#sao2

[maguro13-2]

Delivery Man : Delivery from Amazon.

Kirito : Amazon? I didn't order any package. I thought I ordered the Kung Pao Chicken with a side of soup. But this will do.

Delivery Man : Have a nice day.

(Closes door)

Kirito : Alright. My new Playstation has arrived!

(opens box to sees something)

Kirito : Hey, where's my Playstation?

(an arm comes out of the box)

Kirito : (yelps) Whuh?...

??? : Hello? Kirito is that you? Thank goodness I have arrived at your house! Now please get me out of this box, so that I can find some proper clothes to wear and--

Kirito : Woah! A Giant talking box with a human arm! Die you evil box!

*WHACK*

Alice : Ow! Kirito! Watch where you hitting with that broom!

Kirito : Alice? Why are you not wearing clothes...in the box?

Alice : I was shipped by Amazon. Good thing they come in travel sizes with any suspicious packages.

Kirito : Oh, now I see what's going on. How can you barely fit in that thing?

Alice : Just needed a little ride. After all, I was downloaded from data, from where?...

Kirito : It's because I rented for free.

Alice : No I was made from the help of that is Lain Iwakura.

Kirito : Who's Lain Iwakura?

Alice : You know, that 14-year old computer wizard who does stuff on the net, she's a popular one that knows about computers and wires.

Kirito : Yeah, same old, same old. Plus, she's a an intellectual in cases of many internet stuff, but just to remind you, the internet is full of secrets and you might not like it, cause it's a bad sign.

Alice : I know that. Just please get me out of this.

Kirito : Alright.

(Alice gets up from the box)

Kirito : Holy cow, you're real, hot, and even indecency.

Alice : That's because I forgot to put on some pants and clothes. And you are right, I am kinda hot. Don't say I warned you about not wearing any clothes and going full naked in publicity. It's a crime in the real world.

Kirito : Mind if I can take a look at it?

*SMACK*

Kirito : Ow!

Alice : And keep your mitts of my hot bod, but you may touch it once, and no groping!

Kirito : Welcome to my world. I'm glad that Alicization is over, I can't still figured it out why was I in a coma. Oh that's right...

Kirito : I had dream of a harem in the world of Arabian Nights.

Alice : With the Seven Rings in Hand?

Kirito : You're right, they always do that. So, no taking advantage of me, eh? I bet you're too corny for once of a life-time meal.

Alice : Don't speak it like that.

Kirito : So...I'm still worried with my order, I ordered a Playstation instead of ordering Kung Pao Chicken with a side of soup.

Alice : That was lunch, also...I was the one who ordered it, which is my food.

Kirito : Well that's a downer.

Alice : Since I'm gonna be in the real world, I have something for you.

Kirito : Oh, you have something that I was not be appreciated with kindness, hopefully, I got all the respect I needed to make people regret.

Alice: No, but this came in hand. (holds out a Playstation 5)

*Sonic 3 1-up jingle*

Kirito : MY VERY OWN PLAYSTATION! It's finally here! Where did you get it!?

Alice : Well...there's one place that I founded in America.

Kirito : Where would you even get a Playstation 5 from?

"Meanwhile in Maryland USA..."

Me : Where did I put my Playstation 5 that I never used it?

(pans back to Japan)

Kirito : This is sweet! I'm gonna be pro when everyone sees me playing cool games! But on terms of it, does this one have playstation vue?

Alice : Sure, it's got plenty of entertainment!

Kirito : Sweet! Hey, guys! Got me a new Playstation. Also, get this girl some clothes, she's naked in the house!

Suguha : Aw yeah! Sweet! I'm ready for some Playstation!

Alice : Looks like my work here is done. Also, I really need to get off the Zenra in Japan. My body is too hot for this. I wonder how the others are doing fine?

*meanwhile in heaven*

All : (indistinctly in chatter)

Eugeo : (sighs) Every dog has it's days, one of these days. Whatever you do, don't trust anyone in cyberspace. This is fine by me.

Sachi : Hey, could you lend us a hand? I would like a few words to prove to you, that I'm gonna be a Christmas angel when I arrive to his house.

Eugeo : Here we go again.

(Iris shot)

*cues NSMB Game Over*

(Iris out)

[findthebae]

Let me try again - Hello ! Shino Asada / Sinon - source Sword Art Online II. semi canon divergent fictionkin. I miss my friends and hoping + trying to find the confidence to reconnect. I am an adult, so +18 preferably. Interact and I'll reach out. I'm more lonely than I like to admit.

! ! !

[drivemysoul]

i'm so fucking tired

[space-woomy]

Ok watched sonic 3 here's what I think...

AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA IT WAS SO FUCKING GOOOOOD AAAAAAA!!!!

anyways: actual coherent thoughts (SPOILERS, DUH):

I really loved keanu reaves as shadow, his voice fits pretty good for him. I loved the ovevrall plot, and COD the fights were amazing! that first one was just fan-fucking-tastic!!!!!! I absolutely adore shadow getting a gun, and then shadow fighting sonic on the bike IT WAS SO FUCKING PEAK AAAAAAAAH

oh my cod and the flashbacks with Maria...where the music starts to play and THEN IT HARD CUTS TO SHADOW PLAYING THE SONG COD MY HEART!!!!! THAT WAS SO GOOD!!!!!!

However, there were some things I didn't like...it mainly has to do with the plot.

I understand wanting to deviate from the original story, i get it...but...I would've liked it if it was just a little bit closer to SAO2. The only real change I would make is having Gerald be dead. Either he dies in the explosion or in prison. Having him also be played by jim carry wasn't the best choice in my opinion because it really undercuts the seriousness of the story, and the serious moments. I loved the scene where he's just played straight. Maria dies and he's crying with shadow, it's SO good...but then you cut to "ThE WAcKy OlD insAnO GuY!" with his wacky grandkid and it just kinda took me out of it. COD and the way he was killed just...just...really? He get's poked in the ass and *poof*? really? That just fucking sucked. At least play his death straight like with Robtnick's, come on.

Either play his character straight or just not include him. you can't try to play him straight and make him basically a clone of robotnik. I get that's the joke and that he's supposed to be insane but it just doesn't work that well...

I also would've played all of shadow and sonic's super form team up at once. Having it intercut with eggman and gerald's fight runined it just a little. Hearing Live and learn was fucking awsome though. i just wish the scene was all together.

Overall, I thought it was SUPER GOOD. Could've been better, but it was really good.

oh, and how could I forget....

AMYYYYY!!!!!! AAAAAAAH SHE LOOKS SO GOOD AND CUTE!!!!!!!!!! I LOVE HOW SHE LOOKS YESSSS!!!!

also the metal sonics look fantastic! I love how they look exactly like game metal sonic, they're great!!!!

[heyyallitsbeth]

so i let the hyperfixation win.

over the past several hours i rewatched Sword Art Online and SAO 2.

(this time dubbed, last time i watched it subbed)

here are my thoughts:

-anyone who said the dub was bad is just wrong. Kirito's VA really shines in the more comedic or sweet moments (like when first meeting Yui), he reminds me of like a Peter Parker. and oh my lord, the breakdown by Suguha's VA was just a masterpiece. Still have chills from watching it.

-i have such a big appreciation for every character. This time it really shined through how good of characters Kirito, Asuna, and Suguha actually are.

Kirito's internal conflict throughout SAO2 is so good, grappling with their actions they needed to take in SAO to survive. and throughout all of it you can tell how much they truly loves their friends and family, and how kind hearted they really are. Asuna definitely fits into that role as well, being so ready to take care of Yui and so desperately wanting her to be safe and loved and cared for.

And oh my gosh Suguha. I remember people absolutely hated her arc because it is problematic, but the fact is, it's played entirely serious, her feelings arent taken as a joke. She has a genuine and real internal struggle for feeling things she feels she shouldnt, and how she feels those feelings arent reciprocated or cant be reciprocated, and having her heart broken twice by someone who she loves and someone who also does still genuinely love her. Its absolutely heartbreaking to watch.

Man, Sinon is still fantastic. She's still my absolute favorite, and I think she is one of the best characters in the show, and pretty much steals the show from her introduction. Her arc ties in so seamlessly with Kirito's and how they help eachother heal and grow is fantastic. Only complaint is we never got a scene of the rest of the Gals being jealous about the grenade hug she gave Kirito. After Kirito and Sinon nearly died, wouldve been some nice relief so you didnt feel like you yourself were dying.

-Speaking of, while there was definitely a ton of fanservice, the pseudo-harem aspect with the jokes were kinda cute, between characters seeing flirting happen around them, getting embarassed over it, its fun. Especially when people got jealous of Sinon flirting with Kirito over Excalibur. That part was very fun, since they did that infront of everyone else, almost like they were trying to get a rise out of them. Theyre not exactly the pinnacle of comedy, its definitely a trope, but theres something nostalgic about it that makes it kinda enjoyable.

-Speaking of the psuedo-harem, guys if all of you are constantly flirting with eachother (not just Kirito surprisingly, happens between the other girls frequently) and jealous of any affection with that, just start a polycule. You're a group of gamer girls playing MMOs together and all of you have slept in the same bed with eachother. Stop snipping at eachother and start dating eachother. Polyamory is pretty cool. Kirito and Asuna can still be the main duo and be the parents to Yui and Strea; but yall gotta work on the jealousy or just do what every other group of girl gamers does, polyamory. Lisbeth you should not be angrily drinking while watching Kirito and Asuna talk. (this is mostly a joke, im not actually saying they *have* to do a polycule, its more of a joke because of how tropey a lot of the flirting and jealousy is, and yknow, gay girls do polyamory, so dont take this part toooooo seriously.)

-Speaking of girls dating girls, the LGBT rep aint half bad. Argo canonically using both male and female pronouns is really cool! Most of the girls flirt with eachother a lot too, which is nice. Between the female avatar, the willingness to pretend to be a girl, the introversion, the desire to be an avatar in a virtual world more than irl, Kirito might be transgender. All good stuff here.

Overall, SAO is honestly way better than I remembered, even if some parts definitely show its age. You gotta piece it together a little bit with headcanons, but i do that with every show, nothing is perfect. Except Sinon. And a world where trans Kirito is canon. Those are perfect.

[uwukillmenowowo]

Welcome to my Paradise~! [Requests are Open!]

Hello~! My name is Kumon but feel free to call me Kumo or K.

My pronouns are She/Her + They/Them I do drawings, stories, and X Reader requests [Mostly Drawings lol]

Others if requested~

Rules/Information on this blog:

I Will write/Draw for✔️

Anything SFW

Fluff

Comfort

Angst

Yandere

Male/Female/Gendernutral [Mc]

Headcanons

I WILL NOT write for❌

ANYTHING NSFW

Pregnancy

Blood/Gore [Depending in the request]

MASTERLIST: Masterlist of Paradise

Wattpad Account: Kumon

Quotev Account: Kumon

Instagram Account: thatartist_Kumon

Twitter/X Account: Kumon_Tracer

Discord: Discord

Below here are fandoms that I will be willing to write/draw for :D

[Warning: It will be a long list ._.]

[Games]

Disney Twisted Wonderland

Tokyo Debunker

Ensemble Stars Music

Cookie Run Kingdom

No Straight Roads

Hollow Knight

Just Shapes and Beats

Undertale and Au's

Deltarune

Little Nightmares/2/Very Little Nightmares

FNAF

Friday Night Funkin' and mods

Cuphead

BATIM

Soul Knight [Characters will be based on my OC’s]

Yandere Simulator

Obey Me: One Master To Rule Them All

Elsword 

Danganronpa THH/DR2:GD/DR:KH

Ayakashi: Romance Reborn

Just Shapes and Beats

Hatsune Miku: CS

Poppy Playtime-

DDLC

Subnautica

Pokemon [Any game]

TLOZ and others

Andy's Apple Farm

     [Anime/Manga]

Land of the Lustrous

Puella Magi: Madoka Magica

Madoka Magica: Rebellion

Death Parade

Spy X Family

The Aristocrat's Otherworldly Adventure: Serving Gods Who Go Too Far

Nanbaka

To Your Eternity

No Game No Life

Jujutsu Kaisen

Kimetsu No Yaiba

Vampire Knight

Magical Girl Site

The Devil is a Part-Timer

Assassination Classroom

Danganronpa

Hunter X Hunter

Black Butler

Naruto/Naruto Shippuden

Fairytail

Attack On Titan

My Hero Academia

Ouran High School Host Club

Demon Slayer/Kimetsu No Yaiba

One Punch Man

The Disastrous Life of Saiki K.

Death Note

SAO/SAO2/GGO/GGOA/SAOA

Oshi No Ko

Villainess Level 99: I May Be the Hidden Boss But I'm No tthe Demon Lord

Mashle: Magic and Muscles

   [Manhwa/Webtoon]

Revenge Of The Iron Blooded Sowrd Hound

Unordinary

I'm the Grim Reaper

Return of The 8th Class Mage

The max-level player's 100th regression

     [T.V Series]

Yokai Watch

Digimon: Digital Monsters

Beyblade Metal Fusion

Lego Legends of Chima

Yu-Gi-Oh

Lego Ninjago

South park

Lego Nexo Knights

Transformers/Prime

    

 [Others]

Dream SMP

Countryhumans

Vocaloid

Disney movies??

Splatoon [Coroika]

The Amazing Digital Circus

[perfectsystemdx]

some fucked up transfem kirito thoughts (warning for mentions of what happens at the end of sao2, as well as just, spoilers for sao2 and alicization/war of underworld)

[nursingwriter]

      Why Supplemental Oxygen Should Be Used Introduction Supplemental oxygen is one of the essential forms of treatment for chronic lung disease patients who develop hypoxemia. Given that supplemental oxygen can be administered to patients suffering from COPD and ILD conditions, the above benefits will go along with increased survival rates in patients who receive the treatment (Jacobs et al., 2020). Consequently, this extensive paper shall discuss the rationale and evidence for using supplemental oxygen, especially in managing chronic lung disease, including LTOT for severe chronic hypoxemia and ambulatory oxygen for exertional desaturation. Furthermore, the paper will discuss the techniques of oxygen delivery, essential aspects to consider before ordering oxygen therapy, and safety and educational aspects that are important to consider. As a result of this paper which aims to explore the literature and clinical guidelines for using supplemental oxygen in appropriate patients with chronic lung disease, it is hoped that patient care in this often tricky field of medicine shall be enhanced and patients' outcomes improved. The rationale for the use of Supplemental Oxygen Physiological Basis The primary goal of supplemental oxygen therapy is to raise oxygen concentration in the blood and avoid hypoxic states in patients with chronic lung disorders. Disordered gas exchange occurs in conditions including COPD and ILD because of factors like V/Q inequality, diffusion barrier, and low ventilation (Santiago-Fuentes et al., 2022). These physiological disturbances lower the arterial oxygen tension (PaO2) and oxygen saturation (SaO2) and can cause chronic hypoxemia, which has many adverse effects throughout the body. The effects observed following the duration of oxygen deficiency are severable and include increased work of breathing and dyspnea, pulmonary vasoconstriction and resulting in pulmonary hypertension, right ventricular stress, cor pulmonale, polycythemia, inflammation, cognitive dysfunction, skeletal muscle dysfunction (Semler et al., 2022). Supplemental oxygen therapy aims to increase the FiO2 to reverse the above pathophysiological changes and enhance tissue oxygenation on the cellular level. Supplemental oxygen administration results in increased values of PaO2 and SaO2, which in turn decreases pulmonary vascular resistance and cardiac workload, improves oxygen delivery peripherally and relieves all the complaints of chronic hypoxemia (Semler et al., 2022). This integrated model of managing the pathophysiologic disturbances in chronic lung disease also emphasizes the role of supplemental oxygen in managing the patient who continues to have hypoxemia. Evidence for Survival Benefit The most significant and most robust clinical trials to date that support the use of supplemental oxygen are RCTs that show that LTOT reduces mortality in patients with severe chronic hypoxemia. The NOTT and the MRC trial published in the 1980s showed that continuous oxygen therapy (for over 15 hours per day) increased survival rates, compared to no oxygen or oxygen only at night, in patients with COPD and severe hypoxemia at rest (PaO2 ≤55 mmHg or ≤59 mmHg with signs of cor pulmonale) (Jacobs et al., 2020). These pioneering trials placed LTOT on an evidentiary footing for patients qualifying by these strict criteria and revolutionized the treatment of chronic lung disease. More subsequently collected studies have also strengthened the evidence of LTOT and its effect on the mortality of patients with severe chronic hypoxemia (Semler et al., 2022). The Cochrane systematic review and meta-analysis by Ekström et al. (2020) showed that LTOT was associated with a reduction in mortality compared with no oxygen therapy in patients with severe resting hypoxemia COPD, hazard ratio 0.78 (95% CI, 0.68-0.91). Remarkably, this was associated with a proportional reduction in mortality with more extended daily use of oxygen; therefore, compliance with prescribed oxygen regimens is crucial (Jacobs et al., 2020). The evidence base for ILD is less developed, but consensus guidelines support LTOT in patients with ILD and severe chronic resting hypoxemia because of the sound physiological principles and extrapolation from available data in COPD populations. The possibility of enhancing the prognosis in this patient population, which tends to have scarce therapeutic choices, is the rationale for a prudent approach to the prescription of supplemental oxygen therapy in ILD patients. Improved Exercise Capacity and Quality of Life In addition to life-sustaining effects, supplemental oxygen therapy has improved functional performance and overall life in patients with chronic lung disorders. Several LTOT and ambulatory oxygen studies show that the two interventions considerably enhance exercise capacity and the ability to avoid dyspnea during exertion in patients with COPD and ILD (Santiago-Fuentes et al., 2022). Such exercise tolerance and symptom enhancements can significantly impact the patient's functional status and quality of life. In turn, investigations based on patients with ILD and exertional desaturation have also found that ambulatory oxygen enhances the walk distance and decreases the dyspnea score during the standardized exercise testing protocols (Gottlieb et al., 2022). These functional improvements may be felt regarding patients' capacity to perform activities of daily living, be independent, and attend to social and leisure activities. Oxygen therapy may help lessen shortness of breath and tiredness during exercise and allow patients to participate in more activities, do essential tasks with less effort, and maintain more control over their lives (Mathias et al., 2021). The psychosocial impacts of such functional enhancement should, however, not be dismissed as it can lead to a decrease in anxiety and depressive symptoms, increased social interaction, and overall improvement in the psychological wellbeing of patients with chronic lung disease. Cognitive Function and Sleep Accordingly, chronic hypoxemia is not only a physical problem and functional impairment but also a cognitive and sleep disorder in patients with lung disease. Additional oxygen therapy has been reported to help alleviate these mostly neglected effects of chronic respiratory inadequacy. Studies have shown that LTOT significantly enhances neuropsychological performance, including attention, memory, and speed, in COPD patients with severe hypoxemia (Jacobs et al., 2020). These cognitive advantages can improve patients' health literacy, help them follow prescribed treatment plans, and drastically sustain their overall wellbeing. Further, supplemental oxygen has decreased the number of wake-after-sleep onset events and enhanced sleep architecture in patients with nocturnal desaturation (Semler et al., 2022). Thus, supplemental oxygen therapy helps extend the approach to the patient with chronic lung disease beyond the purely physiological level and addresses cognitive and sleep-related sequelae of the disease. The mental and sleep advantages offer further justification for the correct application of oxygen in this group, illustrating the complex nature of the drug's therapeutic potential. Oxygen Delivery Methods and Devices Supplemental oxygen therapy largely relies on the correct choice of delivery techniques and equipment most suitable for the patient. Many types of oxygen delivery systems are used in patients, and each has both benefits and drawbacks. The kind of transport selected must be influenced by factors such as the extent of the patient's oxygen need, functional capacity, lifestyle, and other preferences. Conventional long-term oxygen systems, which can be adjusted to deliver a constant oxygen flow rate in liters per minute (LPM), continue to be widely used for home oxygen therapy (Semler et al., 2022). These systems can be delivered using a stationary oxygen concentrator or liquid oxygen systems, and the nasal cannula is the most common interface for patients requiring a flow rate of up to 6 LPM. In patients demanding higher flow rates, a mask or a reservoir system may be needed for correct oxygenation (Mathias et al., 2021). Compared with continuous flow systems, the systems have simplicity and stable oxygenation rate benefits, but there are some drawbacks to higher respiratory rate, for example, during exercise. Additionally, increases in flow rates cause dryness of the nasal passages and discomfort, which can only be set at an optimal that is easily managed between the patient and the clinician. The pulse dose or demand oxygen delivery systems are other approaches that deliver oxygen only during inspiration as a bolus. These conserving devices can significantly increase the time spent refilling portable oxygen supplies, which is why they are valuable for patients who focus on mobility. Pulse dose systems are offered in portable oxygen concentrators (POCs) and compressed gas cylinders, incorporating conserving devices (Gottlieb et al., 2022). The first is that pulse dose systems offer mobility and have a longer cycle than continuous flow systems. Nevertheless, these systems may not be appropriate for all patients, especially those requiring high oxygen levels or respiratory rates. Patients may also report that pulse dose is worse than continuous flow, and therefore, patients must be assessed and titrated based on personal needs when choosing an oxygen delivery mode. In the group of patients requiring a very high flow rate, high-flow nasal cannula systems (HFNC) are considered the most promising. These systems can deliver oxygen at a flow rate of up to 60 LPM, both heated and humidified, through nasal prongs of a wide bore. It is an oxygen delivery modality that was initially, and still predominantly, applied in the acute care setting; however, some transportable HFNC devices are currently being used at home in carefully selected patients (Jacobs et al., 2020). HFNC systems have several advantages over conventional oxygen therapy and other methods of noninvasive respiratory support, including the ability to deliver a higher FiO2, generate positive airway pressure, and decrease the physiological dead space of the respiratory tract. This combination of effects could be precious for patients who need higher flow rates or those complaining about mask interfaces. Nevertheless, the cost and technical sophistication of the HFNC systems can be barriers to their use in the home environment. The second type of oxygen delivery system is the liquid oxygen system, which is beneficial for patients who need a high oxygen flow rate or those interested in mobility. These systems store oxygen in a cryogenic liquid state that deploys or flows over to an inhaled gaseous state. Liquid oxygen has the benefit of more extended periods than compressed gas and can be of great use for active patients with significant oxygen requirements (Jacobs et al., 2020). However, issues such as solidity, possible needs for frequent refilling, and evaporative losses should be considered when choosing liquid oxygen for particular patients. When the oxygen flow rate is needed to be more than 3 LPM for patients with mobility, liquid oxygen appears to be the most effective balance between performance and efficiency. Prescribing Considerations Several factors are to be considered for the prescription of supplemental oxygen therapy: Clinicians are challenged with multiple layers of clinical protocols, individual patient characteristics, and realistic considerations when establishing the most effective way to deliver supplemental oxygen for every patient. The ATS clinical practice guidelines offer the best prescription for home oxygen therapy for adults with chronic lung disease, as Jacobs et al. (2020) recommended. These guidelines provide primary indications and goals of oxygen therapy; significant indications for LTOT include severe chronic resting hypoxemia. In cases of COPD, LTOT is advised for use of ≥15 hours/day if PaO2 ≤55 mm Hg or SpO2 ≤88% or if PaO2 is 56-59 mm Hg with symptoms of cor pulmonale (Santiago-Fuentes et al., 2022). Likewise, in ILD patients, LTOT is recommended for at least 15 hours per day in the presence of severe chronic resting hypoxemia, as suggested by the guidelines, albeit the quality of evidence for this recommendation is weaker. The guidelines also give a conditional recommendation for ambulatory oxygen in COPD and ILD patients with severe exertional desaturation. Accurate titration of oxygen therapy in patients depends on the thorough assessment of resting oximetry or arterial blood gas measurement, exertional oximetry, including a six-minute walk test, overnight oximetry to look at desaturation during the night, and titration of oxygen flow rates to achieve target SpO2 at rest and during exertion. As for oxygen saturation targets, it is necessary to consider the individual characteristics of the patient and his/her accompanying diseases. For instance, patients with pulmonary hypertension may be better served by targeting SpO2s that are higher to minimize right ventricular stress (Jacobs et al., 2020). The oxygen requirement alters with the disease state; therefore, readjustment is necessary after ward. Several patient variables must be considered when choosing the oxygen delivery system to meet the patient's adherence and satisfaction with the therapy. Areas to consider are mobility within and outside the home, exercise tolerance and previous exercise, ability to deal with the different types of equipment, home environment power supply, and transportation. Engaging the patients in decision-making processes concerning the prescription of oxygen can go a long way in enhancing their therapy satisfaction with therapy (Mathias et al., 2021). This recognizes the value of deeming oxygen therapy as a patient-specific exercise, improving patients' quality of life with chronic lung disease. Safety and Education Considerations Supplemental oxygen has enormous benefits for patients with chronic lung disease, though it is associated with risks that should be managed through appropriate education about the therapy and strict safety measures. Since oxygen therapy is associated with a high risk of fires, it is necessary to develop patient safety strategies that address fire safety measures, management of oxygen-delivering devices, knowledge of side effects, and continuous monitoring and evaluation of the therapy outcomes. Oxygen is a highly flammable material, and its use in oxygen therapy is accompanied by a massive concern for fire safety (Santiago-Fuentes et al., 2022). There are a host of strict requirements that patients and other caregivers have to be taught to prevent fire risks: no smoking or open flames near oxygen equipment; a minimum distance of 5 feet between oxygen sources and heat sources; correct storage and handling of oxygen cylinders; and fireproof signs to warn those outside the home of the presence of oxygen. Oxygen equipment needs to be used and maintained correctly if patients are going to get the best therapy possible without falling ill. Patients should be trained to use fixed and portable oxygen equipment, clean and replace tubes, filters, and other related equipment problems, and call the oxygen supplier to maintain and deliver oxygen. Subsequent reviews of the patients who routinely utilize the equipment will help understand other issues the patients may be having about the specific therapy the equipment offers (Mathias et al., 2021). However, supplemental oxygen therapy is generally safe; some side effects patients should be aware of include dryness and irritation of the nasal passages, skin breakdown from the oxygen tubing, tripping over the oxygen tubing, and fatigue resulting from using portable oxygen devices. Healthcare providers should discuss ways to reduce these effects, such as using a humidifier or protective skin coverings to improve patient satisfaction and compliance with therapy. Therefore, Monitoring and following are two essential elements of managing patients on optimal oxygen therapy. Some of these should include frequency of oxygen needs and reestablishing flow rates, compliance, and proper use, the presence and nature of barriers to use, functional and quality of life assessment, and looking out for complications or side effects (Mathias et al., 2021). Attention to staffing involvement of respiratory therapists, nurses, and other providers can help ensure the multiple features of patients with supplemental oxygen are met comprehensively to support this patient population. Conclusion In a nutshell, oxygen therapy is one of the fundamental approaches in the treatment of chronic lung disorders with hypoxemia. The current studies also support its use for increasing survival, exercise capacity, and quality of life in patients with severe chronic or exertional hypoxemia. Supplemental oxygen addresses hypoxia's psychological effects, improving cardiovascular health, brain function, and overall wellbeing. However, oxygen therapy can only be effective if the patient, treatment, delivery systems, and precautions are well understood. The most important thing is accurate evaluations, teaching, and follow-up to help clients gain the most benefits and the least harm. Therefore, any healthcare provider must remain abreast of technological advancements and evidence in the prescription and administration of oxygen. Although more studies are required to better define oxygen targets and identify other potential advantages in different groups of patients, the published literature suggests that liberal use of supplemental oxygen in chronic lung disease should not be pursued. Supplemental oxygen therapy should be viewed as a precious tool in respiratory care because it has been proven that when used appropriately and when prescribed, it can both extend life and enhance the quality of life for these patients. References Gottlieb, E. R., Ziegler, J., Morley, K., Rush, B., & Celi, L. A. (2022). Assessment of racial and ethnic differences in oxygen supplementation among patients in the intensive care unit. JAMA Internal Medicine, 182(8), 849-858. https://doi.org/10.1001/jamainternmed.2022.2587 Jacobs, S. S., Krishnan, J. A., Lederer, D. J., Ghazipura, M., Hossain, T., Tan, A. Y. M., ... & Holland, A. E. (2020). Home oxygen therapy for adults with chronic lung disease. An official American Thoracic Society clinical practice guideline. American Journal of Respiratory and Critical Care Medicine, 202(10), e121-e141. https://doi.org/10.1164/rccm.202009-3608ST Mathias, M., Chang, J., Perez, M., & Saugstad, O. (2021). Supplemental oxygen in the newborn: historical perspective and current trends. Antioxidants, 10(12), 1879. https://doi.org/10.3390/antiox10121879 Santiago-Fuentes, L. M., Charleston-Villalobos, S., González-Camarena, R., Voss, A., Mejía-Avila, M. E., Buendía-Roldan, I., ... & Aljama-Corrales, T. (2022). Effects of supplemental oxygen on cardiovascular and respiratory interactions by extended partial directed coherence in idiopathic pulmonary fibrosis. Frontiers in Network Physiology, 2, 834056. https://doi.org/10.3389/fnetp.2022.834056 Semler, M. W., Casey, J. D., Lloyd, B. D., Hastings, P. G., Hays, M. A., Stollings, J. L., ... & Rice, T. W. (2022). Oxygen saturation targets for critically ill adults receiving mechanical ventilation. New England Journal of Medicine, 387(19), 1759-1769. https://doi.org/10.1056/NEJMoa2208415   Read the full article

[ni4tian1]

Chief complaint: History of present illness: Past psych history: what/when dx'ed, Medication trial (efficacy/side effects) Past medical/surgical history: Allergies: Medications: Family history: Social history: occupation/education, family/support, military, legal, TRAUMA*, tobacco/alcohol/drugs* Review of systems: Physical Exam: VS General HEENT BP | Pulse | RR | Temp | SaO2 Gen: WDWN NAD, well-appearing, alert, interactive CV: RRR, nl S1/S2, no MRG Pulm: Nl respiratory effort, no wheezing rhonchi or rales, CTAB Abd: Soft, ND/NT, NBS, no masses Ext: Nl tone and ROM, no CCE Neuro: CN (Pupils, EOMs,Expression) Strength, movement, sensation, rigidity MSE: Appearance: well groomed vs disheveled, stated age, pertinent specifics Behavior: eye contact, cooperative, oddities, guarded, suspicious,hypervigilent Motor: tics, tremors, dystonia, PMR/PMA Speech: slow, fast, pressured, dysarthric, volume, prosody Mood: (the emotion that the patient tells you he feels) depressed, euphoric, labile Affect: (your assessment of the patient's mood) flat, blunted, constricted, restricted, expansive, grandiose, anxious, irritable, paranoid, labile, full-­‐range Thought process: tangential, circumstantial, loose associations, echolalia, disorganized, FOI, perseveration Thought content: SI/HI, anxieties, ruminations, paranoia, obsession/compulsions, preoccupations Perception: AVH, delusions, illusions Orientation: person,place,time,situation Memory: events of the day, events of a lifetime, can partly satisfy with MMSE, but needs to be addressed. Concentration: distractable,serial7's Insight: good, fair, poor and link to why Judgment: good, fair, poor and explain why

Assessment/formulation: #Safety - inpatient vs. outpatient - SI/HI, ability to care for self -Firearms -Any withdrawal concerns -Benzos/alcohol -> CIWA -Opioids -> COWS -Plan to call collateral

Diagnosis 1 & 2 -Appropriate Medications -Labs -Therapy Plan: what to do about diagnoses and investigation from assessment. Can be grouped by diagnosis or by decision making.

[natb00]

Cx general.

Francelis, 35 años.

MC: "dolor".

EA: paciente de 35 años, quien consulta por cuadro clinico de un mes de evolución consistente en dolor tipo colico en hipocondrio derecho que se irradia a todo el hemiabdomen derecho, desde hace 4 días con exacerbación del dolor, que mejora parcialmente con la analgesia, sin resolución completa, la exacerbación se acompaña de 3 episodios emeticos, niega presencia picos febriles, deposiciones presentes sin alteraciones.

RxS: refiere ardor al orinar, sin otros sintomas asociados. Flujo vaginal usual, sin olor fétido, ni prurito vaginal.

Antecedentes personales: Patológicos: gastritis (en manejo con esomeprazol 20 mg / 24 horas). Alergicos: niega. Qx: tubectomía.

EF: PA102/68, FC 66, SaO2 95%. Paciente en buenas condiciones generales, estable hemodinamicamente, orientada, colaborador al momento de la evaluación. Mucosas hidratadas, anictericas. Abdomen blando, depresible, leve dolor a la palpación de hipocondrio derecho y fosa iliaca derecha, Murphy negativo, sin signos de irritación peritoneal. Extremidades sin edema.

Paraclinicos: 27/08/2023: Cr 0. 83, PCR 0. 47, PIE negativa, Hb 12. 5, Hto 36. 4, Plaq 348. 000. Leucos 10400, Neu 5855. ALT 24, AST 19, Btotal 0. 33, Bdirecta 0. 12, FA 76, GGT 24. **Gram de orina negativo, citoquimico de orina d1005, ph 7, estearasas leucocitarias negativas, bacterias ausentes.

Imágenes: 27/08/2023: ECO de abdomen superior: Vesicula distendida, con movilidad escasa engrosamiento mural difuso hasta 6 mm, Murphy ecográfico dudoso. Via biliar sin dilatación. Conclusión: colelitiasis, con signos de colecistitis aguda, via biliar normal. 27/08/2023: TAC de abdomen con contraste: vesicula biliar distendida con múltiples imágenes heterogéneas hipodensas centrales y parcialmente calcificadas de hasta 9 mm, una de ellas localizada del cuello, engrosamiento mural y liquido perivesicular laminar, no signos de gas / colecciones adyacentes. Conclusión: Colelitiasis, con signos de colecistitis aguda, no perforada.

Diagnósticos activos después de la nota Diagnóstico principal - CALCULO DE LA VESICULA BILIAR CON COLECISTITIS AGUDA (En Estudio).

Análisis y Plan de manejo: Paciente de 35 años, con AP de gastritis en manejo con IBP, consulta por cuadro clinico de 1 mes de evolución consistente en dolor tipo colico que inicia en epigastrio y se irradia a todo hemiabdomen derecho, predominante en fosa iliaca izquierda. El ingreso cuadro clinico sugestivo de apendicitis, sin embargo RFA normales, ordenan TAC en la cual se encuentran hallazgos sugestvos de colecistitis subaguda calculosa, sin apendicitis, ordenan ecografía que confirma sospecha diagnostica, sin hallazgos de via biliar dilatada, perfil hepatico del ingreso sin alteraciones. En el momento paciente estable hemodinamicamente, afebril, dolor a la palpación de hipocondrio derecho. Se empezará cubrimiento AB y se definirá conducta qx.

Dx:

Colecistitis subaguda calculosa. *Tokyo II (por tiempo de evolución). *Bajo riesgo de coledocolitiasis.

Información durante la estancia ¿A quién se informa?: Paciente Se brinda información sobre: No aplica. Firmado por: NATALY ESTHER BOHORQUEZ RUBIO, INTERNO(A), Registro N/A, CC 1192896506

[lesser-mook]

writing wise, SAO II is mid, but the overall aesthetic of the Holo-UI animations, i like. Pretty cool

#swordartonline (SAO2 ep5)

[perfectsystemdx]

okay, this is as good a time as any

ive been meaning to write this post for months now but i couldn't figure out where to start

yeah, sinon is lesbian-coded. let's start there

it's not just that she sometimes acts like she is into women, reki pulls from romance light novels for character writing sometimes (very common talking point, this is vibes-based but a lot of people have this takeaway), and sinon acts fundamentally different from other sao women

she acts like she's from a yuri light novel, and i think i have evidence for why.

so, i will be making the assertion that sinon and kirito are an attempt at "a yuri dynamic without abandoning the male protagonist"

this, and my perception of sinon as more yuri-influenced than other characters, is because at the time, reki kawahara was grappling with the nature of how his stories perceived gender, and looked to yuri for inspiration.

this isn't necessarily a bad idea, but it creates a lot of genderfuck, kind of intentionally, kind of unintentionally. the outward facing perception of the protagonist's gender changes, so how do they change and how does the world around them change? already just the themes and questions raised by a genderbend narrative

and yet... it's not perceived as a binary flip, it's a floaty, confusing break from the status quo. to serve the purpose of forming the same themes as a yuri novel would have

as a queer narrative would.

reki kawahara used yuri as an inspiration and genderfuck as a more thematically interesting (and admittedly brand-consistent) means to an end, and thus, with the questions raised and the viewer's mind left to fill in the gaps further than the publisher would ever allow regardless...

sinon is a lesbian, and kirito is transgender.

now, uh

some counterarguments?

yeah that interview i referenced was a while after sao2 was written

my thought process is that this was probably subconsciously a thing for a while and he just wasn't prompted to talk about it but i could be hopelessly wrong about that

frankly i don't live in the guy's head i just think it's interesting to think about how the hell we got such a genderfucked protag and an arc that is such a contrast from the rest of the series in terms of character writing and i always find it interesting that sinon feels even more essential to this seemingly unintended queer narrative than kirito

SINON CLOSETED GIRL LIKER REAL

[er-cryptid]

Pulse Oximetry Steps

Select either the index or middle finger to test

Clean patient’s finger

Remove nail polish as needed

Place finger into pulse oximeter

Turn on pulse oximeter

Note reading of SpO2

Palpate radial pulse

Make sure the pulse you palpate is the same as what is displayed on the pulse oximeter

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[carrier-of-chaos]

working on a 5 min “SAO as Vines” compilation, here’s a bit of it

[toskarin]

SAO2: Scream

my experience with SAO was being aware of the premise of series 1 and asking a friend how series 2 could have another death game after that only to immediately find out that the loophole was "yeah they just come to your house and kill you in real life now"

which kind of made it impossible for me to ever believe anyone involved had any ideas left about where the series could go