KDS

@Rainmaker1973 1 dollar? Might as well leave a nickel lol

POV: You started a towel war with the cleaner at your hotel [📹evinmaz]

@Bornakang that's crazy, i dont even watch that show and i knew

It’s crazy we all know exactly what show this is from

@strauss_matt @IM_Crit_ Please link evidence to show that fluid loading a distended RV with systolic dysfunction improves mortality.

@IM_Crit_ Please link evidence to show that inotropes prevent mortality in this situation.

Right ventricular (RV) involvement complicates >30% of acute inferior STEMIs, though hemodynamically significant RV infarction occurs in ~10–15% of cases. The classic teaching is that when a patient w inferior STEMI becomes hypotensive & has clear🫁on physical exam, the treatment

@IM_Crit_ As a CT/CC anesthesiologist, I have to remind myself that other specialities are not used to using peri-intubation push-dose pressors multiple times a day for years and years on end

ICU/ED Airway "Secrets": ~40% of endotracheal intubations (ETI) performed in the ICU or the ED result in hypotension, hypoxemia, or cardiac arrest Of all procedures, ETI is the one I find most intimidating & have the greatest respect for #foamed #foamcc #meded #medtwitter

@PropertyMan219 @samstein This same fuckin' retard probably thinks Trump has 30 sexual assault / harassment accusers over 40 some years and they ALL must be lying lol. Sit this one out, dipshit.

@samstein So democrats were just covering for him while he was useful, but now that he's a threat, they'll expose his nasty side. The compassionate left is a bunch of covert narcissists. Weird.

The accusations against Swalwell aren't he-said-she-said. They're well reported, fairly corroborated, detailed and damning. And while he's denying them, it's with precise language ("These allegations are false" v. I have never engaged in any such type of behavior). He has allies abandoning him (Pelosi giving the TKO) and, in all likelihood, more stories coming. This is unsustainable.

@SteveUrkelDude Market is desperate to go up. No idea why it would take Pakistan mediations seriously, though

This why we pumping? 2 week extension talks…

@SenateGOP You guys are fucking embarrassing cowards

Iran would be wise to take President Trump at his word.  They can choose the easy way or the hard way.

@BulwarkOnline What the fuck is wrong with you people..... Give the helm to Tim

"There are so many arguments against the war in Iran they practically write themselves. And frankly, the public doesn’t need persuading that it was a huge mistake. They already believe that. Democrats need not flatter Piker or his audience." lnk.thebulwark.com/4tBc0tb

@dubious_gal @ryangrim Her peltola post was an obvious logical fallacy to anyone with half a brain.

@ryangrim Muting someone over good faith discourse? I was on the fence about you and this is where you’ve lost me. She’s actually right and you’re just like Hasan.

As much as I've enjoyed this discourse, gonna have to mute this person. If you have so thoroughly lost a debate that you are now constructing psychedelic-level straw men -- lady, nobody ever claimed the only way to win a senate race in alaska is to go on hasan piker's twitch stream! -- you're not just debasing yourself but anybody who engages with you.

@BulwarkOnline I like Tim but about to unsubscribe from the bulwark post-haste

Hasan Piker "is drawn to political violence, whether it’s Hamas rapists, Mangione shooting a defenseless and innocent health care executive, or Putin pursuing his imperialist expansion. Sounds awfully familiar." lnk.thebulwark.com/4tBc0tb

@JC_ParetsX Deep underlying sentiment is bullish. Markets want to go up. But unfortunately we have the fucking dumbest, most chaotic, most irresponsible, most corrupt president of all time. Uncertainty kills.

The biggest tailwind is probably how many people still haven’t figured this out. They're too busy complaining to notice. Good.

@SarahLongwell25 I'll take logical fallacies for $500, Alex.

How is she doing this without going on DSA podcasts?

@SethMoldenhauer @IM_Crit_ If the BP is just hovering around 90 would not start with milrinone since it would be systemically vasodilating. My preference here would be dob+-norepi or epi. However, meds are just symptom control. Need to ask why RV is failing

@kdsvector @IM_Crit_ Like I said, that was my initial thought process but I talked myself out of it. We use POCUS to assess fluid status frequently in our ICU, so the increased IVC measure made me weary. Do you have a preference between dobi or milrinone?

ICU - Board Review Qs: 60 yo pt admitted to the ICU because of inferior STEMI. Emergency cath: 100% proximal RCA occlusion treated successfully with stenting One hour post-PCI: dyspnea/anxiety - BP: 94/70, HR: 60/min (sinus). Phys exam: JVD (+), clear lungs, cool extremities

@TheOneNamedAdam @TheOmniLiberal The right in Sweden is essentially the center-left here. Leftists in the US are advocating for universally popular things among all parties in Europe.

I’m from Sweden and also a social democrat (Socialdemokraterna). And I’m getting tired of the left fucking eating it self from the inside. The right is somewhat like in the US now unified in Sweden. And the other parties on the right have now also accepted to include the far right party Sverigedemokraterna to be included in the government if they as a coalition get majority in the upcoming election. And the left; what are they doing? Absolutely nothing, they can’t unify about anything it seems. They are torn between ”small” issues and wanting far to much say for their involvement in a possible government coalition. Sweden is soon gonna turn from being a beacon of equality to a far-right cesspool if they win this election. The real reasonable left need to stop supporting these absolute good for fucking nothing socialist and communists, that do nothing but create division and dissent in the left. I feel like when these people get the promoted views from the left, all they do is opening the possibility for them to steal votes and people that could be otherwise contributing to a more healthy left, instead of just wanting to burn everything down.

Don't worry, we already knew that. Socialists/commies will never support anyone who's electable. This is why it's better to turn out your base and appeal to the moderate elements of your base (something most Dem voters prefer anyway) rather than the fringe, weirdo margins who only support candidates with no chance of winning elections.

@SethMoldenhauer @IM_Crit_ The most important thing to keep in mind is that the LV is empty not because of global hypovolemia, but because the RV is unable to pump enough to fill the LV. The massively dilated IVC tells you there is enough volume- you just need inotropes to get it to where it needs to go

I see where you're coming from and that was my initial thought also, but then I considered the vasodilation of the inotropes. Also my understanding (I'm just a nurse), is they have far more effect on the LV than the RV, so wouldn't that have the potential to worsen LV filling 2/2 to increased SV and decreased filling? Or will the inotrop work on the RV enough? Obviously cath +/- RP Impella is the end point, but I was trying to stay true to the question. @CoffeeBlackMD, curious about your thoughts on this. Just trying to learn. I appreciate the convo 🤝

@SethMoldenhauer @IM_Crit_ Dobutamine does not typically cause systemic vasolidation or lower the MAP, especially if cardiac output is low. It can cause reflex pulm vasodilation, which is beneficial here. The RV is as responsive to inotropes as the LV.

@SethMoldenhauer @IM_Crit_ Inotropes +- pulm vasodilators plus Cath to make sure the stent did not go down is the right answer.

500 bolus. Right sided failure post PCI. So RV function is preload dependent. Even though it seems like there is elevated pressures on the right and IVC is dilated, we still need preload to force fluid through. Lactic is elevated due to decreased CO secondary to right sided failure and inadequate filling of LV. Dobi could help a little, but could potentially worsen the issue if the LV is empty. RV after load is not the issue so pulm dialator doesn't help much. Nitro, lol.

@donwinslow It's not surprising at all. If you don't use For You to scroll then it's all just nazi shit

I am shocked I am on here And horrified by what has happened to X/Twitter.

@mistergeezy @jonlovett You're a fucking idiot calling a dude who has been anti-racist for as long as anyone can remember "anti black"

Fuck you. Cory Booker doesn't owe an explanation. Has Barack Obama ever appeared on Rush Limbaugh? Why would you ask a Black US Senator to explain why he doesn't want to appear on an anti-Black platform? Are you slow? @jonlovett