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In highschool on my wall I had an American flag, the constitution and a painting of George Washington praying next to a horse or some shit so any one can become a socialist if they want to.
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vogueress, RN
48.3K posts
vogueress, RN retweetledi
The “Everyone is 12 now” theory truly is foundational for our times.
William Turton@WilliamTurton
A source sent me this photo of Kash Patel’s customized Nike’s. The shoes feature a number 9 (Patel is the 9th FBI director), a Punisher skull (a vigilante killer from Marvel Comics), and his personal logo (K$H). The backs of the shoes show the FBI motto: "Fidelity, Bravery, Integrity". Patel was photographed wearing them at an FBI Academy event that featured UFC fighters.
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@virgo_tendency @elizabethbelsky It’s quite abnormal for modern Mormons.
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@elizabethbelsky maybe i’m not woke enough but it’s insane that yall are making it seem like he’s some kind of predator and completely ignoring the context of the show. they’re mormons? do you really think an age gap like that is abnormal for them???
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"Intimacy issues" is such a funny way to say this young woman was sexually abused as a 6-year-old, married the GROWN man who groomed and impregnated her when she was 15-16, and once she started processing all that, she didn't want to have sex with him anymore. SHE'S FREEEEE
Bye Wig Hello Drama@HousewivesHub
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@johnsemalhuis @Hragy That’s the way to go if you have the blood stores. Blood can be replaced relatively quickly and easily, cardiac muscle cannot be replaced quickly or easily
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Im once thrombolysed a guy back in the day with a bleeding ulcer and an LAD STEMI in a rural hospital.
In the days of streptokinase , which was a bit of an unguided missile.
Nearest clever doc like you guys was 200 miles away , which may as well have been the moon.
Gen surg had a tantrum.
Small town . I knew him and he had 4 kids.
He lived after many units of O- and some judicious scoping. Sometimes roll the dice....
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Talking about evidence and guidelines.
One day I was walking into hospital to do my cath lab list,there was a medical doctor with anterior STEMI,on an ambulance trolley by the patient lift, he vomited a huge amount of blood, it was not my case, i took it from basement to Cath lab
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@UFGators352 @ross_prager How long did you run it for? It can be 10-15 minutes before you start seeing improvement in hemodynamics and up to an hour before you see the full effects.
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@ross_prager @slippish When I added milrinone to rv failure it didn’t help. I thought it was indicated in rv/PH?
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Learning hemodynamics is hard.
I created a simulator that let's you titrate vasopressors, inotropes, vasodilators, and fluids across different hemodynamic states.
How can I make this even more realistic? Still some hemodynamics responses to optimize. Try it and let me know👇
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@Pete24674598463 @drjohnm Because humans are bad at understanding long term benefits. We are bad at doing things now that will only benefit us in the somewhat distant future.
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I’ve said many times that statins are the most studied medicine ever and there is a consistent 25% relative risk reduction in major cardiac events. Close to certainty as it gets.
But. But. If you use the verb “need” and statins together you fail evidence based med
Siyab Panhwar, MD@DrSiyabMD
A greatly under-appreciated side effect of niche academic debate on twitter is that everyone else (aka gen public) can see it too. While other docs rightly call out obvious misinformation, John comes out and says well actuallyyyyyy, if you look at the data, he’s not *actually* wrong! See?! What others see: hmm Aseem Malhotra is making sense… hey look an esteemed cardiologist using papers to support Aseem Malhotra’s claim, looks legit! 🤔 Do you think people realize the nuance that the actual problem (the “fuss”) is not that data itself but the fact that it is being intentionally misused to push a dangerous and misleading narrative that might influence people who actually need their statin the most, to stop taking them? No. Why should they either? John could have used this opportunity to really highlight that, but he didn’t. Interesting. The problem is not the data, it is the messaging and narrative.
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@ross_prager It’s impressive how good it is already! Had fun messing around with it.
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@slippish Good call, will improve that logic. I have it built in for RV failure and inhaled NO but should have it penalize use of alpha in some circumstances
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@IM_Crit_ On a positive note maybe the doctors at my hospital will stop ordering UFH for PE patients. It’s crazy how many patients aren’t fully anticoagulated until they have been on the heparin gtt for 24 or even 48 hours. It’s frustrating doing so much work for inferior results
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@tazmanldn @anaesthetic_spr Yeah… I could see the argument if they were not responding to pressors at all, but plenty of people in septic shock don’t respond to fluids, and are drowsy and hypoglycemic. Unless they are on chronic steroids jumping to adrenal crisis with that info is hunting for zebras.
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@anaesthetic_spr In no defence to ACPs whatsoever as I dont think they should exist, based off your description of the case there is no reason on the face of it to suspect an increased risk of addisonian crisis - please educate me
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Someone spent more than 15 minutes explaining to the ACP in ED why they needed to give IV hydrocortisone to a drowsy, hypotensive, and hypoglycaemic patient who was not responding to IV fluids and was at risk of an Addisonian crisis.
ACPs know nothing about niche presentations and tend to treat everything as sepsis/dehydration.
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@idiotdoesart @utacult All sorts of dubious lawsuits are allowed to go through, and there are “doctors” whose only job is to lie on the stand as “expert witness” for money so those dubious lawsuits end up winning. It’s one of the major problems on US healthcare.
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@utacult i just know saw that one reply and thats crazy how did they even get that lawsuit to go through
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@austincamp I imagine you would have to somehow get a good sputum sample from a patient who isn’t coughing lol
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@OvercastPatriot @tagdemnbagdem @ObviousRises Well he is wrong there too, he was a Ronald Reagan supporter and far from liberal.
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@tagdemnbagdem @ObviousRises I believe he's talking about the stereotypical mindset of a Cali liberal. Not literally a Californian.
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I remember seeing the movie Into The Wild and thinking he was the biggest dumbass, rich spoiled liberal douche fresh out of (paid for) college thinks he can brave ALASKA (the last frontier) with ZERO survival training or knowledge and everything would be handy dandy? He brought minimal gear/survival equipment and would literally have died the first night had he not found the bus, he refused to take advice or even buy a map (a local literally offered to draw him a free map to a safe place/area and he said "he didn't need it") the dude was 100% the perfect example of a liberal Californian and was an absolute arrogant retard.
Oh and (because I just have throw this in there) the dude was so lucky he actually scored a whole moose, instead of properly preparing/storing it and keeping it cool he let it rot.
You know what F*CK Christopher McCandless he got what he deserved.
Sorry but this shit just makes me so mad. The blatant and absolute disrespect for not only Alaska but for wildlife and nature itself, I hate smug liberal Californians so much its unreal.
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@imAustinFeldman @MLFootball His mom is but all evidence points to him no longer being an active Mormon
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PUKA NACUA WAS DRUNK OUT OF HIS MIND GOING CRAZY IN THE STREETS LAST NIGHT.
💀💀💀
What the hell…
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@chloroprocaine @nickmmark @PulmCrit Sure, but if you take someone who is competent at both they are going to fail to be able to get a PIV more often than they are going to fail to be able to get a central line.
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@nickmmark @PulmCrit PIVs are not harder than central lines if you’ve done more PIVs than central lines
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This is all wrong.
All *may* be able to draw back blood. All are fine for pressors. All come with thrombosis and infection risks. PIVs are often harder to place.
CORE IM@COREIMpodcast
2/ Length 💧Short: Peripheral IV - Easy to place - No pressors/chemo/TPN or draw blood 💧Longer: PICC and triple Lumen catheter - Use for pressors/chemo/TPN and can draw blood - Risk for clots and infection 💧Midline: - No pressors/chemo/TPN or draw blood - Secure
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@TheFigen_ And ladies... I BEG YOU... stop with the horrible Septum piercings.
I have NEVER met a man who likes them (in fact the exact opposite).
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@Sigue_adelante0 @DrAkhilX Thrombectomy window is 6 hrs in all cases and 24hrs when perfusion imaging shows a small core relative to symptoms or a small core with a large penumbra
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vogueress, RN retweetledi
DON DRAPER: "We quiero many things. Family, safety, love. But this guy--"
(Taps drawing of chihuahua)
"There's only one thing he quieros."
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There is not actually a way to defend against Russian ICBMs once they are fired. If they actually ever fired them they would fire so many that we wouldn’t be able to stop them. That’s the whole point of how US and Russian nuclear systems are set up. Owning Greenland doesn’t help.
Nik Bhatia@timevalueofbtc
At my daughter's friend's birthday party yesterday and pulled out this map from the WSJ as a conversation starter, there was almost no scenario in which this wasn't going to happen
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@LiffersGert @TrackYourHeart If you damage or occlude the brachial artery there is a whole lot of tissue at risk of ischemia, possibly the whole arm below the elbow. If you damage or occlude the radial artery at worst a couple fingers are at risk, but usually even those are okay due to flow from the ulnar.
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@LiffersGert @TrackYourHeart I mean they kind of do. The radial artery is what is usually used now, which turns into the brachial artery. It is better to access that artery down at the wrist though b/c easier to compress and there is collateral flow to the tissues it supplies through the ulnar artery
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The most serious acute complication of PCI is:
a) Coronary dissection
b) Coronary perforation
c) Acute stent thrombosis
d) Contrast nephropathy
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