When we see operators using a successful procedure or just best practices we want to share it with the rest of the community. Take a look at this month’s finds.
1. ↓ These chicken breasts just came out of the fryer. This crew is totally on their game, ensuring the proper kill step temperature of 165F for 15 seconds or more was achieved. They also document it. Way to go!
Case: A 63-year-old woman with a long history of hypertension faints after experiencing the sudden onset of severe chest pain that radiates to her back. She is rushed to the ED. Upon arrival she is agitated and demands immediate relief. Her HR is 110 bpm and BP is 90/50 mmHg. Jugular veins are distended. An intraarterial catheter shows significant variation of systolic blood pressure related to the respiratory cycle. Chest x-ray shows significant widening of the mediastinum. What is the most likely cause of the patient’s syncopal episode?
Let’s break it down:
Long history of hypertension (HTN) - higher risk of stroke, myocardial infarction (MI), heart failure, aortic dissection.
Severe chest pain radiating to the back - what internal blood vessel is retroperitoneal? why, did someone say, aorta? Add in the HTN, and you’ve got (most likely) an aortic dissection!
But the question isn’t asking what happened to the patient, they’re asking why she had a syncopal episode. Her BP is low, which we call hypotension in the medical world. Let’s look at the other info. Physical exam shows jugular venous distention, or JVD. “Variation of systolic blood pressure related to respiratory cycle” - a lot of words for the medical term pulsus paradoxus. Okay, but WTF is this “pulsus paradoxus” shit?
Normally when you breathe in, the pressure in the chest cavity becomes negative in order for air to go in, like a vacuum. The same is also true for the right side of the heart. During inspiration, more blood gets sucked into the right heart, causing the volume of the right heart to become larger. Since the heart has a limited amount of space, the extra filling of the right squishes the left side of the heart slightly, which means less blood gets pumped out to the systemic circulation. So, normally when you breathe in, your systolic blood pressure will drop a little, around 10 mmHg. But pulsus paradoxus is when there is MORE than a 10 mmHg drop in systolic BP with inspiration. Oooohhh…
Now we have: aortic dissection + hypotension + JVD + pulsus paradoxus. Together this equals cardiac tamponade, one of the most dangerous consequences of aortic dissection. (Hypotension, JVD, and muffled heart sounds are classically known as Beck’s Triad, which is associated with tamponade.) Aortic dissection (tear in the inner wall of the aorta causing blood to go in and separate the layers) can rupture into the pericardial sac around the heart, causing blood to accumulate in the sac and put pressure on the heart. The heart doesn’t like other things squeezing it, because it limits the amount of blood that can go into the heart. And when you decrease the amount that goes into the heart (preload), you automatically decrease the amount that goes out of the heart (cardiac output) - which is a bad thing. Syncope, or fainting, can be caused by decreased blood flow to the brain.
Hope you’ve enjoyed this moment of medical knowledge, brought to you by USMLEWorld Qbank. Now back to your regular scheduled programming of emo landscape pictures and random pictures from the imgur gallery.
Anonymous asked:
feltelures answered:
I started out answering this by saying I didn’t think it was a big part, but I’m already revising that opinion. No matter what, though, I think it’s unavoidable that Tain would have influenced the way Garak relates to Julian—and everyone else, for that matter, but for the purposes of this, I’ll just stick to him.
Oftentimes, with an abusive parent, the child will either emulate them or completely reject their means of behaviour, without much middle ground. Certainly, it’s possible to see echoes of Tain’s observation training with Garak (if you go by A Stitch in Time’s canon) in his early interactions with Julian. We don’t see Garak really starting to react against Tain until Improbable Cause/The Die is Cast, and even then, he’s still trying to win Tain’s approval, so you could argue that even if he is starting to find a different way of interacting with people, it’s largely on a subconscious level.
I would say that I can see less of Tain’s influence in the way Garak interacts with Bashir in later seasons, when he seems to regard Julian as more of a peer than someone he needs to help to stop being quite so naive (though given he’s still trying to get Julian to be more pessimistic as late as Season 7, you could argue that he’s just given up).
Tain telling him that he should have killed his mother before Garak was born, as well as what I assume Tain’s interactions with Mila would have been like (for example, he wouldn’t have been affectionate with her in front of little Elim!), wouldn’t have helped with the formation of Garak’s ideas of what healthy intimacy looks like, either. Given he didn’t have a positive relationship to pattern his own ideas about that sort of interaction, I’d say he would have some pretty odd ideas of what’s “normal” in a relationship that Julian would find undesirable or even alarming.
Relatedly, as my friend Ben pointed out when I rambled at him about this a bit last night, I definitely would say that the job Tain ensured Garak would do had a big impact on the way Garak treats Julian. I imagine he would have significant problems with intimacy, as I mentioned before, particularly in public spaces. After all, he would have learned that it was a weakness that could be used against him, or something that could be used against other people.
All that said, I like to think that Garak would have eventually been able to start sorting out the toxic shit Tain had indoctrinated him with, even if it would be a very difficult road and would require a great deal of patience on his part—and on Julian’s part. But, well, that’s my preference for narratives involving people breaking free from their abusers; I’m very sure there are other ways to read this as well.
…Hopefully this makes at least some sense, given I’ve been thinking about it since last night. It’s just hard to put into words.
This interesting. You should read it.
Good article with some really good points to consider.
“Around once a week, her husband tried to reach through the invisible barriers she built — the going up to bed early, the intense concentration on a book, the hoping he was too tired to want anything but sleep. “He’ll move closer to me in bed, or put his arm around me, or rub my back.” She willed herself not to refuse him. And mostly, she didn’t. Usually they had sex about four times each month. But it upset her that she had to force herself and that she put up those barriers to deter him from reaching more often.
“I’m scared that if it’s slimmed to this by now, what’s going to happen as we get older?” she said. “I want to stay close, not just psychologically, physically. I want to stay in love. I have a friend, they have sex so intermittently, every three months. She is so unhappy. I don’t want that to happen to me.” She longed for a cure, a tab of magic. As she got into her car in the parking lot at the center, she hoped that her first set of pills had been placebos, that she’d been given fakes for the first eight weeks, that today she was driving away with the real drug and that their sex life would be transformed.”
chequerootlurks
I’m an apprentice tattoo artist. An artist who owns a few shops invited me to their team.
I’ve got a long way to go. I’m still learning basic shading techniques. Working with a tattoo pen adds depth to the traditional flat plane I’m used to working on.
One is never too old to learn a new skill.
At times I feel like a complete newb.
So, here is a meme that I love. I’m sharing it for everyone who is learning something new.
