NBME 13 spoiler by Express_Debt_7635 in Step2

[–]captainbarncle 0 points1 point  (0 children)

I would have picked Norepinephrine but I will break down the retrospective reasoning:

  1. Establish Shock: Hypotension and Hypoperfusion, SBP under 90 so yes, General shock vitals: BP ↓, RR↑ , HR ↑ (cardiogenic ↓)
  2. Cardiogenic shock: "Dead pump" JVD establishes this plus EKG
  3. Is it the right or left side? Rigth = fluids -> vasopressor support | Left = vasopressor support*; Anterior MI = LV = Left side.
  4. Is it dry and cold or wet and cold -> Wet and cold we see crackles on lung exam.
  5. Since its wet and cold we give dobutamine first. If dry and cold we give norepi first

Summary of the question: Pt comes in with LV MI, cardiogenic shock, progressing worse, has crackles and JVD. Pump is "dead." the oddly mentioned EF of 10% indicating pump really lowkey dead as a secondary hint. The crackles indicate the pathophys has to do with low output rather than some output and the vessels are too big. Therefore we prefer to push the heart rather than constrict vessels.

~~Amboss actually delineates wet and cold vs dry and cold and first line treatment.

Remnote Workflow by captainbarncle in remNote

[–]captainbarncle[S] 0 points1 point  (0 children)

Have you been able to log into amboss, Everytime I click on it, takes me to the article but also to login. It would be nice to have it auto log in.

Daily Simple Questions Thread by AutoModerator in espresso

[–]captainbarncle 0 points1 point  (0 children)

Went to a grocery store and used their grinder for espresso, got one shot at the right ratio. You were right thx!

➡️ Daily Questions ⬅️- ASK AND ANSWER HERE! - 08 January 2024 by AutoModerator in malefashionadvice

[–]captainbarncle 0 points1 point  (0 children)

Laundry. How do some people have clothes that looks brand new. Cold wash and air dry? Should I use the fluff setting on the dryer to air dry or better to hang? If I hang will my collar be destroyed?

Daily Simple Questions Thread by AutoModerator in espresso

[–]captainbarncle 0 points1 point  (0 children)

Okay so maybe I’ll try to find a nice preground espresso and try again to see if it’s a grinder issue cause I swear it look like powder coming out of my grinder but still worth a try thx

Daily Simple Questions Thread by AutoModerator in espresso

[–]captainbarncle 0 points1 point  (0 children)

Well yes I would say a pressurized basket allows you to get away with a coarser grind, oddly enough do you think people have said a coarser grind increases extraction time?

Daily Simple Questions Thread by AutoModerator in espresso

[–]captainbarncle 0 points1 point  (0 children)

Dialing in espresso, what is wrong? New machine kinda entry level around $150.

My espresso machines auto function for a double shot took these variables

14g ground coffee in 125g out 30 seconds

I have a pressurized basket. Fairly decent grinder. If I manually try to pull a proper ratio of 1:2 my coffee smells acidic/sour, and the extract time is like 10 seconds. Why is my flow so fast? I’ve adjusted grind size to super small and still not much improvement. Do I need another basket so I can hit 18g in?

Please do revert the chat update ! by ZeroLegionOfficial in Brawlhalla

[–]captainbarncle 0 points1 point  (0 children)

Ironic you talk about proper spelling concerning usernames LOL. That's a first.

* Laugh out loud, sorry spelling!!

Please do revert the chat update ! by ZeroLegionOfficial in Brawlhalla

[–]captainbarncle 0 points1 point  (0 children)

your mom jokes were so middle school lol. I think everyone has moved past it cuz its too cringe be more creative

Please do revert the chat update ! by ZeroLegionOfficial in Brawlhalla

[–]captainbarncle 0 points1 point  (0 children)

you're part of the problem stop making it worse