Discover and read the best of Twitter Threads about #shock

Most recents (18)

La FA es la arritmia mas común en #Amyloidosis #Cardiaca ya que existe una predisposición en el depósito de fibras amyloides en el atrio y en adición a un aumento de las presiones intra-atriales, resultando una dilatación.
🚩: FA + Bajo Voltaje + LVH Image
Un 33% de estos pacientes presentaron trombo intracardiaco en autopsias, con un riesgo elevado de #shock cardiogenico.
El tratamiento es poco tolerada, ya que pueden provocar un estado de bajo gasto cardiaco y deterioro hemodinámico, por la fisiología restrictiva de la #AC

◼️Rythm: Amiodarona y Dofetilide

◻️Rate: bajas dosis de #BetaBlockers

🔲La ablacion por catéter a tenido grandes avances
Read 6 tweets
Al jaren noem ik ze de #GroeneMaffia en dan zeggen mensen: nou nou nou, tut tut tut. Ik moest er zelfs eens voor op het matje komen bij de krant waarvoor ik toen columneerde.

Maar zelfs ik ben in shock nu. De openbaarheid! Het misplaatste gevoel van morele superioriteit. =>
Maar vooral de domheid van de useful idiots die hier in meegaan. De gehersenspoelde suffers die straks de straffen uit mogen zitten.

Het totale gebrek aan wil tot waarheidsvinding, tot de dag van vandaag, over Volkert en zijn achterban.
Alles. Alles. Alles.

Doodeng. #shock.
Maar ga vooral door met vanaf je kreupele morele paard iedereen die niet in deze gekte meegaat tot extreem rechts bestempelen.

Maak deze zieke wereld nog gevaarlijker. En ja, dan bedoel ik jou @SigridKaag.
Read 8 tweets
Discussions about #FreeSpeech are misguided in the information age.

Even before our voices are drowned out by the noise on social media, or overwritten by information combatants, we lose our agency and decision autonomy to manipulative complex systems we don’t fully understand.
The whole point of the #enlightenment, the scientific revolution, our educational and #epistemic institutions was to empower individuals to find a way out of their self-imposed #immaturity, to take #agency over their lives and make informed decisions.
We need #epistemic clarity about reality, for without it, our agency will be blunted & our freedom a charade

It is public-interest education, journalism & science that truly make individuals in a #democratic society free, not the right to cast a vote or to elect a representative
Read 12 tweets

5+6= 11 More Hours—Stay Tuned. .

I truly can give the word & that word gives EVERYONE what they want, LITERALLY …

Is any of this about money? …
Is any of this about possessions/Materialistic objects ? ..
Has ANY of what’s unfolding ever been about the Gold?
In your mind, right this very second—Take it all away & show yourself what YOU see ..
- Take all evil away.
- Take all money away. ..
- Take all possessions Away. …
- Take all [NEED] away. .
- Take all Addictions away.
- Take all away that makes this world hurt & Thrive.
Once you have taken it all away, What/Who do you see? …

Starting from #ZERO, What is all YOU/EVERYONE [NEEDS] ? …

Out of the entire world population, how many would now know exactly what has been wrong with the world for THOUSANDS of years & know exactly how to-
Read 38 tweets
Lana Del Rey is a fan of a photograph taken of my father's home at 508 Macarthur St in Greenwood Mississippi. The photo is called The Red Ceiling (Untitled) Greenwood Mississippi 1973 by William Eggleston.
The Red Ceiling photo is part of Eggleston's Murderabilia collection. Eggleston claims he took the photo where my father was murdered at 103 Virginia St, but the photo was never taken there.
Eggleston is praying off everyone's emotions and grief by this claim he made.
Many people besides Eggleston cash in on my father's unsolved murder with lies and Murderabilia Eggleston is selling.
Some of the lies made about my father's murder are put with nude photographs taken of my father by Eggleston.
Like this nude photo of my father 👇
Read 13 tweets
🚨Ayer en #cafeclubdelconocimiento hablamos de #rcp y #guiasERC. Os dejo HILO cambios #SVAP :
- Ventilación con dos reanimadores si posible.(Uno sella-otro ventila)
- FR: 25/min (lactante)-20 (1-8a)-15(8-12a)-10(+12a)
- Desfibrilación: 4J/Kg. ⚠️Si + de 6⚡️ ➡️ subir hasta 8J/Kg Image
(2) Corregir causas reversibles: Hs y Ts
➡️Especifican los tratamientos específicos en las recomendaciones de manera más amplia que en las previas. #rcp Image
(3) Fármacos 1 💉:
- Adrenalina precoz si AESP/asistolia en cuanto via IV/IO disponible - Tras 3er ⚡️ en desfibrilables. Dosis 10 mcg/kg. Luego c/3-5min
- Amiodarona 5mg/kg tras tercer y quinta ⚡️desfibrilación
- Bicarbonato: no recomendada salvo hiperpotasemia e intox por ADT. Image
Read 18 tweets
Patient in Janus Jeneral Hospital with neutropenic septic shock. 3ml/hr of single strength noradrenaline - MAP 65, FiO2 30%, Lactate 7. CVP 5. UO 50ml/hr. CTPA negative for PE. AP4C on arrival. #vexus #echo #shock #FOAMed @GUH_ICU_Anaesth @IrishEMtrainees @ICSIreland
Has already had 3L of crystalloid pre admit to crit care.

RVSP = TR Max PG (18.4) + CVP (5) = 23mmHg
Overnight, lacto-bolo reflex sets in & gets 'maintenance' plus multiple boli of IV crystalloid b/c of high lactate.

In the am, increasing shocked state. On norad 20ml/hr SS, vasopressin max, adrenaline 5ml/hr to maintain MAP > 60.

RV & RA acutely dilated on focused US.
Read 7 tweets
Continuing the vasoactive meds week, we will talk about dopamine. It is a precursor of norepinephrine, inducing its release. There are dopamine receptors in the renal, splanchnic, coronary and cerebral vascular beds; stimulation of these receptors cause vasodilation. #critcare
Again, since our historical "nerdiness" was so well received, this is one of the first papers that talked about dopamin in shock:…
And this is their conclusion:"Because dopamine increases myocardial contractility, selectively redistributes perfusion to essential viscera and allows a pharmacologic titration of effect, it is a logical first-choice catecholamine for treatment of shock and refractory HF."
Read 7 tweets
📌Evaluación y manejo del #Shock en #COVID__19 🦠

•Entre el 5%-10% de los pacientes infectados con el virus SARS-CoV-2 🦠requieren UCI🏥

•Hasta 67% de shock en desarrollo

•Causa principal de muerte hasta en el 7% de los casos

•Factor contribuyente de☠️ hasta en el 33% ImageImage
1️⃣Shock distributivo
2️⃣Shock cardiogénico
3️⃣Shock obstructivo
4️⃣Shock hipovolémico Image
📌Shock distributivo

• Predominante: Séptico
•Limitada información de las coinfecciones
•11-18% coinfección bacteriana(extrapolación de SARS y MERS)
•𝐌𝐚𝐧𝐞𝐣𝐨 𝐜𝐨𝐧𝐬𝐞𝐫𝐯𝐚𝐝𝐨𝐫 𝐝𝐞 𝐥í𝐪𝐮𝐢𝐝𝐨𝐬
•Utilizar variables dinámicas
•Nora TAM > 65 mmHg

Algo nuevo⁉️🤷🏻‍♀️
Read 6 tweets
Not all hypotension is from hypovolemia. Then why load every hypotensive patient with #fluids? 🤔 An excerpt from a previous lecture. Very basic. Intended for #medicalstudent #MedEd
Experts, stay away 😄
First, what happens when somebody is hypovolemic?
The cardiac output drops
Unless doing #POCUS, we are not measuring cardiac output. We are measuring blood pressure. So, why does it drop? because it depends on the cardiac output!
Read 17 tweets
1/10 It’s hard to shut my mind off in the face of #COVID19. As #AcuteCareSurgeons our day/night/weekend jobs taking care of #injured patients and #patients needing #EmergencySurgery for abdominal and soft tissue diseases do not dissipate.
2/10 Yet we are also experts in #CriticalCare and need to prepare to care for patients w/ #respiratoryfailure and #shock due to #COVID19. We are implementing #plans based on the little evidence that exists while trying to stay #safe, #healthy, and #resilient.
3/10 We step into the trauma bay as others threaten to shoot our patient (but police can protect us). We do operations where rHepC/HIV risk is high (but PEP can protect us). We don't shy away from blood, feces or dead flesh up to our eyeballs (but we have #PPE to protect us).
Read 10 tweets
Kicking off @CRT_meeting #CardiogenicShock sessions: Pathophysiology by @drmortkern...
Don’t forget the RV: by #DrJamesGoldstein...
Trials and evidence (presence and absence) in #Shock treatment: by @thiele_holger...
Read 25 tweets
1/ THREAD: Body Language Analysis No. 4414: Alex Bozarjian, news reporter slapped by runner on live TV: "He took my power" — #Nonverbal #EmotionalIntelligence #BodyLanguage #BodyLanguageExpert #AlexBozarjian #Shock #Assault #ThreatAssessment #MeToo
2/ From a body language perspective, the perpetrator's jaw can be seen to be projecting forward [Jaw Jut]. In addition, his lips are pulled inward, between the teeth [Inward Lip Roll].
3/ This facial expression combination [cluster] is indicative of an adrenaline surge and consistent with Ms. Bozarjian's recounting of "it was a heavy impact" and "he hit me hard".
Read 13 tweets
People with courage exist.

We allow children to be kept in concentration camps.

America disgusts me.
I can't wait to go on trial for over 3 years of my life against #TheState!

The #CityOfPortland wants me in jail and I will demonstrate that my peaceful #FreeSpeech was both entirely truthful and correct. #Portland's City Council colluded with @G4S to sign a $10 million contract.
Mayor #TedWheeler's cowardly City Council rammed-through a new 5-year contract without public testimony, and while ignoring KNOWN PUBLIC DISAPPROVAL.

@G4S security also armed, trained & included #OmarMateen in their "security agent" ranks - the #Pulse mass-shooting killer of 49.
Read 9 tweets
More details on the schism between the Hazimis and lesser-extremists in #IS: Abu Anisa al-Dagestani, an Azeri commanded and Hazimi, blames the caliph's insufficiently stern position on takfir for the loss of land and men last year.
According to Abu Anisa al-Dagestani, the caliph reversed the May 2017 expansion by the Delegated Committee of the takfir ruling after his wife had a dream in which Abu Musab al-Zarqawi, Abu Muhammad al-Adnani, and Abu Muhammad al-Furqan came to his house and ignored him. #pt
The caliph reversed the May 2017 takfir ruling by a deft institutional manoeuvre: he invited its author, Ismail al-Ithawi (Abu Zayd al-Iraqi), to a meeting in August 2017 and threatened to kill him if he didn't reverse himself. #pt
Read 5 tweets
It's #12leadthursday-- time to test those #cardio skills! Look out for answers tonight so you don't miss a beat ☺️ #FOAMed #cardiotwitter
Read 6 tweets
Una de las cosas más maravillosas que te pueden pasar es enamorarte, ¿no?. ¿Quién no se quiere enamorar? HILO👇
Todo empezó cuando yo estaba pasando una etapa durilla. Me acababan de echar del trabajo.
Me había costado lo suyo tener algo de estabilidad laboral cuando... Pum! No sé qué de ajustes presupuestarios y que yo no era indispensable.
Read 213 tweets

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