#anti ntgs

[sovereignsystem]

Tumblr: Yeah. We're the cool, smart-but-chaotic side of the internet 😎

Also Tumblr: DID is an identity and all narcissist are douchebag abusers. Also I'm transautistic and transabused

[shitty-proendo-blackout-posts]

soup DNI

[sovsys-afterhours]

If you're feeling bad about yourself, remember; at least you're not as bad as an endo

[syscourse-confessions]

I am (diagnosed by a trauma specialist) traumagenic. I have DID.

I feel like being traumagenic comes with so much pressure. You cant support non-traumagen systems, it feels like. That's the reason i havent said anything on my blog. it feels like a hot take in traumagen world.

Tulpamancy is a bad word, I listen to what people say about it, specifically people who are from the groups having their culture appropriated... but non-traumagenic systems aren't all bad. I can acknowledge the parts of the whole community that can be improved while still being a bit of a fan of them.

You know what all of this reminds me of? Neopronouns. Bear with me.

I used to be disgusted by neopronoun users, when i was way younger. Before i used them, obviously. I bought all the rhetoric! "They make trans people look bad", "they make nonbinary people look bad!" "they're making a mockery out of us" "they have so many excuses!" "they aren't really nonbinary, they need to find a different word for it."

Sound familiar? I don't think i need to spell it out. Replace some words with others and you get anti-NTG syscourse.

I know pointing out similarities in discourse is not mind-blowing. You can do this with lots of things. But i feel like if you take a closer look, think about *posts* that you are *casually reading* EVEN IF ITS NOT ESSAYS OR ADVERTISEMENTS and even if you aren't boosting them, then you'll notice a good amount of syscourse boils down to kneejerk reactions, bad analysis of good facts, fair points that propose insane solutions.

You cringe at them, look at the science for traumagenic systems and say "they aren't like us, but they're using OUR resources and OUR words!" not even realising that they *also* need our resources and our words. They aren't appropriating our language, they're using it. Getting top surgery as a trans person isn't depriving breast cancer survivors, to use an analogy of a recent ask from an anon. The science doesn't even matter, and if they're trying to justify their experiences by proving they can be the same as us just sans trauma, that's because YOU have made them feel like they have to in order to exist. You make fair points about cultural appropriation, really good points actually, points that I can't contest and do not want to. You make good points about singlets and normies looking at NTGs as freaks and then dismissing our whole community. But then a lot of you decide that means all NTGs are ill-willed and that the opinions of fucking *singlets* should scare us into hating completely innocent people. You hate them.

I guess I'm unique in this discussion. I can't hate anybody as much as my abusers. All of my hate is away from syscourse, busy with other things. I'm not made of the stuff, it's a finite resource of mine. I guess I spare some for people who post videos of their children, people who are attracted to kids, etc. But those are obviously extreme people that I don't find myself encountering so often. I can't hate NTG systems because they aren't the types of people who would've caused any of my trauma. I guess it's my fault for setting that as the bar? You tell me. But I can't hate them, and the more that others do, the more sympathy I feel. The more I start to actually kinda like them, as a community. They don't seem like the types to tell me my trauma didn't happen, and that I'm not a system. They would never be the doctor who said I don't have DID just because I didn't know what dissociating was. They would never tell me I'm not traumatised based on my good grades. They just wouldn't, I've met a lot of them outside of tumblr. They're decent people, and they don't hate traumagenic systems. And yet I can think of traumagenic systems that have told me I'm not traumatised enough. Getting molested as a little kid and surveilled and shit wasn't traumatising enough! They had it worse :rolling_eyes:. I can easily picture a traumagenic system doing any of the bad things I just said NTGs wouldn't.

I hope someone out there considers all of this. At least enough to look at supporters and refrain from harrassing them and being disgusted by them (I've been bullied about it before. My heart goes out to NTGs that have to put up with bullying.)

By the way, are people allowed to submit things un-anonymously?

.

(Answering your question: You can post non-anonymously! Whatever your preference is.)

[fallloverfic]

@rise-ha replied to your post "hey hey so glad to have found you on tumblr...":

glad u enjoyed the ask! i posted the ask, but i think i accidentally | ticked the anon box lol i like how positive u r abt the characters and main ship. there’ve been other sites where readers/fans are anti-seth x anyone, and they prefer seth to end up w/ no one at all which always struck me as counter-intuitive to the themes of his character (loss of agency, narrative of his story, trust in family, etc.) like, how can he relearn trust without being around other people and overcome his curse without suffering and taking action to fix the problems he caused? plus seth doesn’t seem like the internal introspective sort- he needs external interference to make him realize he’s even feeling things (re: sekhmet and his self-destructive feelings in S1). it’s also canon that when isis was MIA seth just spiraled for centuries n did ntg to climb out of the abyss of angst.

ur hypotheses on what might happen is interesting… but on the memory loss. i agree with u that in canon it's unlikely horus will lose his memory upon ascending, but it's quite intriguing for fanfic fuel: seth not realizing how much horus meant to him until suddenly he means nothing at all to the god!horus. if you'd ever be into writing that haha i'm still slowly going through your existing ennead fics XD - thanks for the all the great content!

It's okay! It happens XD Tumblr is a strange existence and as you can see I too am not doing so well using it alkdjlaj (I apologize if I'm doing this wrong, replies are just clunky and this got longer than I expected).

But yeah I love the main ship and I love most of the characters :3 I climb walls about them adlkajdlak

I definitely have a "ship and let ship" approach for folks who want Seth to end up alone or with idk an OC or something. To each their own, folks can do whatever they want.

From a canon standpoint, I do find it to be a deep misunderstanding of his character that being alone would somehow be the "best" ending for him. After all, we have that panel in S01E40 where Seth says, "I was afraid... of being forgotten by them." One of the few things we know Seth wants for himself is to be loved and not forgotten, and this has been repeated a few times at this point. So him ending up alone would not be happiness for him. It would, like you mentioned, be right back where he was during his kingship: depressed and self-isolating to the point of suicide.

That being said, a lot of folks who are pro this position have acknowledged that while this would be a sad Seth, he would be less sad than if he ended up in any of the ships people stick him with, particularly the four tops. Which I would personally argue against, particularly after Seth initiated the kiss with Horus when he realized that Horus loves him and didn't want to forget him, both things Seth wants the most. Heck, even ending up with Anubis would be better than ending up alone, since at least Seth has wanted to follow Anubis. But what's personal autonomy and choice, I guess? -shrug- But again, to each their own! It's not what I write and I have no interest in it! But folks do for a variety of reasons, and more power to em!

I think it's perfectly fine for folks to make fanworks and headcanons about the potential for Horus getting amnesia! That's the awesome thing about fanworks :D My opinion only affects my own thoughts and fanworks, and other folks can do as they please! A few folks have tackled the amnesia thing before, and I wish them the best! I'm not the biggest fan of amnesia plots generally (and I generally can't stand permanent amnesia because I view it as character death), and I'm very particular when I write them, I just think there's enough ambiguity and stuff with Horus' powerset and background that it's not guaranteed in canon. This particular set-up is unfortunately not a plot I have any interest in writing, and the only ENNEAD amnesia plotline I ever wrote involved Seth having temporary amnesia, and it was in my Dear Monster/ENNEAD crossover. Anything can change, of course, and I never say never when it comes to fic writing, but it's one of the saddest plots I think about (which I imagine is amusing, given some of the terrible situations I put Seth in lol but brains are weird sometimes) and I have other things I'm prioritizing, so it's a bit unlikely.

I wish you luck with any fics you try :D And thank you so much for reading them!! <3 <3

hey hey so glad to have found you on tumblr. it was a bit hard for me to find content creators for ennead on this site, oddly enough

i saw some of your ask me prompts and i was wondering if you could do 4 and 10?

Hello!! And welcome :3 Thank you for the ask!! And yeah, tumblr is very quiet for the fandom. Twitter, pixiv, Ao3, and instagram are far more hopping.

I think this is for the ENNEAD ask me meme, so I'll answer based on that!

4. Who is your favorite character (if you have one)?

Shockingly I know, after publishing 48 fanfics that star or otherwise feature him in some fashion... it is Seth alkdjaldja he is best boi for me. Sad man, angry man. Love him. He's beautiful, he's tragic, he's fun. I love the way Mojito is exploring so many things with him, whether it's suicidal ideation, self-destructive tendencies, self-blame for things that are out of your control, cycles of violence, anxiety, responsibility... Just a lot of things. I love his power set (no pun intended). Shapeshifter characters have been my favorites since I was little (big fan of werewolves and shifters generally, and always have been, pretty sure it's why The Little Mermaid and other similar stories about water people who can change their shape have always stuck with me), especially when they can like dissolve into particles and reform. And I love his relationship with Horus. He's also really smart and can be quite thoughtful and I love how creative he is. Also I love when he gets into Situations. Angsty, whumpy man.

Second place is Horus. I love him so much. He's gorgeous, he's such a fun character, and he's hilarious. And his wings are so gorgeous T-T He and Seth are so cute and I go feral whenever I see them.

I like most of the cast, though.

10. How do you think ENNEAD will end?

I don't have good luck with guessing what Mojito will do intentionally, so take this with a lot of grains of salt lol I do have some luck doing it unintentionally when I write things into fics with like, "This would be cool if it happened", and then it kind of does lol And I do have some luck guessing what she won't do, so. Anywho.

We know Horuseth is the endgame ship, so they'll end up together. I assume they'll rule Egypt together in some fashion or, worst case, go off into the sunset together. Seth will fully get his powers back and the curse will be resolved. I imagine whatever's going on with Hathor's mirror will also be resolved (I think Nephthys was split into two people, and she'll be recombined and get all her memories back, and I think Hathor did it to take revenge for Ra). I'm still on the fence for whether Horus will actually "ascend" properly or not, or what that'll look like. He's kind of a strange demigod (Nut calls him the "link between the gods and humankind" (S02E44)), so I wonder if he won't actually ascend/he already has. But his ascension might also just be different than other gods, at which point I think Isis will step aside and let him rule fully on his own, with her help as needed. He doesn't marry Hathor. She gets booted out of Heliopolis. I also don't personally think he's going to lose his memory. He could, but on top of the circumstances around the whole "ascension involves memory loss" thing being still kind of unclear and questionable, he's a special kind of demigod/god, and his power involves knowing things. I think he'll be fine.

I assume Osiris will be defeated in Duat in some fashion (possibly by Seth, Horus, Anubis, and maybe FG) and just be stuck down there, stewing (Mojito likes sticking to the original mythology in a lot of ways, and I don't think she'd like... perma-dissolve Osiris of all people), and he and Anubis will be on more of a balanced power stance, and just sort of share a power domain. I feel like part of ENNEAD's conclusion will involve Anubis leaving his control and just coming into his own power entirely. And he gets his memories of Seth back to some degree.

I assume FG will head home after/around when we learn his name and the Egyptians will be like "huh, well idk who that was, but whatever, I guess we'll keep an eye on [FG's home country], though." Which... if it's Greece or Rome... -cringes a little-

I also hope that Anubis will have a heavily implied partner of some kind. It's not gonna be Seth, and I don't really think it'll be Khnum, much as I love that ship (though I'm rooting for it fully and he's as likely as anyone), but it could be Isis, too. Mojito did do some Anubis/Isis art years ago. I just want him to not be so alone.

I think Isis, Seth, and Nephthys will reconcile to some degree. I don't know that they'll be very close, but I think they will be on speaking terms, though I honestly think Seth and Nephthys are the least likely of the group for this to happen with. It depends on whatever is actually happening with the mirror. Seth and Isis are already on the path to reconciliation. Nephthys is the only actually sort of static one.

If anyone would like to ask more questions, here's the meme again :D

(If this is for the fanfiction author ask me meme I linked, I can answer that one, too! I just didn't know which meme it was, and assumed based on context it was the ENNEAD one)

[mcatmemoranda]

Acute MI Lecture by Dr. Viliane Vilcant

Typical angina = squeezing, tightness, heaviness, substernal CP that is brought on by exertion and relieved by rest or nitroglycerin. 2 out of 3 is typical angina.

Tall R waves in V1 and V2 = Posterior MI.

Think of arteries that correspond to leads.

Type 1 MI = STEMI Type 2 = demand ischemia Type 3 MI = sudden cardiac death before biomarkers available Type 4a = MI related PCO Type 5 = MI after CABG

Get EKG, H&P (focused), repeat EKG with troponins. Repeat troponins in 4 to 6 hours.

ST elevation more than 1 mm in two contiguous leads other than V2 and V3 is STEMI.

Hyperacute T waves = peaked T waves in Pt C/O sudden CP. Not just hyperkalemia.

Elevation of ST segment then occurs.

Then ST segment normalizes, then T wave inversion and Q wave.

Pathological Q waves = Q waves in V2 and V3.

New LBBB or isolated posterior MI also occur in STEMI. R wave in V1 and V2 should be short. R and S waves should be equal in V4. Tall R waves in V1 in a pt with CP can be posterior MI.

Sgarbossa criteria. Greater than 120 ms.

Troponin is most sensitive for MI. Troponins rise and stay high longer than CK-MB.

TIMI risk score more than 4 or 5 is high risk. It’s out of 7 points. TIMI score is more for unstable angina and NSTEMI to risk stratify the pt. If score is more than 5, you may want to cath the pt. TIMI predicts 30 day mortality.

Door to balloon time is 90 minutes. Less than 120 minutes if being transported to a hospital that has PCI ability.

If presented 2 to 3 hours after sxs started, give lytic and transport to PCI capable facility.

Lytics only given to STEMI pts.

Management:

O2 given if needed. Then ASA and P2y12 inhibitor (clopidogrel). Can give NTG (sublingual). If inferior wall MI or aortic stenosis or pt is hypotensive or taking ED dysfunction meds, you don’t give NTG. Give beta blockers within first 24 hours if no C/I. High intensity statin (Atorvastatin [Lipitor] 80 mg). Lifestyle modification. Can do noninvasive test for ischemia before discharge.

For NSTEMI, there’s a reduced O2 supply. No ST elevations, but have troponins. Higher rate of long term mortality because they’re usually treated conservatively (no PCI). Tx the NSTEMI with: ASA, plavix, beta blocker, high intensity statin, anticoagulation (unfractionated or LMWH, bivalirudin, or fondaparinux). Lovenox (enoxaparin) better than unfractionated heparin; dosed 1 mg/kg. Lovenox lasts 12 hours.

Early approach, delayed invasive approach, ischemic approach.

STEMI goes straight to cath lab. STEMI and NSTEMI should be on antiplatelets for 1 year. Pts who got stent needs anti-platelets for 12 months. If you need to stop antiplatelets, they should’ve been on them for a month at least before you interrupt them.

Elevations in aVR = left main coronary artery MI, which is really dangerous.

Complications of MI:

LV free wall rupture, rupture of interventricular septum, rupture of papillary muscles, acute mitral regurg. RBBB, LBBB, 1st degree AV block. 2nd degree and 3rd degree AV block. More common for inferior MI. Pericarditis (within days of MI), pericardial effusion (with or without tamponade), Dressler syndrome (weeks to months later). Never give NSAIDs to pts who just had MI. Can give NSAIDs for Dressler, since it’s long enough since the MI.

[thecentredoha-blog]

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[gellidiumcartilagineum]

MICROPARA:

Vibrio cholerae - comma shape

Doxycycline- use for prophulaxis and treatment of mild leptospirosis

Penicillin G - mild to severe leptospirosis

Brucella sp.: undulant fever

Borrelia recurrentis: relapsing fever

Chlamydia psittaci: parrot fever

Francisella tularensis: rabbit fever

Histoplasma capsulatum: bat fever

Culture on lowenstein-jensen medium - gold standard for the diagnosis of tb

DOTS - Directly Observed Treatment, Short-Course

2nd line agents anti-TB drug - Amikacin, Levofloxacin, P-aminosalicylic acid, Cycloserine, Streptomycin & other Aminoglycosides, Fluoroquinolones, Polypeptides, Thioamides

Typhoid fever doc: international:chloramphenicol, Philippines: ceftriaxone & ciprofloxacin

Penicillin - cell wall synthesis

Ampicillin + Sulbactam = Unasyn

Amoxicillin + Clavulanic acid = co amoxiclav

Cilastatin - added to imipenem to inhibit structural degradation by the kidney

Red man syndrome - adverse effect associated with vancomycin

Cycloserine - cell wall synthesis inhibitor also active for mycobacterium tuberculosis

E. Coli - most common cause of UTI

Cystitis - UTI only in urinary bladder, Fosomycin

Pyelonephritis - UTI affected kidney

Linezolid - drug selectively inhibits the 23s ribosomal RNA of the 50s subunit

Chloramphenicol - inhibits transpeptidation, alternative drug for typhoid fever

Malassezia furfur - tinea versicolor/ pyturiasis versicolor; KOH mount: spaghetti and meatballs appearance

Hepatitis B - the only hepatitis virus that is a DNA virus

Oseltamivir - DOC for influenza

Clostridium difficile - associated with antibiotic use

Corynebacterium diptheriae - chinese character arrangement, club-shaped

Listeria monocytogenes - tumbling motility

Entamoeba histolytica - flasked-shaped ulcer

Clindamycin - antibiotic for anaerobic infection above the diaphragm

Metronidazole - antibiotic for anaerobic infection below the diaphragm

Giardia lamblia - trophozoite: old man with glasses, traveler’s diarrhea

Balantidium coli - barrel shaped ulcers (amoebiasis - flask-shalped ulcers)

Ancylostoma duodenale (old world hookworm) & Necator americanus (new world hookworm) - causes iron deficiency anemia

Diphyllobotrium latum - causes megaloblastic anemia

Wuchereria bancrofti - tropical elephantiasis

Enterobius vermicularis - detection of the characteristic eggs on the anal mucosa

S. japonicum: rudimentary lateral spine

S. haematobium: prominent terminal spine

S. mansoni: prominent lateral spine

AMINOGLYCOSIDE SIDE EFFECTS:

Ototoxicity : NAK (Neomycin, Amikacin, Kanamycin)

Vestibulotoxic : SG (Streptomycin, Gentamicin)

Nephrotoxic : NTG (Neomycin, Tobramycin, Gentamicin)

[garden-of-everything]

ABIM: Cardiology

ABIM syllabus can be found here Let me know if you find any errors Sources: UWorld, MKSAP 16/17, Rizk Review Course, Louisville Lectures, Knowmedge (free version)

Hypertension

Essential Hypertension:  lifestyle modification first - >140/90 = thiazide only (ACEi if DM) - >160/100 = thiazide + __ (two drugs) Renal Hypertension: - woman with flank bruits, flash pulmonary edema - increased renin and aldosterone - treat with ACEi Coarctation of the aorta: - high arm BP, low LE BP; radiofemoral pulse delay, cold extremities, PVD-like cramping symptoms - AS murmur (early systolic murmur @ RUSB) - figure “3″ on CXR, posterior rib notching - if symptomatic, Tx with balloon dilation Hypertensive urgency: >180/120 Hypertensive emergency: urgency with end organ damage; Tx: IV Hydralazine Undifferentiated hypertension: - PCC (catecholamines) - Cushings (decreased K, metabolic alkalosis, hirsuitism) - Hyperaldosterone (decreased K, increased aldosterone:renin), etc

Pericardial disease

Acute Pericarditis: - within ~42hours post-MI; may have increased troponin - Tx with high dose ASA (NOT NSAIDs, NOT steroids) vs. Dressler: weeks to months after MI associated with fever, leukocytosis, pleuritic chest pain; Tx NSAID if >1mo from PCI/CABG Pericardial effusion: can be associated with malignancy - continue ASA or DAPT - leave it alone if asymptomatic Constrictive pericarditis: calcification on CXR (pathogmnomonic) - loud S3 (pericardial knock) and rub - ECHO shows swinging ventricular septum (NOT seen in restrictive CM) --> if indeterminate results: get hemodynamic catheterization - associated with liver disease and cirrhosis with ascites*, increased JVD but normal CVP - Tx with supportive IVF and vasopressor s--> pericardiectomy *if ascites present: ascites protein >2.5, SAAG >1.1 (vs. cirrhosis: ascites protein <2.5, SAAG >1.1)

Ischemic heart disease

Stable angina pectoris: - goals: BP <140/90, A1c <7%, LDL <100 - Tx: ASA + statin + beta blocker + ACEi if EF <35% (or if they have CAD equivalent) + Diltiazem or Verapamil to keep HR 55-60 Acute coronary syndrome:  PCI within 90 minutes > tpa within 30 minutes and then transfer to PCI hospital anyway. - PCI after 4 hours of continued pain + STE - tPA contraindications: CVA within 3 mo, brain cancer, major surgery within 3 weeks, BP>180/110, >10minutes CPR, pregnant - when to do CABG: left main >50%, LAD and prox Cx >70%, 3 vessel disease  MI complications: acute hypotension, heart failure symptoms - VSD:  palpable thrill --> obtain TTE; Tx: nitroprusside, pressors --> OR - acute MR / pap muscle rupture: acute pulmonary edema (may have holosystolic murmur) - free wall rupture:  death Coronary vasospasm associated with migraine headaches; Tx with CCB Heart failure from ischemic cardiomyopathy: *FYI: Metoprolol = okay even in COPD patients *FYI: decreased cardiac output in heart failure may improve with afterload reduction with Nitroprusside (may counterintuitively raise BP) - NYHA III-IV: Spironolactone decreases mortality - NYHA III-IV in AA patients: Hydralazine + Nitrates - ICD if EF <35% after 3 months of failed maximal medical therapy - BiV if NYHA III-IV with QRS>120 or NYHA II with QRS >150 - heart transplant if decreased vO2max Pacemaker settings prior to surgery:  change ICD settings to asynchronous pacing and disable shock

Dysrhythmias and conduction defects

*FYI: reperfusion arrhythmias after MI don’t need anti-arrhythmic treatment - WPW: decreased PR with slurred up broad QRS (delta wave); AVOID BB/CCB/Digoxin (may induce VFib); acute Tx with procainamide (*mnemonic: proCANUSamide treats WOLFf-parkinson-white) OR if unstable: cardiovert; ultimate Tx: ablation *be suspicious of WPW in Afib with broad/unusual QRS Bradyarrhythmias: Tx: atropine Tachyarrhythmias: Valsalva, BB (Metoprolol or Verapamil), CCB 1.  Regular rhythm: - Sinus tach (>100bpm) - AVNRT (p waves buried in QRS, but otherwise regular): Tx: adenosine - AVRT: decreased RP interval - Atrial tach: increased RP interval 2.  Irregular rhythm: - Afib: warfarin for CHA2DS2-VASC >1; for pre-op: hold warfarin and DON’T bridge - Aflutter: Tx: ablation > medication - MAT: >3 p waves Other: - VTach: wide QRS (”tombstone”); Tx: BB, Lidocaine, Amio, shock - Torsades: Tx Magnesium

Congenital heart disease in adults:

Atrial septal defect: fixed split S2 (mnemonic: “split ASs” (a butt has a crack in it so it’s split into two cheeks)), EKG shows RAD with partial RBBB - often discovered with pregnancy - close if symptomatic (orthodeoxia/platypnea) or RA/RV hypertrophy Patent foramen ovale: don’t worry about it.  Start ASA if cryptogenic stroke. Bicuspid aortic valve: very young patient with syncope and weird systolic or diastolic murmur (can be either, but most often associated with AS); evaluate for dilated aortic arch PDA:  continuous machinery murmur; pulmonary HTN and LE cyanosis (vs ToF cyanosis which has cyanosis of all extremities) VSD: loud holosystolic murmur that obscures S2 with palpable thrill --> may also develop pulm HTN, R to L shunt, AR (blowing decrescendo diastolic murmur) or TR (holosystolic murmur that radiates to liver) Pulmonary regurg:  decrescendo diastolic murmur at LSB that increases with inspiration, may present with parasternal heave, associated with Tetralogy of Fallot repair

Valvular heart disease

* see Heart Sounds post for more detailed valve disease facts *if mechanical heart valve, even if pregnant, DO NOT STOP WARFARIN (and aspirin). Aortic stenosis: - systolic crescendo decrescendo murmur at RUSB that radiates to the carotids, - decreases with Valsalva, increases with squatting - pulsus parvus et tardus (delayed carotid upstroke) - preload dependent state (DO NOT GIVE NTG) - severe <1cm or mean TV gradient > 50mmHg = Tx with valve REPLACE, otherwise Tx with diuretics and ACEi Aortic regurgitation: - blowing decrescendo diastolic murmur that radiates to the apex - associated with Marfans, aortic dissection, Syphilis/aortic aneurysm - chronic Tx with ACEi, Nifedipine - acute Tx: valve REPLACE with nitroprusside, IV diuretics and dobutamine/milrinone for support Mitral regurg: - associated with chordae rupture after MI --> acute pulmonary edema/cardiogenic shock - Tx: nitroprusside, diuretic, BB, ACEi +/- dobutamine/milrinone if hypotensive - Surgical Tx: REPAIR > replace (unless hypotensive) Mitral stenosis: - rumbling diastolic murmur with RHF symptoms - often noted in pregnancy, associated with Rheumatic Fever - Tx: BB, CCB --> if <1cm^2 or <1.5cm^2 with exercise limitation or gradient >5-10 or pregnant: valvotomy.  *NOT a surgical candidate if there’s MVR. Tricuspid regurg: holosystolic murmurat LUSB that radiates to the liver Pulmonary regurg:  decrescendo diastolic murmur at LSB that increases with inspiration, may present with parasternal heave, associated with Tetralogy of Fallot repair Prosthetic valve: if suspected dysfunction, go straight to TEE - choose bioprosthetic valve if patient has high bleeding risk (mechanical valves need AC) - mechanical mitral valve INR 2.5-3.5 (all other goal including aortic valve = 2-3) - all need 81mg ASA

Heart pressures:  “nickels, quarters, dimes” RA --> RV --> PA --> wedge/LA: 5 --> 25/5 --> 25/10 --> 10mmHg

Myocardial disease

Heart failure with preserved ejection fraction: candesartan decreases hospitalization (not mortality) Myocarditis: elevated trops --> cardiogenic shock, arrhythmias --> Tx: supportive care + HF treatment Hypertrophic cardiomyopathy:  Autosomal Dominant (AD), LVH + LAE with deep inverted T waves in V3-V6 - have carotid bisfiriens pulsus , murmur that increases with valsalva and decreases with squatting and prolonged handgrip - at risk patients 12-18yo: f/u TTE Q12-18 mo; >18yo, Q5 years - all HCM patients need genetic counseling - avoid strenuous exercises; Tx: BB/CCB +/- disopyramide --> surgical myomectomy/septal ablation --> fail/not candidate: ICD placement Restrictive cardiomyopathy:  amyloid (neuro, ocular, liver symptoms), sarcoid (Dx: MRI with gadolinium), XRT, anthracycline, hemochromatosis (cardiomyopathy with transaminitis) Dilated cardiomyopathy: acute myocarditis, EtOH, cocaine/amphetamine (avoid BB; Tx with CCB), GCA Peripartum CM:  LVEF 45% 1mo pre- to 5 mo post-delivery; Tx with early delivery and HF Tx (make sure to hold ACE/ARB/Statins until AFTER delivery given teratogenicity) Takotsubo:  apical ballooning; Tx BB Heart transplant: - symptoms <1 year: rejection --> Dx with endomyo bx - symptoms > 1 year: vasculopathy --> Dx with angiography

Cardiac tumors:  atrial myxoma needs to be surgically removed

Endocarditis

Endocarditis: - FROM JANE - Tx Abx 4-6 weeks - suspect abscess when there is increased PR interval/conduction delays Endocarditis prophylaxis:  dental only (with gingival involvement) with Amoxicillin or Clindamycin for h/o cardiac transplant, prosthetic valve, or previous bacterial endocarditis

Vascular disease

Carotid artery disease:  if pacemaker, LBBB or structural heart issues --> chemical nuclear perfusion scan Thoracic aortic aneurysm: - type A: repair vs - type B: monitor with TEE (as below) and Tx with BB, Nitroprusside - <3.5cm: Q3-5 year US *counsel against pregnancy if >4cm - root <4.5cm: Q1 year US - >4.5cm: Q6mo US - >5-5.5cm or >1cm/year: repair Abdominal aortic aneurysm: *screen male 65-75yo smoker with US - Dx acute aortic dissection with MRA or CT (NOT US); Tx with BB - Surgery if >5.5cm or >0.5cm/year or symptomatic; monitor Q6mo PAD: - ABI<0.9 - PAD - ABI>1.4 suggests DM or calcification = false normal --> get toe:brachial index - Tx: supervised exercise > Cilostazol (Cilostazol is CI in HF, EF <40%) SVC:  associated with coarctation; facial/neck vessel plethora

Syncope

*be sure to r/o (1) exertional syncope from AS/HCM, (2) PE --> pulmonary HTN, (3) arrhythmia (no prodrome) Neurocardiogenic / vasovagal syncope: ECG only; can send home if it’s obvious Situational syncope: can occur after elderly person eats; can get tilt table testing if recurrent/high risk of injury Postural hypotension: associated with orthostatic secondary to hypovolemia, drugs or autonomic dysfunction (DM, Parkinsons plus); Dx: carotid massage

Preoperative consultation

*FYI: stop warfarin 5 days prior to surgery and bridge with Heparin after INR 1.5 only if at high risk (h/o clots, mechanical valve) --> resume AC within 24 hours *FYI: if recent PCI, delay elective procedure 4-6 weeks after BMS or 1 year after DES; if urgent procedure, continue DAPT throughout if within the minimum time limit.  If beyond minimum time limit for BMS, but still within 1 year, hold Plavix 5 days before and continue ASA. *FYI: okay to go to surgery if BP <180/110 No testing required: >4METS, low risk Sx (endoscopy, superficial, breast, ambulatory procedure) Testing indicated: MI w/n 30 days, acute HF, arrhythmia, severe valve disease, vascular surgery

Lipid disorder = #1 risk factor for future MI

- goal: keep LDL <100 or <70 if CAD + other risk factor

Other

- Eisenmenger cyanosis is NOT improved with O2 supplementation (so don’t bother giving it to them) - Tamponade triad:  (1) JVP, (2) distant heart sounds, (3) hypotension, ((4) tachycardia); will also have pulsus paradoxus (>8-10mmHg difference between inspiration and expiration), Kussmaul (increased CVP/JVD with inpsiration), right atrial collapse - Aortic atheroemboli: cholesterol embolus/Hollenhorst plaque (bright cholesterol in retinal artery) --> transient vision loss, digital gangrene, livedo reticularis or CVA/AKI following invasive coronary procedure; Dx: biopsy - Subclavian steal:  UE PAD --> dizzy with arm use; Dx: bilateral UE BP’s (difference of 15mmHg) - a sudden rise in end tidal CO2 is the earliest indicator of ROSC during CPR

[mdifilm]

Synco Mic-D2 comparing to Sennheiser MKE600, 416 and Rode NTG3 from Johnny Wu on Vimeo.

Synco's Mic-D2 Shotgun Microphone Compared with Sennheiser MKE600, Rode NTG3 and Sennheiser 416

This is tested in an actual film environment settings in mind, not a laboratory scientific test, at the end of the day, it's up to the listener to decide which microphone works best.

Get a chance to win a Synco Mic-D2 microphone! Follow the instruction below to and on December 15, 2019, Synco will select a lucky winer for their microphone! #syncoaudio #mdifilm #microphone #shotgun

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SYNCO Mic-D2 is a Shotgun Mic shielded with brass metal body which provides strong anti-interference ability and solid construction. Universal Gold-plated shielded 3-pin XLR connector is used to achieve better signal transfer and at the meantime with extremely low self-noise.

intro: 00:00 Indoor: 1ft distance Synco Mic-D2 : 02:46 Sennheiser mke600 : 03:32 Rode NTG3 : 04:03 Sennheier 416 : 04:48

2ft distance Synco Mic-D2 : 05:46 Sennheiser mke600 : 06:16 Rode NTG3 : 06:57 Sennheier 416 : 07:35

3ft distance Synco Mic-D2 : 08:38 Sennheiser mke600 : 09:05 Rode NTG3 : 09:52 Sennheier 416 : 10:35

Outdoor test: Synco Mic-D2 : 12:03 Sennheiser mke600 : 13:43 Rode NTG3 : 15:34 Sennheier 416 : 17:20

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[imchanbaektrash]

baek is my bias too

ahh anon, back when baekyeon was confirmed, both baek and tae got a lot of hate. They called him a ‘traitor’ and over 1800 ‘fans’ signed a petition for him to leave exo.

apart from that, as much i love him y’all have no idea how much i adore this lil 

he did a few inappropriate actions when he was younger and I’m not gonna just blindly defend him just because I love him so much:

1. involved in underage drinking and smoking 

2. insulting autistic children

I admit that what he did was wrong, but everyone does something wrong at some point of their lives right? No human is a saint. There’s a reason why we’re humans, we make mistakes. I know many fans (especially new ones) don’t know about this matter because SM tried covering it up.

Anyway, I’m sure Baekhyun has matured after so many years and he is sorry for committing such things. 

I’m not asking for y’all to worship him. Just please, don’t hate on him. He isn’t perfect, but nobody is. 

To non-fans of Baekhyun, y’all don’t have to stan Baekhyun if you don’t want to. But as a bbh stan, it hurts to see him get so much hate and death threats. He even has to take anti-anxiety medications. My heart hurts for him.

He has changed and I hope his future actions will prove it to you. 

sorry this turned into a mini rant i still love my bby so much and i want to do ntg but protect him 

[sovereignsystem]

Screenshot:

^ do they know they're talking about themselves? Whose gonna tell em?

- ❔ (it/he)

[shitty-proendo-blackout-posts]

If you support endos, you're supporting me too.

[sovsys-afterhours]

I used to think the majority of the online mental health community was intelligent, well read, educated individuals; however, after seeing so many of these online spaces falling into the same trapdoors of misinformation and harmful language, I think I'd be more inclined to believe otherwise.

[pharmaldape-blog]

Study Guide

Anticoagulants in General-1

Low Molecular Weight Heparin-3

Warfarin-3

Heparin-1

Lipid Therapy—1

Congestive Heart Failure and drugs that reduce afterload-1

Digoxin-5

Terazosin – 1

Beta Blockers-3

Pt teaching in Hypertension-1

Cardiac Glycosides-1

Anti-dysrhthmics-1

Nitroglycerin (NTG)- 4

Aspirin (ASA)-1

Lipid levels-1

Statin drugs-2

Spironolactone (Aldactone)-3

Diltiazem (Cardizem)-1

Furosemide-2

Hydrochlorothiazide (HCTZ)-1

ACE Inhibitors-3

tPa (Tissue Plasminogen Activator)-1

Thrombolytic therapy in general-1

Antihypertensives in general-4

Multi drug therapy for hypertension-1

Beta blockers for CHF-1

Nicotinic Acid-1

[sovereignsystem]

By the way, endos (NTGs) coming up with derogatory terms for trauma survivors is the most disturbing shit ever. Like I cannot believe that shit actually happened.

-🧟‍♂️ (He/him)