#noreps

[vector418]

MoT #643 Clyburn Says Elders Must "Talk Some Sense Into Young Voters"

[populationpensive]

Shock

Time for the learning! A quick breakdown of the 4 types of shock so all you students getting pimped on rounds will be freakin' bosses. In all seriousness, this is vital to understand and if you're thinking of emergency medicine or critical care, it is extremely important to get this down pat. Remember, septic shock and hemorrhagic shock are SUBCATEGORIES, not one of the 4 main types.

When you think about shock, generally think about someone who (usually) has a reversible problem that causes enough hemodynamic instability that they require vasopressors. Essentially, cardiac output is reduced. Depending on the etiology of the shock, the symptoms can very. Before thinking about shock, it's important to understand cardiac output.

Stroke volume is defined as the volume of blood (in L/min) that exits the left ventricle per heart beat. More specifically, this is EDV-ESV of the left ventricle. You've learned about the Frank Starling Curve - I'm choosing to explain it a little differently without using the curve.

I think of heart rate as being a response to a certain change in stroke volume. Two of the three components of SV are proportional.

When preload increases, stroke volume increases. When afterload increases, stroke volume decreases.

Preload is referred to as end-diastolic volume, i.e. the amount of blood in the ventricle at the end of diastole and prior to ejection through the aortic valve.

Contractility is the amount of cardiac muscle stretch prior to ejection.

Afterload is the amount of pressure the left ventricle must overcome to eject blood through the aortic valve. You can think of this as systemic vascular resistance.

When thinking about shock, think about what components of stroke volume are possibly being effected.

General symptoms of shock: hypotension, tachycardia, bradycardia, confusion, delirium, LOC, dizziness, lightheadedness, general malaise, febrile, sweating, pallor, shortness of breath

In the treatment sections below, please consider your ABCs first.

Hypovolemic

Main problem: there isn't enough volume in circulation to support normal hemodynamic function. Not enough preload.

Examples: dehydration (vomiting, diarrhea), hemorrhage (loooooong list of etiology), pancreatitis, severe insensible fluid loss (big burns, open abdomens), etc

Subcategory: hemorrhagic shock

Treatment: fluid or product resuscitation, stopping the source of bleeding

Obstructive

Main problem: something is compressing the heart or creating a circulatory blockage which disrupts normal hemodynamics/heart function. Afterload is increased.

Examples: tamponade, tension pneumothorax, PE, severe STEMI.

Treatment: reduce the afterload. Dependent on cause - pericardiocentesis, needle decompression, chest tube insertion, anticoagulation/ thrombectomy, cardiac angio/catheterization.

Distributive

Main problem: something is causing volume to be dispersed in places that it should not via severe vasodilation. Blood vessels are so vasodilated that adequate tissue perfusion doesn't occur. Disruption in preload via reduced afterload (systemic vascular resistance). This type of shock is also referred to as vasodilatory shock.

Examples: bacteremia, large burns, polytraumatic injury (or anything particularly inflammatory like anaphylaxis), spinal cord injury, TBI

Subcategory: septic shock, neurogenic shock, anaphylactic shock, shock due to adrenal crisis.

Treatment: increasing systemic vascular resistance with use of vasoconstricting drugs, +/- treating the infection, reducing inflammation (steroids)

Septic shock is tricky because CO can be maintained for a time. The heart will compensate by increasing the rate, which is why septic patients routinely have HRs well over 120 bpm. But the increased HR is a sign that SOMETHING ISN'T right. If you have a patient with a new, increased HR, do NOT simply treat with a beta blocker (you'll probs code them if they are septic). Think WHY is the HR increased? If you need a vasopressor for a septic patient, norepinephrine is ALWAYS the first choice per Surviving Sepsis Guidelines.

Neurogenic shock presents itself differently because the etiology of the vasodilation is decreased sympathetic tone. Because of this, you'll have a hypotensive patient who is also bradycardic. Seen in patients with new spinal cord injury most commonly and sometimes new TBIs. These patients need MAP goals, usually over >80, with the help of a vasopressor to keep them out of a shock state. Any pressor will do, generally if my patients aren't excessively bradycardic I'll use phenylephrine.

Anaphylactic shock is unique due to it's rapid development and more immediate risk to the airway. Intubating these patients is the first priority. The vasopressor of choice is epinephrine.

Shock due to adrenal crisis should first be treated with high dose hydrocortisone. Any pressor will do (though to be honest, I have never had a patient in adrenal crisis myself, so suggestions welcome). This type of shock has some secondary concerns like sodium and calcium loss that need to be corrected immediately. It's most commonly triggered by dehydration so fluids are a must.

Cardiogenic

Main problem: pathology within the heart is causing disturbed hemodynamics. Increased afterload OR increased preload (think right heart failure). Reduced contractility. It's the one form of shock that is less likely to be reversible, ie. if you have structural heart disease of any kind, that's not reversible.

Examples: chronic heart failure (left or right), cardiomyopathy, severe aortic stenosis, Takasubo's, STEMI, ventriculoseptal defect, ventricular outflow obstruction (LVOT obstruction).

Treatment: depends on etiology but generally involves increasing contractility by adding an inotrope like dobutamine, milirinone, etc. Correcting or improving the underlying issue can improve things. These patients often need vasodilating agents to reduce afterload. If they are too sick for an intervention, they may need ECMO, IABP, or LVAD/RVAD to bridge them to improve enough for a procedure.

Overall Message

When you have a patient with low blood pressure requiring vasopressors, think about the underlying etiology to figure out the differential. Don't look at clinical symptoms separately - there is often a bigger picture at play. Also worth nothing that multiple kinds of shock can exist in the same patient OR treatment for one type causes another.

Good luck!

[chasityorn]

Application Error The application could not run because of the following error: Details Type: HttpException Code: 0 Message: cURL error Maximum (5) redirects followed: 47 (https://curl.haxx.se/libcurl/c/libcurl-errors.html) for https://twitter.com File: lib/contents.php Line: 284 Trace #0 index.php(7): RssBridge->main() #1 lib/RssBridge.php(15): RssBridge->run() #2 lib/RssBridge.php(88): DisplayAction->execute() #3 actions/DisplayAction.php(136): TwitterBridge->collectData() #4 bridges/TwitterBridge.php(222): TwitterBridge->getApiKey() #5 bridges/TwitterBridge.php(531): getContents() #6 lib/contents.php(138): _http_request() #7 lib/contents.php(284) Context Query: action=display&bridge=Twitter&context=By username&u=IFinestQuotes&norep=on&noretweet=on&nopinned=on&nopic=on&noimg=on&noimgscaling=on&format=Atom Version: dev.2022-06-14 (git.master.c2c88e9) OS: Linux PHP: 7.4.33 Go back Find similar bugs Create GitHub Issue arnd-s "Start a day of happiness and get free stuff In my Bio"

[soglitterchaos]

Application Error The application could not run because of the following error: Details Type: HttpException Code: 0 Message: cURL error Maximum (5) redirects followed: 47 (https://curl.haxx.se/libcurl/c/libcurl-errors.html) for https://twitter.com File: lib/contents.php Line: 284 Trace #0 index.php(7): RssBridge->main() #1 lib/RssBridge.php(15): RssBridge->run() #2 lib/RssBridge.php(88): DisplayAction->execute() #3 actions/DisplayAction.php(136): TwitterBridge->collectData() #4 bridges/TwitterBridge.php(222): TwitterBridge->getApiKey() #5 bridges/TwitterBridge.php(531): getContents() #6 lib/contents.php(138): _http_request() #7 lib/contents.php(284) Context Query: action=display&bridge=Twitter&context=By username&u=luvisss_&norep=on&noretweet=on&nopinned=on&nopic=on&noimg=on&noimgscaling=on&format=Atom Version: dev.2022-06-14 (git.master.c2c88e9) OS: Linux PHP: 7.4.33 Go back Find similar bugs Create GitHub Issue arnd-s "Get happiness and free stuff In my Bio"

[miss-v-is-fine]

I saw something in my work mailbox that looked like a little treat, but when I pulled it out, it was just a packet of mayo like you would get from curbside pickup???

Anway, last day of parent teacher conferences today. There is one I'm dreading, but I'll also probably have more unfilled spots today, during which I can do paperwork. I finished my ESY determinations yesterday, so I could use the time to revise and send NOREPs.

[444names]

Names generated from atomic and subatomic particles combined with atomic and subatomic particles backwards, excluding the letter "Q"

Accelem Acham Acside Acsino Acsivark Anarino Angam Anoulg Anoum Anoydark Anoyna Antalop Anticxe Antino Antinoton Antivarb Antivarg Antohpivark Axionanoixa Axionauark Axiongeon Axioniton Axionneg Axions...

Bosemon Bosemoton Bosivarb Bosob Bosobsggsid Bosoni Bosop Bosottosop Boticxe Botohpivark Brana Brangeoniz Brantonirts Brauarg Brauaton Braud Braviphon Bravison Chamele Charb Charinorels Chark Chartcele Chartuen Chyon Chype Dilaccele Dilarb Dilarg Dilargih Dilark Dilartuens Dilas Dilat Dilcun Dirtcele Dirtsdlog Dirtuenitom Discaron Dislog Disloperon Disob Dison Disotnark Duaron Duartuengam Dyonartcele Dyonitalg Dyono Edilark Ediscark Elcun Electrangam Electrojam Elekton Eleon Elepyh Elsivark Epyhc Excitauark Excitet Exciticxe Genitnat Genuclepton Geonirtuen Geoniw Gineutrino Ginoimryks Glark Glasmoton Gluinoimuon Gluinoum Gluonar Gluoni Gluoniralid Gluxon Gluxona Golaben Golarg Golaron Golaton Goldstimp Goldstivark Goldstom Golsid Grachark Grahca Grahcalid Gralid Gralp Grauark Higgih Higginflark Higginon Higgsboside Higgsinoum Higralide Higrat Hyonitino Hypele Inflyew Inoele Inoldstana Inonixa Inoson Inotohp Inots Inoynantino Ionilark Ionimp Ionison Ionitna Isggsbosop Islog Isonitnarg Kraccatop Kracferp Kradyon Krahc Krahcark Kralferon Kralid Krall Kralog Kralp Krana Kranano Krangeon Kranoum Krantaud Kranticxe Krantino Krantohp Kranyonixa Krativark Kratomsalat Krauangam Krauarb Krauarg Krauark Krauatsdlog Kraud Kraun Kravislop Kravison Kravitna Kravitnarg Kraviton Llaron Llaun Luenirtueno Luens Luinon Luinoton Luinottob Luinoyd Luonafermiw Magnantohp Magnatongam Magneutraun Magneutron Magno Magnon Magnoum Mahcalid Majorele Majorep Melem Merojam Meron Mesob Mesoniulg Mongam Mopels Motalid Motinflark Motinottohp Muineboson Muino Muinoimreon Muonepyhc Muoni Muonimryks Muonirtcelp Muonirups Muonislog Muonitna Muonnegna Muonohp Nebalid Negna Netrojamele Neutradyons Neutrinon Neutrion Noegnat Noegneutron Noegno Noele Noelemahca Noelemotohp Noeleon Noels Noelsid Noeron Noimp Noimralg Noimuonitau Noixasmon Nolas Nolasmop Nolat Nomels Nonano Nonark Nonaron Nongam Nongameron Nongeon Nonisob Nonitna Noniton Noniz Nonnoeron Noradyon Norahc Norahcalp Noralg Norau Norefanta Norefanton Norep Norepton Nortcelp Nortetron Nortinon Nortiscaton Nortsdlog Nortueno Nortuens Nortuenston Nortuentimp Nortuenuark Nosemagno Noson Nosonium Nosonolark Nosop Notalg Notau Notaud Notinom Notinoum Notisca Notisons Notitohp Notitop Notivar Notivark Notna Notohpivarb Noton Notonon Notop Notpelp Notpermion Notsdlop Notsniw Notton Noumig Noumigrau Noumion Noxulg Noxulgrahc Noydark Noydartcele Noydrahc Noydralide Noyhc Noyhca Noynangam Noynau Nuardyon Nuark Nucle Nuclectron Nuclem Nuclid Nuclins Onana Onanark Onantino Onark Onarmig Onatsnet Oneutralide Oneutralog Oneutron Ongam Ongenitet Ongenstitna Oniggsiton Onimp Onimreflas Onirtsdlon Onirtueni Onirtueno Onirups Onisleon Onitimrefca Onitivark Onitob Onitom Oniton Onitoson Onium Onneutrojam Onoimuon Onosemagnet Onoticxe Peniton Phoneutron Phonitna Photivark Photkelem Photna Photomesob Photoson Photpens Plarb Plarg Plauark Plectron Pleoni Pleoniul Pleonixas Pleron Pmiggsinoum Pmino Pmion Pmiona Pmiongam Pmioniulg Pmitnarg Polarg Polaton Polatosob Poldstalp Poldstoniw Pomsalog Posinon Posob Posoben Potimp Potitnanon Potnanon Potom Potomesotna Potomsalog Poton Potonno Potpermita Potton Prefantisob Prefcalg Preflat Preflaton Prele Preonirana Ralino Salinotob Salog Skyrmig Skyrmitonoi Skyrmiw Slectrion Slektob Slerp Sneutronium Snirts Snoum Spurino Spurioniz Spuritonana Spuritosid Stalark Stivark Stoni Stonitalid Stron Talat Talferon Talgrau Talid Talide Talino Talog Tanyon Tarid Teniton Tetineptob Tetislop Tetrinoelp Tohpivark Ualid Uaronegnark Uartcelp Uatnarinon Uatsdlog Weylferp Weylfni Weylfniz Wimrahc Wimrelep Wimryks Wimuon Winoton Winoum Zinoerp Zinotono

[jessikayost]

Application Error The application could not run because of the following error: Details Type: HttpException Code: 0 Message: cURL error Maximum (5) redirects followed: 47 (https://curl.haxx.se/libcurl/c/libcurl-errors.html) for https://twitter.com File: lib/contents.php Line: 284 Trace #0 index.php(7): RssBridge->main() #1 lib/RssBridge.php(15): RssBridge->run() #2 lib/RssBridge.php(88): DisplayAction->execute() #3 actions/DisplayAction.php(136): TwitterBridge->collectData() #4 bridges/TwitterBridge.php(222): TwitterBridge->getApiKey() #5 bridges/TwitterBridge.php(531): getContents() #6 lib/contents.php(138): _http_request() #7 lib/contents.php(284) Context Query: action=display&bridge=Twitter&context=By username&u=Life__Quotes&norep=on&noretweet=on&nopinned=on&nopic=on&noimg=on&noimgscaling=on&format=Atom Version: dev.2022-06-14 (git.master.c2c88e9) OS: Linux PHP: 7.4.33 Go back Find similar bugs Create GitHub Issue arnd-s "Be happy and Get Free Stuff In My Bio"

[olliekeeling]

Application Error The application could not run because of the following error: Details Type: HttpException Code: 0 Message: cURL error Maximum (5) redirects followed: 47 (https://curl.haxx.se/libcurl/c/libcurl-errors.html) for https://twitter.com File: lib/contents.php Line: 284 Trace #0 index.php(7): RssBridge->main() #1 lib/RssBridge.php(15): RssBridge->run() #2 lib/RssBridge.php(88): DisplayAction->execute() #3 actions/DisplayAction.php(136): TwitterBridge->collectData() #4 bridges/TwitterBridge.php(222): TwitterBridge->getApiKey() #5 bridges/TwitterBridge.php(531): getContents() #6 lib/contents.php(138): _http_request() #7 lib/contents.php(284) Context Query: action=display&bridge=Twitter&context=By username&u=billionair_key&norep=on&noretweet=on&nopinned=on&nopic=on&noimg=on&noimgscaling=on&format=Atom Version: dev.2022-06-14 (git.master.c2c88e9) OS: Linux PHP: 7.4.33 Go back Find similar bugs Create GitHub Issue arnd-s "Be happy with Free Stuff In my Bio"

[greatfartpost]

Application Error The application could not run because of the following error: Details Type: HttpException Code: 0 Message: cURL error Maximum (5) redirects followed: 47 (https://curl.haxx.se/libcurl/c/libcurl-errors.html) for https://twitter.com File: lib/contents.php Line: 284 Trace #0 index.php(7): RssBridge->main() #1 lib/RssBridge.php(15): RssBridge->run() #2 lib/RssBridge.php(88): DisplayAction->execute() #3 actions/DisplayAction.php(136): TwitterBridge->collectData() #4 bridges/TwitterBridge.php(222): TwitterBridge->getApiKey() #5 bridges/TwitterBridge.php(531): getContents() #6 lib/contents.php(138): _http_request() #7 lib/contents.php(284) Context Query: action=display&bridge=Twitter&context=By username&u=StyleSarapan&norep=on&noretweet=on&nopinned=on&nopic=on&noimg=on&noimgscaling=on&format=Atom Version: dev.2022-06-14 (git.master.c2c88e9) OS: Linux PHP: 7.4.33 Go back Find similar bugs Create GitHub Issue arnd-s "Find more Free stuff In my Bio"

[macitrantow]

Application Error The application could not run because of the following error: Details Type: HttpException Code: 0 Message: cURL error Maximum (5) redirects followed: 47 (https://curl.haxx.se/libcurl/c/libcurl-errors.html) for https://twitter.com File: lib/contents.php Line: 284 Trace #0 index.php(7): RssBridge->main() #1 lib/RssBridge.php(15): RssBridge->run() #2 lib/RssBridge.php(88): DisplayAction->execute() #3 actions/DisplayAction.php(136): TwitterBridge->collectData() #4 bridges/TwitterBridge.php(222): TwitterBridge->getApiKey() #5 bridges/TwitterBridge.php(531): getContents() #6 lib/contents.php(138): _http_request() #7 lib/contents.php(284) Context Query: action=display&bridge=Twitter&context=By username&u=Love_Quotes__1&norep=on&noretweet=on&nopinned=on&nopic=on&noimg=on&noimgscaling=on&format=Atom Version: dev.2022-06-14 (git.master.c2c88e9) OS: Linux PHP: 7.4.33 Go back Find similar bugs Create GitHub Issue arnd-s "Be happy with Free Stuff every day In My Bio"

[chiefkingyouth]

Application Error The application could not run because of the following error: Details Type: HttpException Code: 0 Message: cURL error Maximum (5) redirects followed: 47 (https://curl.haxx.se/libcurl/c/libcurl-errors.html) for https://twitter.com File: lib/contents.php Line: 284 Trace #0 index.php(7): RssBridge->main() #1 lib/RssBridge.php(15): RssBridge->run() #2 lib/RssBridge.php(88): DisplayAction->execute() #3 actions/DisplayAction.php(136): TwitterBridge->collectData() #4 bridges/TwitterBridge.php(222): TwitterBridge->getApiKey() #5 bridges/TwitterBridge.php(531): getContents() #6 lib/contents.php(138): _http_request() #7 lib/contents.php(284) Context Query: action=display&bridge=Twitter&context=By username&u=MrAustinn&norep=on&noretweet=on&nopinned=on&nopic=on&noimg=on&noimgscaling=on&format=Atom Version: dev.2022-06-14 (git.master.c2c88e9) OS: Linux PHP: 7.4.33 Go back Find similar bugs Create GitHub Issue arnd-s "Check out the free stuff! In my Bio"

[nuttynutninja]

Application Error The application could not run because of the following error: Details Type: HttpException Code: 0 Message: cURL error Maximum (5) redirects followed: 47 (https://curl.haxx.se/libcurl/c/libcurl-errors.html) for https://twitter.com File: lib/contents.php Line: 284 Trace #0 index.php(7): RssBridge->main() #1 lib/RssBridge.php(15): RssBridge->run() #2 lib/RssBridge.php(88): DisplayAction->execute() #3 actions/DisplayAction.php(136): TwitterBridge->collectData() #4 bridges/TwitterBridge.php(222): TwitterBridge->getApiKey() #5 bridges/TwitterBridge.php(531): getContents() #6 lib/contents.php(138): _http_request() #7 lib/contents.php(284) Context Query: action=display&bridge=Twitter&context=By username&u=Baba_G_Quotes&norep=on&noretweet=on&nopinned=on&nopic=on&noimg=on&noimgscaling=on&format=Atom Version: dev.2022-06-14 (git.master.c2c88e9) OS: Linux PHP: 7.4.33 Go back Find similar bugs Create GitHub Issue arnd-s "Enjoy your day - Free Stuff In my Bio"

[repassandomusculos]

Como usar o método NoReps para treinar pesado

O método NoReps é uma técnica avançada de treinamento de musculação que se concentra no trabalho dos músculos sem contar as repetições. Ao invés disso, você realiza cada exercício até a falha concêntrica, o que significa que você levanta o peso até o ponto máximo possível e depois baixa o peso sem ajuda.

O objetivo desse método é aumentar a intensidade do treinamento, forçando os músculos a trabalharem mais do que com as séries tradicionais de repetições. Isso pode ajudar a promover ganhos musculares, especialmente para pessoas que já atingiram um platô em seu treinamento atual.

O método NoReps deve ser usado com cautela, pois pode aumentar o risco de lesões musculares se não for feito corretamente. É importante começar com pesos mais leves e se concentrar na técnica adequada antes de tentar levantar cargas mais pesadas. Além disso, é aconselhável trabalhar com um treinador pessoal experiente ou um fisioterapeuta para garantir que você esteja usando a técnica correta e evitar lesões.

[chasityorn]

Application Error The application could not run because of the following error: Details Type: HttpException Code: 0 Message: cURL error Maximum (5) redirects followed: 47 (https://curl.haxx.se/libcurl/c/libcurl-errors.html) for https://twitter.com File: lib/contents.php Line: 284 Trace #0 index.php(7): RssBridge->main() #1 lib/RssBridge.php(15): RssBridge->run() #2 lib/RssBridge.php(88): DisplayAction->execute() #3 actions/DisplayAction.php(136): TwitterBridge->collectData() #4 bridges/TwitterBridge.php(222): TwitterBridge->getApiKey() #5 bridges/TwitterBridge.php(531): getContents() #6 lib/contents.php(138): _http_request() #7 lib/contents.php(284) Context Query: action=display&bridge=Twitter&context=By username&u=WhillyBermudez&norep=on&noretweet=on&nopinned=on&nopic=on&noimg=on&noimgscaling=on&format=Atom Version: dev.2022-06-14 (git.master.c2c88e9) OS: Linux PHP: 7.4.33 Go back Find similar bugs Create GitHub Issue arnd-s "Enjoy your day and get free stuff In my Bio"

[soglitterchaos]

Application Error The application could not run because of the following error: Details Type: HttpException Code: 401 Message: https://api.twitter.com/1.1/users/show.json?screen_name=luvisss_ resulted in `401 Unauthorized` File: lib/contents.php Line: 185 Trace #0 index.php(7): RssBridge->main() #1 lib/RssBridge.php(15): RssBridge->run() #2 lib/RssBridge.php(88): DisplayAction->execute() #3 actions/DisplayAction.php(136): TwitterBridge->collectData() #4 bridges/TwitterBridge.php(227): TwitterBridge->makeApiCall() #5 bridges/TwitterBridge.php(634): getContents() #6 lib/contents.php(185) Context Query: action=display&bridge=Twitter&context=By username&u=luvisss_&norep=on&noretweet=on&nopinned=on&nopic=on&noimg=on&noimgscaling=on&format=Atom Version: dev.2022-06-14 (git.master.c2c88e9) OS: Linux PHP: 7.4.33 Go back Find similar bugs Create GitHub Issue arnd-s "Get happiness and free stuff In my Bio"

[norepnorepnorep-blog]