
Un tipo que le gustan los juegos, MGZ, aprendiendo MDU en la UC. Escuchanos en #ElPosturno en #Spotify!
Santiago, Chili
Joined April 2009
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eamm18 retweeted
🔥 Brilliants minds debate oral fosfomycin for complicated UTI including pyelonephritis. With increasing ESBLs, we need options for UTI beyond cystitis. Oral fosfomycin is an appealing option, but is it ok for infection outside the bladder?
#pharmacist #MedEd
🔥Wow🔥It's published!
Congratulations everyone, honored to be part of this letter!
Oral Fosfomycin for Pyelonephritis: Time for Evidence Over Eminence-based Guidelines
We are concerned that the process used by IDSA, and other specialty societies, to construct clinical guidelines continues to produce recommendations absent–or even contrary to–evidence, potentially causing patient harm #idxposts
eamm18 retweeted
Este tipo grabó una noche cualquiera en un Blockbuster en 1993.
Entrar, recorrer los pasillos, elegir una película y volver a casa para una noche de cine.
En ese momento era algo normal. Hoy es un pequeño viaje a una época que ya no existe.
eamm18 retweeted
Una idea simple aunque polémica. Que haya un curso obligatorio de formación legislativa para parlamentarios electos por primera vez. Nociones básicas del derecho público y un marco general del derecho privado. Con eso podríamos reducir la chapucería y el chamullo jurídico diario.
eamm18 retweeted
Tham Luang cave rescue in Thailand (2018):
💊Alprazolam 0.5 mg PO
💉Atropine 20 mg/kg
💉Ketamine 5 mg/kg IM plus 2.5 mg/kg additional doses PRN
This is similiar to the midazolam-ketamine strategy we use for sedation in critically ill patients (MidaKet). These agents are effective and have a wide therapeutic index so they’re very forgiving (unlike, say, propofol).
(More on MidaKet: emcrit.org/pulmcrit/midaket/)
Each boy received oral alprazolam, then intramuscular atropine and ketamine. Wrists were cable-tied behind the back so they could not claw at the gear if they woke.
“It could be like I’m euthanizing these boys.”
Australian anesthetist Richard Harris said that before approving the rescue plan. What came next was not heroics by children. It was a medical extraction run through a drowned mountain.
In June 2018, twelve school footballers and their coach entered Tham Luang in northern Thailand after practice. Heavy rain closed the way out and trapped them inside the cave for nine days. Later, British cave divers John Volanthen and Rick Stanton reached Chamber 9 and found all thirteen still alive.
The clip of that moment went viral and created hope. Inside the rock, it solved nothing. The way out was an hours-long underwater drag through slits of stone and floodwater the color of coffee. A trained former Thai Navy SEAL, Saman Kunan, had already collapsed on a tank run and died. Officials feared a conscious boy would rip the mask, flood his airway and take the diver down with him.
British cave divers asked Thai officials to summon Richard Harris, an Adelaide anesthetist and experienced cave diver. Upon arrival and after studying the situation, he designed a ketamine protocol so the boys would stay unconscious but keep breathing on the way out.
The chemistry was precise. Harris chose ketamine because it can drop a child into unconsciousness while leaving spontaneous breathing intact. Alprazolam (Xanax) went first. Atropine dried saliva that could choke them. Preloaded syringes rode with the lead divers. When a body twitched in the dark, another shot went through the wetsuit.
Harris thought the first child might emerge dead. He would still have to go back in for the others. Thai officials granted Harris legal protection if a child did not survive the passage.
Then they executed the plan. The first boy came out alive. Then another. Over three days in July 2018, all twelve boys and their coach were brought out.
The public story is often told as a miracle. The medical plan was narrower. Twelve healthy minors were put under in a cave, bound and moved like cargo because fear itself was the deadliest part of the route.
eamm18 retweeted
We must work to better align work and rewards for that work with people’s skills and passions and not force people into boxes where they don’t fit. The problem is most medical students don’t quite know which box they fit in just yet. 3/
eamm18 retweeted
In January 1991, Norman Schwarzkopf knew the exact number of body bags the Pentagon had ordered in anticipation of the coming ground campaign. He was 56 years old, and he had been handed a responsibility no American commander had carried since the Second World War: more than half a million soldiers from 34 nations, arrayed across the Arabian desert, waiting to be pointed at one of the most battle hardened armies on the planet.
Saddam Husseins forces had spent eight years fighting Iran. They had fortified every approach into Kuwait with mines, trenches, and pre aimed artillery, all built on a single assumption: that when the Americans arrived, they would come straight through the front door.
Schwarzkopf had no intention of using the front door.
He had learned something during two tours in Vietnam that desk generals never quite grasp. He had been decorated three times with the Silver Star for gallantry under direct fire. The most famous of those moments came in May 1970, when he received word that soldiers under his command had stumbled into a minefield. He flew in by helicopter and found the men trapped, with a wounded soldier lying on the ground screaming and a very real danger that the mans panic would cause him to set off another mine. Schwarzkopf crawled across the minefield to the wounded soldier, pinning him down safely so another man could splint his shattered leg.
Believe me, it wasnt a heroic act, he said later. It was something that somebody had to do, and I was the man in charge. Because of experiences like that, he knew, in a way that cannot be taught in a classroom, exactly what he was about to ask his soldiers to do.
For six weeks before a single ground soldier moved, coalition aircraft worked methodically. They struck command centers, severed supply lines, silenced communication networks, and systematically blinded the Iraqi military, all while Iraqi generals watched the Kuwaiti border and waited for the frontal assault they were certain was coming.
It was not coming.
Instead, two hundred thousand soldiers and thousands of armored vehicles moved west, deep into the open desert. They moved at night, in total electronic silence, far away from cameras and away from every position the Iraqi army had spent months preparing to defend. All the while, the Iraqi generals kept their eyes fixed on the coast.
When the ground war finally began on February 24, 1991, coalition forces were already hundreds of miles to the west. They swept through open terrain no one had bothered to defend, drove deep into Iraq, pivoted east, and struck the Republican Guard from behind. Every escape route was already closed.
The ground war lasted just 100 hours. One of the largest armies in the world collapsed in a mere four days of combat. Kuwait was liberated, and coalition casualties were a tiny fraction of the numbers that had been feared.
The Left Hook, Schwarzkopfs famous flanking maneuver, is still studied at war colleges today, and military historians still marvel at its elegance.
Six months later, the offers poured in: Senate seats, presidential conversations, corporate boards, and television contracts. The full machinery of American celebrity was pointed directly at the man who had just won the most precisely executed military campaign in a generation.
Yet, he retired in August 1991, moved to Tampa, Florida, and went fishing. He wrote just one memoir, It Doesnt Take a Hero, published in 1992, and gave a small number of speeches. He did not spend the following decades reminding the world of what he had achieved. He had led, he had brought his people home, and the job was finished.
Norman Schwarzkopf died on December 27, 2012, in Tampa, Florida, at the age of 78, from complications of pneumonia. Veterans mourned him, and military historians wrote long assessments of his career. His ashes were buried at the West Point Cemetery alongside those of his father, another general, also named H. Norman Schwarzkopf, who had famously directed the investigation of the Lindbergh baby kidnapping in the 1930s.
The operational records of Operation Desert Storm are preserved in military archives. His name is on all of them, quietly and permanently, because a record like his doesnt require his presence to stand.
eamm18 retweeted
Let’s describe the cold intensity of the unmanned battlefield with a real-world example.
1) A Ukrainian soldier is wounded.
2) A Ukrainian UGV makes a pickup of the wounded soldier and begins extraction.
3) A Russian UAV disables the Ukrainian UGV.
4) A second Russian UAV comes in to finish the soldier off.
5) A Ukrainian UAV defends the soldier from the Russian UAV.
Are you beginning to understand yet?
eamm18 retweeted
*En clases de español para extranjeros.*
YO: ...entonces, algunas personas le ponen salsa inglesa a sus michelada y--
ALUMNO 🏴: ¿"Salsa inglesa"? ¿Qué es eso?
YO: Ya sabes. La salsa esa con nombre impronunciable.
🏴: ¿...?
🇺🇸: No te hagas menso. La salsa Wosterer... algo.
🇫🇷: Así no es. Es Worcestar... algo.
🇨🇦: Ay, ya sé de cuál hablan. La Worsesescer... algo.
🏴: ¡Ah! La salsa Worcestershire.
TODOS: Ajá, esa.
🏴: Ay, no es necesario hacerse bolas pronunciando todo el nombre. Nosotros la llamamos "Wostah sauce". No porque nos parezca difícil pronunciarlo, sino porque el nombre es demasiado largo.
🇫🇷: Pues qué mamada.
🏴 (a mí): ¿Entonces ustedes le llaman "salsa inglesa".
*El alumno francés señala al estadounidense y al canadiense.*
🇫🇷: Si ellos que hablan inglés no pueden pronunciarlo, ¿crees que los mexicanos sí?
YO (encogíendome de hombros): ¿Qué puedo decir? Somos gente sencilla con soluciones rápidas.
eamm18 retweeted
Je crois qu’on ne se rend pas compte à quel point ce baiser sur la main d’Historia a détruit la vie d’Eren en une seconde il se fait spoil son avenir, ses pertes, sa propre mort et tout ce qu’il devra sacrifier pour y arriver, toute la fin de SNK commence ici c’est du pur cinéma
eamm18 retweeted
The ending of “Victory and Death” (2020) is the moment THE CLONE WARS stops feeling like a cartoon and starts feeling like a tragedy. Years spent turning the clones into individuals, only for the final image to be rows of identical helmets in the snow.
eamm18 retweeted
Watching footage from WW2 makes me realize how brave this generation was and how pathetic the current one is.
eamm18 retweeted
Alta Dirección Pública.
Datos del Servicio de Registro Civil:
Han dejado puestos, en el Estado de Chile, 175 funcionarios de primer nivel jerárquico -altos directivos- y de segundo -como subdirectores o jefatura de unidades, entre otros- de los cuales 139 se registran en el sistema "renuncia no voluntaria”. Todos llegaron, por sus méritos, seleccionados por concursos de Alta Dirección Pública
eamm18 retweeted
¿POR QUÉ LOS CLÉRIGOS DE LOS JUEGOS DE ROL Y FANTASÍA LLEVAN MAZA?
El "clérigo" de los juegos de rol y la fantasía, desde 'Dungeons & Dragons', va siempre con maza o similares y nunca con espada por un supuesto, y es que el clero tenía prohibido derramar sangre y recurría al arma roma para matar sin cortar. Suena muy bien pero es falso.
No hay ningún decreto papal ni canon que prohíba a los clérigos las armas con filo y les permita las contundentes. El principio que se cita, "sine effusione sanguinis", existía, pero el IV Concilio de Letrán de 1215 lo aplicó a que los clérigos no presidieran ordalías, ejecuciones ni cirugía, no a qué arma empuñaban en combate. Lo que la Iglesia repitió durante siglos fue que el clero no fuese a la guerra en absoluto, con filo o sin él, y aun así muchos fueron.
El origen del mito está documentado. Gary Gygax, creador de 'D&D', leyó sobre el obispo Turpín del 'Cantar de Roldán' y sobre Odón de Bayeux, y dedujo una regla donde no la había. A Odón lo pintan en el tapiz de Bayeux en Hastings, 1066, con un 'baculum', un garrote, y de ahí salió la leyenda. El problema es que en ese mismo tapiz el duque Guillermo, que no era clérigo, lleva un bastón igual, porque era un símbolo de mando, el antepasado del bastón de mariscal, y no un truco para no cortar. Que se atribuya a su condición de clérigo es, para los especialistas, más que dudoso.
Y los clérigos que sí combatieron usaron de todo. El arzobispo Turpín pelea con espada en el 'Cantar de Roldán'. El obispo-príncipe Hermann de Dorpat llevó a sus hombres al combate sobre el hielo del lago Peipus. Las órdenes militares, templarios y teutónicos, iban con espada, lanza y maza según conviniera. Hay además un problema físico. Una maza hace sangrar tanto como una espada, porque hundir un casco y reventar un cráneo abre heridas y astilla huesos. El arma roma nunca evitó la sangre.
Bibliografía recomendada en los comentarios.
eamm18 retweeted
The 60/60 sign is a cardiac #POCUS finding used to support the bedside diagnosis of acute pulmonary embolism. It refers to the simultaneous presence of two measurements, both involving the number 60.
RV outflow tract (RVOT) acceleration time ≤60 ms - This is the time from the onset of blood flow through the pulmonary valve to its peak velocity. In acute PE, the sudden obstruction causes blood to accelerate and decelerate abnormally fast, producing a "truncated" or shortened flow profile.
Pulmonary artery systolic pressure (PASP) ≤60 mmHg (but >30 mmHg) - estimated via the tricuspid regurgitation jet.
In acute PE, the thin-walled right ventricle cannot generate very high pressures because it has not had time to adapt. A PASP above 60 mmHg suggests a chronic process (e.g., chronic pulmonary hypertension) where the RV has hypertrophied over time
eamm18 retweeted
Hange's sacrifice was an objective improvement over the manga version. Storyboarded by Hayashi, and animated by Jason yao, Sheng meng chen, Xinxiong ceng, Sakai, Taichi Furumata and the star; Q-Kawa, coming back to deliver another dymanic cut.
And obviously Blauklötze returning.
eamm18 retweeted
The physics of what's happening in that 0.1 seconds of contact should bother you.
Those tires are completely stationary when they hit the ground. The plane is moving at 250 km/h. For the first fraction of a second, the rubber isn't rolling. It's skidding. Pure friction has to accelerate 22 wheels, each weighing 120 kg, from zero to 155 mph in roughly a tenth of a second.
The tread surface goes from -50°C at cruising altitude to over 200°C at the moment of contact. A 250-degree temperature swing in 0.1 seconds. The smoke you see at every commercial landing is rubber vaporizing off the tire surface. Studies at Manchester and Heathrow found that tire smoke at touchdown produces a greater magnitude of particulate emissions than the jet engines themselves.
The tires are inflated to 200 PSI, six times your car's tire pressure, and they're filled with nitrogen instead of air. Regular air contains moisture that would flash to steam and oxygen that could combust at those friction temperatures. Nitrogen eliminates both risks.
Each tire costs $5,500 and lasts about 250 landings before replacement. The A380 carries 22 of them. At max landing weight, those 22 contact patches are distributing 391 metric tons across roughly 15 square feet of rubber. That's 57,000 pounds per square foot.
The reason they don't pre-spin the wheels before landing, which would eliminate the skid and save millions in tire wear, is weight. Adding electric motors to 22 wheels increases fuel burn on every single flight. The math says it's cheaper to vaporize rubber 250 times and buy new tires than to carry the motors.
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