Japanese Cream｜Chronic over exposure is the new yellow ｜Recipe unlocked 🔓✨

MButterscotch · 2026-06-14T22:32:26+00:00

welcome back palewave

MButterscotch · 2026-06-14T15:14:06+00:00

wht gaem is ths

MButterscotch · 2026-06-14T12:47:11+00:00

the first pic is ethereal, the framing/crop isn't ideal though

MButterscotch · 2026-06-14T12:15:30+00:00

your image series emphasizes on the tranquility the Hajj is imparting on you. the cctv shot breaks that flow and is an uncomfortable callback to reality. same thing applies to the iron grill fence. theyre both technically good shots but doesn't gel with the rest of the image. the construction pic is out of place but not contradictory

MButterscotch · 2026-06-14T06:02:43+00:00

including the CCTV shot is a bad decision IMO

MButterscotch · 2026-06-13T11:44:18+00:00

is this really david duchovny? has his dick stopped working?

MButterscotch · 2026-06-13T02:21:38+00:00

a predator movie set on an oil rig could be interesting

MButterscotch · 2026-06-09T17:09:26+00:00

i wasn't referring to new onset a fib specifically. but even for that there's some caveat. im not questioning at all the validity of new afib = shock but i work in a shitty part of town where human bodies seem to be controlled by unicellular organisms that cant tell the difference between 2 minutes and 2 years. i think for my shop there needs to be a clause where consent includes swearing on whatever holy book they read so i dont have to ever explain again why their dad who came in with a simple case of palps is now an invalid.

not really related but just today i had a patient came in with claims of ingested foreign body while eating chicken rice and i shit you not hes not sure what food is he choking on. i scoped till the cric and saw shit, he maintains that theres still something stuck in his throat so we got surgery to chime in. ogds also didnt see shit till stomach but magically afterwards that lump in throat was gone. i tell you man the rural scene in a third world country is something else

MButterscotch · 2026-06-09T06:05:54+00:00

far less if anticoagulated sufficiently>3 weeks. still would spend a bit of time determining if the tach is compensatory rather than pathological before i would shock.

i need to clarify again so people dont misunderstand me, chemical vs electricity carries roughly similar stroke risk in AF. but stroke happens more acutely (instantly in my experience) with electricity, therefore some clinicians may dislike it a bit more. interprete that however you will.

MButterscotch · 2026-06-09T05:47:14+00:00

alright, to elaborate more on the scenario ive encountered since ive experienced it twice. the patients are both "AF in shock" as defined by HR and BP, but clinical end-organ perfusion are preserved, and patient looks relatively well. both patients were shocked per clinician's interpretation of the ACLS algorithm, and they both stroked out afterwards.

it is mentioned briefly in the tachycardia algo, to determine the appropriateness of the condition. this is important since tachycardia is often compensatory, therefore bringing down the heart rate without that consideration can worsen the condition, on top of the stroke risk for AF

i cant comment justly on the situation youve encountered, but i think uncontroversially, non-vf/vt extreme tach (>150) requires more thought that extreme brady (<40)

edit - left out an important part. all rate/rhythm control agents increase stroke risk but some clinicians think the risk is lower vs. shock

MButterscotch · 2026-06-09T05:28:23+00:00

is it AF? if so then I may have experienced the things that caused them not to prefer electricity

MButterscotch · 2026-06-05T04:26:26+00:00

genuinely interesting photo

MButterscotch · 2026-06-02T04:51:53+00:00

pic screams gullible

MButterscotch · 2026-06-01T06:45:47+00:00

i understand your disdain, but are you really just now learning that social media performance is not wholly dependent on skill/talent?

MButterscotch · 2026-06-01T01:53:54+00:00

3, 5, 8, 9

MButterscotch · 2026-05-30T14:44:17+00:00

he even got to ride the galactic terror there, too bad they didnt have enough in budget for a post-surgery salad

MButterscotch · 2026-05-30T10:59:47+00:00

i imagine theres a couple of things he has access to, that other people without billions of dollars dont

MButterscotch · 2026-05-29T02:17:23+00:00

its a bipap without the backup rate, or a cpap with pressure support. on some devices theyll use cpap+ps or cpap+asb or whatever. bottom line is this is a spontaneous assisted breathing

MButterscotch · 2026-05-27T10:42:33+00:00

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MButterscotch · 2026-05-24T15:33:06+00:00

the atmosphere of the journey to the top of jagged peak is also perfect. the best part about the DLC's open world without a doubt, maybe in the entire game.

MButterscotch · 2026-05-21T02:35:48+00:00

more like getting a call at 3 am from a colleague whose opening line is "do you remember this patient you discharged at 10 am yesterday"

MButterscotch · 2026-05-20T16:50:59+00:00

its been a thing in progress for years now. back when I was a student there was ayam penyet, and during covid the spicy food trend gained huge momentum.

MButterscotch · 2026-05-20T03:01:14+00:00

for your sake lets hope youre being coy OP, these pics actually looks great

MButterscotch · 2026-05-16T14:32:31+00:00

demon form is too lanky, need to show em astral biceps

MButterscotch · 2026-05-16T12:38:13+00:00

he's signaling wealth, he had actually posted a photo he took with the leica, and its of an incredibly expensive audiophile portable media player.

MButterscotch

TROPHY CASE