppressive entity... 📌📌Share this and tell the world about the brutality of this occupation

Israel es responsable de casi dos tercios de las muertes de periodistas en 2026. efe.com/otras-noticias…

🔵#LaTerceraPM | Apartheid hídrico: el nuevo foco de la escalada de violencia contra los palestinos en Cisjordania latercera.com/mundo/noticia/…

Israeli authorities have used access to water as a weapon against Palestinians, systematically depriving people in Gaza of water in a campaign of collective punishment. Our latest report has the details: msf.org/israel-uses-wa…

This is Yaroun in South Lebanon, right now. One of the oldest villages on Earth. Israel has annihilated everything. Every home destroyed. Every sign of civilian life erased. A village that stood for over 3,000 years — wiped off the map.