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See, that’s what the app is perfect for.

Sounds perfect Wahhhh, I don’t wanna
strangelyineffable thunderheadfred
thunderheadfred

Okay. It surprised even ME that I was able to complete Portrait of Madame C in less than 24 hours. So, I thought it might be neat to share the process, which sorta explains how I was able to whip through it. It’s the same process I learned while doing master oil studies in art school, only this time, I got to use Photoshop, which is approximately a million billion times easier.  and oh ho hoooo, if my painting teachers only knew the number of master studies I did at 3am, hauling canvases into critique with the oils still dripping wet…

Having the original to reference (unlike Sargent, who had to paint his own 8ft-fall masterpiece from scratch) was certainly key. I didn’t trace anything, though tracing CAN be useful for studies and note-taking, don’t let anyone tell you otherwise. I worked side-by-side with the masterwork the entire time, and used some conveniently perfect Sargent oil blender brushes from the Kyle Webster Photoshop megapack.

Above all, this was really fun to paint, as it’s long been one of my favorite portraits, and it was a great learning opportunity. It’s like having a great painter whispering clues at you from Beyond, which is… just… Neat.

1) Gesture - After studying the painting and taking some notes on Sargent’s sketch (including a gesture tracing) I used grid-lines alongside to mimic the gesture and landmarks, trying to get a feel for the original painting’s structure. 

2) Sketch - Using full-body references of David Tennant, I drew over my original gesture sketch to make a figure approx a foot and half taller (at a guess) than the original. I also broadened her shoulders and attempted a first pass at Crowley’s likeness

3) Color sketch -  I sampled key areas of color from the original painting, like blue-gray undertones, pale faint pink/salmon flesh, and those glorious emerald blacks. I was astonished to learn that despite the sumptuous richness of the blacks, nothing is black black. It’s all variations on extremely dark greens and blues and browns. Lastly, I widened the narrow original framing to accommodate tumblr’s bogus compression algorithm, which only allows 2x3 ratios.

4) Details - Refining brushwork, still trying to find Crowley’s likeness. At this point I showed the painting to my husband, who encouraged me to carve additional Tennant-like severity into the features. I superimposed my references to demonstrate how I work, with crap just pasted everywhere for quick glances.

5) Final - shown next to the original painting for comparison

p.s. - included some detail shots just for fun

p.p.s. -  yes. prints are available. thank you so much to all the folks who have asked! <3

OMG I LOVE EVERTHING ABOUT THIS POST i love seeing the process crowley is so beautiful good omens crowley my gender fluid babe
chubbycattumbling fullmetalrekishiya
thecutestcatever

I will never understand why some cats have a bread addiction like

No cat, …….you are a carnivorous predator.

You no eat bread

What are you even doing

thecutestcatever

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themintycupcake

My coworker who adopted one of Mona’s kittens gave him some bagel once and now he’s a mad bagel fiend. He had to put locks on his pantry so the cat wouldn’t break in and eat through the bagel bag.

f1rstperson

One of my cats was rescued from outside. I’d only ever had a super polite cat who would come up and sniff food and then be like “can i have this?”

So when this other cat came up I was like oh you wanna sniff the bread right? Here it is so you can sniff it. 

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Instead she just Jean Valjeaned the whole thing. 

thecutestcatever

Oh my god 😂😂😂

ace-and-ranty

I was super curious about this, so I googled it, and apparently: it’s the yeast! Cats are batshit for the taste of yeast, to the point where it’s used to flavoUr kitty food.

I also read that MOST breads should be safe in small quantities, but other types (like garlic or raising bread) can be dangerous, and raw dough is a big no-no. So! PSA!

regionstraumapro

What’s The Best Trigger For Your Massive Transfusion Protocol?

Every trauma center verified by the American College of Surgeons Committee on Trauma (ACS-COT) must have a massive transfusion protocol (MTP). The details and logistics of the protocol are up to the individual center. The difficult question is: how is a trauma professional to know that the MTP should be activated?

Sometimes it’s extremely obvious. The patient is very hypotensive. Blood is spurting all over the room. But sometimes it’s more subtle and the need just seems to creep up on you. And frequently, this delays activation and the actual arrival of the blood that is so desperately needed.

I’ve previously written about common triggers for the MTP, including psychic powers, shock index, and ABC index. See the links below to read my MTP week posts. But is one better than the other? The group at Vancouver General Hospital in British Columbia, Canada performed a systematic review of the literature to try to answer this question.

A total of 45 pertinent articles were identified in the literature up to 2017. Fifteen different scoring systems were evaluated involving combinations of clinical assessment, laboratory tests, and ultrasound evaluation.

Here are the factoids:

  • The best validated score using clinical assessment plus ultrasound was the Assessment of Blood Consumption score (click here for my post). This was the easiest to score compared to other systems using ultrasound.
  • Shock index (SI) was the only validated system using just the clinical exam
  • Some other studies were promising, with excellent areas under the receiver operating characteristic curve (AUROC), but had not been validated. The best of the bunch was one from Mina et al, but it is complicated enough to require a smartphone tool for calculation.
  • Other promising studies required laboratory evaluations which preclude their use at the time of patient arrival
  • Scoring systems that used more variables generally showed better correlation with actual need for MTP, but were more less likely to provide suficiently early predictions
  • Most validation studies involved single centers
  • No studies were designed to or able to show improved outcomes

Bottom line: There are many, many systems out there for predicting need for activation of the MTP (at least 15 to date)! This review concludes that the system used should be tailored to the center implementing it.

Simpler is better. I still recommend either Shock Index (SI) or ABC. Shock index is quickly calculated based on physical exam as heart rate divided by systolic blood pressure. The normal range is 0.5 to 0.7. The likelihood of MTP escalates 2x with SI > 0.9, 4x if SI > 1.1, and 7x with SI > 1.3. The ratio can easily be calculated based on numbers available from EMS providers prior to arrival. Basically, pick your threshold.

The Assessment of Blood Consumption (ABC) uses four parameters, three of which could be reported prior to patient arrival:

  • Heart rate > 120
  • Systolic blood pressure < 90
  • FAST positive
  • Penetrating mechanism

If two or more criteria are met, the patient has a 41% likelihood of needing MTP.

So basically, use a system that works for you. From my experience, centers that use a system tend to use ABC. But definitely pick a system, don’t leave it up to chance with the trauma surgeon. And use your trauma PI program to assess utilization to see if it’s the best tool for your center.

Related posts:

Reference: Systematic Reviews of Scores and Predictors to Trigger Activation of Massive Transfusion Protocols. Accepted ahead of print, J Trauma, 2019.

Source: https://thetraumapro.com/2019/07/15/whats-the-best-trigger-for-your-massive-transfusion-protocol/
Source: thetraumapro.com
MTP transfusion
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