I am taking a break from social media. Once again, the people that suffer the most in what is curently happening are the ones least responsible. Stay safe and stay sane ❤️
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let's talk about Bridgerton tea, my ask is open
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@thelittlenessie
I am taking a break from social media. Once again, the people that suffer the most in what is curently happening are the ones least responsible. Stay safe and stay sane ❤️
Medical Cheat Sheets🩺📕
Part One
Working on some medical summary sheets; first up is the ECG! Comment with what should be the next part!🔖📝
Okay, I was going to message OP directly but I actually think this can be a bit of a cool learning experience for anyone observing or who’s reblogged this - as there’s quite a lot going on here that I’d address. *Also as a general note, the above all appear to be depicted as broad QRS complexes, and nearly all of them should be narrow, as most all of them represent AV node depolarisation with conduction via presumably intact purkinje fibres (with exception of the stemi and VF). **Secondary note that all of these rhythms should be regular with the exception of AF and VF and potentially a sinus brady can show R-R variability in response to inspiration. I get that it’s difficult to demonstrate that in hand drawn examples, but it’s quite an important point. The ddx of regular vs irregular rhythms is quite important, especially for tachycardias. Sinus Rhythm: What makes a rhythm sinus? - In order to meet the criteria for sinus rhythm, some conditions need to be met: 1. There needs to be a p wave in front of every QRS 2. The p wave is positive in leads II, III and avF, negative in avR 3. PR interval is constant 4. All p waves have the same morphology Problems with the above: QRS can be of any height or width, does not need to be an R wave. Sinus Bradycardia: A bradycardia is a rhythm with a ventricular rate under 60 beats per minute. It meets all the above criteria for sinus rhythm. Problems with the above: The depicted slide into the t wave is unusual and not necessary for a sinus brady. It is true that you can have a compensatory stroke volume increase (which would be true for athletes with a resting sinus brady of no pathological significance) but may not be true in other scenarios. Sinus Tachycardia: A tachycardia is a ventricular rate above 100 beats per minute. It meets all the previous criteria for sinus rhythms and is often not elevated above 150 bpm. Common causes are fever or other systemic illness, anxiety, low blood pressure, etc. Problems with the above: This very strange baseline is more indicative of electrolyte abnormalities than a sinus tachy. There’s strange changes to p wave morphology and t wave morphology, also more indicative of electrolyte changes. The above does demonstrate clear J point depression, that can occur in sinus tachycardia, but is not necessarily present (and may be present for many other reasons). 1st Degree AV Block: What is an AV block? It implies delayed conduction through the AV node. In a first degree block, it is delayed such that the PR interval increases to over 200 ms. Problems with the above: P waves of obvious different sizes would indicate multiple foci of atrial depolarisation, which I think is probably just a result of it being a drawn ECG, but still might be confusing. Of the above traces, this is probably closest to accurate (though it’s an extraordinarily prolonged PR, and the PR has to be equal on all intervals depicted). 2nd Degree AV Block: (Mobitz I) A second degree AV block includes the phenomena of an AV node that is not conducting all beats that arrive from the atria, demonstrating progressive dysfunction and failure. In a Mobitz I (also called a Wenckebach) there is progressive lengthening of the PR interval leading up to a dropped beat. Problems with the above: There is a depicted dropped beat but no mention of the requirement! 3rd Degree AV Block: This is the most severe type of AV block, which occurs when there is a complete dissociation between the atria and ventricles, with no electrical impulses crossing the AV node. In a third degree block, the rate of ventricular depolarisation and thus QRS complexes is controlled specifically by the AV node, which will be slower than the impulses generated by the SA node, hence the bradycardia. Problems with the above: If the impulse is generated by the AV node, there will be no changes to the QRS complex. Or T waves. If the impulse is generated by the AV node, the QRS will remain narrow and not be broad. The only criteria for dx is the presence of AV dissociation. Ischaemia: ST segment depression can be indicative of ischaemia! However, to be of diagnostic significance, it needs to be greater than 2mm and present in more than two anatomically contiguous leads. Problem with the above: This is very slight! Does it meet the criteria for true ischaemia or is there another, better explanation for very slight ST segment depression? Injury: Myocardial injury can certainly look like ST elevation (though there is quite a ddx for that as well, you always need to rule out infarct first). I think what this is attempting to depict is the phenomena of “tombstoning” which is an acute myocardial infarction, also called a STEMI. It’s important to note that occasionally people may have myocardial injury or infarct that does not cause ST elevation, called an NSTEMI. To diagnose ST elevation, you ONLY need an elevation of more than 2 mm in more than 2 anatomically contiguous leads, it does not have to be as obvious as tombstoning. Problems with the above: There is a strange secondary elevation within the tombstone that I’m not sure makes any sense? This morphology is most clearly described as the QRS merging with a peaked T wave, there should not be another wave between those two. Atrial Fibrillation: AF occurs when there is no coordinated electrical activity within the atria, thus there are no p waves visible on the ECG. There is, instead, a wavy, irregular baseline. The AF can result in a bradycardia, a normal rate or a tachycardia, but will always be irregular (unless there is additional underlying pathology), as there is no underlying rhythm that dictates which beats are conducted through the AV node and which are not. Problems with the above: AF is often NOT a ventricular rhythm. Random electrical impulses that come from varying ectopic foci in the atria reach the AV node at varying intervals, leading to an irregular (often tachycardic) rhythm. Ventricular Fibrillation: VF a similar phenomena to AF in that there is a lack of coordinated electrical activity. The ventricle does not have a coordinated contraction of the muscle, and just “twitches” as varied areas of the muscle are contracting at different moments. There is no pulse, and thus blood flow ceases. This rhythm requires an immediate defibrillation to restore coordinated electrical activity and thus heart beat. Problems with the above: Because of the lack of coordination in VF, the amplitude of the waveform is often very small or slight. There are often not easily recognisable complexes as is depicted above. _______________ I hope it’s clear why I felt this was worth commenting on, as ECGs can be such a tricky topic and learning them from the beginning with potentially more confusing or less appropriate depictions setting people up for massive confusion later on. If anyone has anything to add, especially if I missed something, please feel free to reblog with your thoughts, and your ECG resources. I personally am a huge fan of www.lifeinthefastlane.com as an awesome learning resource. Please feel free to use the following summaries that might be more clear in depicting the waveforms discussed, and give a good understanding of how to approach reading an ECG. (thanks @doctorfoxtor )
Wildflowers, wood smoke, dying light.
this user wants to lay down in a field of flowers for a bit.
Pastel pink is so soothing to look at 🌸
A cloudy day ⛅️ Does anyone else like their coffee with lots of cinnamon? ☕️
Cinnamon is the best!
5/13/20
my monthly spread in my bujo for may. she’s so cute i love her
xo- gg
days 21, 22, 23, and 24 of 100 days of productivity have been full of mcat and cooking. i made my mom a five course dinner on mother’s day (day 22), so i couldn’t get much studying done - it was a great break though :) day 24 (today) is going to be full of chemistry, i hope 🌙🤍
11/5/2020 | 55/60 Days of Productivity
So ready for exams to be over so i can hibernate
not so much study tips, more thoughts on university/studying in general
although these posts are abundant, i like to have my own collection of study tips/uni thoughts
- i’ve been viewing my studies as an office job, mostly because of the 9 to 5 mentality. i am not one for night studying, i have tried and tried and felt guilty when i heard others talk about their late night study sessions, but it is just not for me. which is fine, because with this 9 to 5 idea i have created working days for myself and i can use my evenings for extracurriculars, books, friends, netflix
- the train has (weirdly) become one of my favourite study spots. of course this really depends on the public transport you use. i am on a train for two hours a day, no transfer, and i either go to a silent area (have not yet seen this elsewhere, but dutch trains have carriages in which there is complete silence) or i put in my earpods. i love this because when i come home, i have already done so much work, e.g. organized my lecture notes of that day, inserted my professor’s comments into my paper etcetera
- although i’ve also learned to recognize when i am just done. sometimes i have had enough and it is way better to accept that and then i either listen to some music and stare at the passing landscape, or i watch an episode of the crown. when feeling exhausted, there’s no point in pushing and forcing yourself
- this goes for many many aspects: comparison will kill you. it is often still my tendency to compare myself to others on all levels - grades, kindness, clothing, weight, work ethic - but i make the effort to not ‘indulge’ in it. what my therapist told me has really helped: just notice that the urge to compare is there but then leave it be. like it’s a tiny spider crawling on your leg; you don’t have to do something with it
- on the topic of work ethic: don’t listen to your fellow students. don’t listen to what some wonderful academic says (online). don’t even listen to what your professors say regarding study hours. it has often made me feel very uncertain, but i think it is way better to figure it out yourself. to build up a feeling of trust towards yourself, so you can really start to notice, to feel, when you have done enough. that is something only you should be able to judge and not some external source
- sometimes i get overwhelmed with this sensation that i have not done enough, that i am lazy and have accomplished nothing. however, every (every!) time i have noticed this to be untrue. so perhaps i have not studied every chapter, but i have studied other chapters. i found the cliché of looking at what you have done to really be true. it helps me put things into perspective, i think we can really underestimate ourselves in how much work we have done. what you consider to be 20% may actually be 60%
- motivating internal monologues are completely normal and actually very good! give yourself that motivating speech, it’s like a snow track that becomes deeper and clearer everytime you repeat it
it helps me to look back on these at times, has been in my concepts for a while now (like some kind of motivating internal monologue) but i want this to have a place on my actual blog, because i believe tips like these (less focused on studying and more on coping with the whole world of studying/academia) are important as well
These are… rlly good
Anatomical Cross-Sections Made with Quilled Paper by Lisa Nilsson
no offense but neuroanatomy sucks, we should all just be plants
Yes.
Nobel Awarded Women In Medicine and Physiology
Gerty Theresa Cori - 1947 Discovery of the course of the catalytic conversion of glycogen (also known as Cori Cycle)
Rosalyn Yalow - 1977 Development of radioimmunoassays of peptide hormones
Barbara McClintock - 1983 Discovery of mobile genetic elements
Rita Levi-Montalcini - 1986 Discoveries of growth factors
Gertrude B. Elion - 1988 Discoveries of important principles for drug treatment
Christiane Nüsslein-Volhard - 1995 Discoveries concerning the genetic control of early embryonic development
Linda B. Buck - 2004 Discoveries of odorant receptors and the organization of the olfactory system
Françoise Barré-Sinoussi - 2008 Discovery of human immunodeficiency virus
Carol W. Greider - 2009 Discovery of how chromosomes are protected by telomeres and the enzyme telomerase
Elizabeth H. Blackburn - 2009 Discovery of how chromosomes are protected by telomeres and the enzyme telomerase
May-Britt Moser - 2014 Discoveries of cells that constitute a positioning system in the brain
We can be the next. WE CAN DO IT!
#WOMENINSCIENCEWEDNESDAY
STOP WRITING OFF OLD PEOPLE
they were not “going to die in a few months anyway”
the average life expectancy at age 70 is 15 years. fifteen years! when i am 70 i can tell you i am going to want every minute of every remaining year i can get because i’m not going to be anywhere near done thinking and talking and traveling and being with loved ones. it’s 2020, 70 is just not that fucking old any more
“okay but what about like an 85 year old” no. fuck you. the average life expectancy at age 85 is 6.5 years. (that’s not a discrepancy ... the longer you live, the likelier you are to be made of resilient stuff.) my father is 84, a bit creaky round the edges, got a few of those underlying conditions, but yanno he’s not fucking done yet either, he’s full of beans, and many many people would prefer him to stay that way
old people’s lives are important. i’m sorry about your generational trauma, i sympathize even, but stop it
for everyone who’s a bit sick of being stuck indoors
I know that feel. I’ve been in isolation for about four years due to illness. It was let’s say a very difficult life change. I crashed out of the world pretty hard and spent a few months in bed in constant pain wishing I was dead, while everyone thought I was just being incredibly rude. It sucked.
I’m saying this because I’m about to drop a few pieces of advice and I want you to know that they’re coming from a place of experience and empathy.
We are nowhere near the end of this crisis. We need to be ready for the long haul, because we still have months of isolation, restriction, and caution ahead of us. This is normal now. That’s a lot to deal with. This sucks.
And hey if you’re still enjoying the veg-out binging netflix in your pyjamas with a bucket of chicken phase, that’s great. You deserve to rest. Come back to this post later when you need it.
But if you’re realising there’s actually a limit to how long social media, TV, and video games can keep you civil? Let me help with that.
0. Thank you. I’m immunocompromised, so thank you for staying home, washing your hands, and following the guidelines to flatten the curve and slow the spread of the virus so I don’t die. I know it’s hard. Remember you’re doing a good thing.
1. Keep using the internet to stay in touch and communicate with people so you feel less lonely. Use social media to socialise, not as a news source. Learn new things, fall in a wikihole, tell someone something interesting you just found out. But logging off will do you a power of good.
2. You need to engage your other senses to stave off depression. Your body and your senses need to be kept occupied, not just your brain. Learn to cook from scratch, try new recipes, bake something, have a home spa day, light that fancy scented candle you’ve been holding on to for a special occasion.
3. Oh yeah, whatever you’ve been holding onto for a special occasion, bust that baby out now. The nice outfit, the posh food, the fancy soap, whatever little treats you have squirreled away. Instead of saving them for a special occasion, use them to create an occasion and make it special. If nothing else, it will help stop the days blurring into each other quite so horribly.
4. Don’t get drunk. A drink is ok, but a hangover will make everything feel worse.
5. Your round toit is here. Mend and repair those things, do a deep clean, rearrange that room, organise that stuff, do some arts and crafts, try a new hobby. Make and do something with your hands. BUT! Pace yourself. Spread things out a bit. Do a little bit of this and that each day, instead of doing one thing all day or everything in one day.
6. Don’t sleep in. Go to bed early, take naps, get your rest, but if you’re going to have to go back to work after this, you really don’t want to let your sleep pattern shift, and the best way to avoid that is by not sleeping in. Sorry. Really, I am so sorry.
7. You need to move your body, especially when you feel anxious. Anxiety is in the body, you can’t think your way out of it, you need to move. Yoga is uh fine I guess, pretty good for stress, but tai chi is actually a lot better for anxiety. Or do some bodyweight exercises, or pilates. Or come up with some choreography and rehearse it and then perform it in the street for your neighbours. Or just pace around the house like a zoo animal, and roar occasionally. Roaring helps too.
8. Mind your diet. I know it’s a hassle when you can’t go grocery shopping as often and you’re probably eating more tinned and frozen foods than usual, but do your best to vary your meals and eat a balanced diet. Don’t add nutritional deficiencies and the misery of food boredom to your problems. And stay hydrated.
9. Look after something living. If you don’t have a child or a pet or a garden or a houseplant, try growing some sprouts or microgreens, or start a sourdough mother or a ginger bug. Nurturing and caring for something alive (even yeast) is incredibly healing and stabilising. Also we’re starting to realise plants are super important for mental, emotional, and physical health. Humans need green time, so if you don’t have a houseplant maybe see about getting one.
10. Be thankful. I don’t mean in a stupid platitude way like “some people have it worse” or anything fake like that. You can still be angry, bored, outraged, frightened, disappointed, exhausted, dismayed. But to avoid falling into meaningless grey despair, set aside a few minutes each day and find things to be grateful about on purpose. It doesn’t have to be big. Your pet has been super affectionate? Favourite youtuber uploaded? Weather was kind of nice? New episode of that show you like? Chair comfy af? Tasty breakfast? Recognise it and be thankful for it. You don’t have to be thankful TO anyone or anything in particular, just be thankful FOR something in particular. Try for five things per day to start, but do more if you want.
11. Take some cosy time. I think this is maybe kind of like hygge? Spend some time each day doing something that makes you feel calm and cosy and safe. Build a blanket fort or snuggle up with a hot drink and a book, and just be cosy for an hour or so. This is a very stressful and frightening event we’re all going through so making a deliberate effort to cultivate feelings of warmth, contentment, and safety every day will help fend off trauma.
12. Speaking of books, reading a book engages your brain differently from watching a movie or listening to a podcast, and is very good for your brain and mood. If you have a to-read pile you’re probably already making a dent in it but if you don’t, or if you’ve reached the bottom of it, a lot of writers and publishers are offering free ebooks to help with isolation. You can read ebooks on your phone if you don’t have an ereader or tablet.
13. Balance your news intake. Restrict the amount of time you spend looking at news about the pandemic, and limit yourself to a few reliable sources. For every hour you spend reading the news and watching the scary numbers go up, spend an hour specifically looking for good news. Incompetent governments are failing their people, a minority of profiteers are trying to take advantage of the situation, and a lot of people are sick and dying, but that’s not the whole story. People can be SO GOOD. Did you hear about the medical drama shows donating their PPE to hospitals & fire departments? And the cosplayers and actors doing in-character birthday videos for kids who can’t have parties? People are helping each other, taking care of each other, there is so much good news so look for it, and then share it.
14. Get fresh air & sunshine. If you have a garden or a balcony, use it. Spend as much time there as the weather allows. Open your windows, weather permitting. Pull a chair up next to a window and read a book. Depending on your location, you may even be safe to shove your hands in your pockets and go for a walk–but keep at least 2m away from other people and if you’re in a hard lockdown or enforced quarantine, don’t flout it.
15. If you’re working from home, be able to close a door on your work space. When I worked remotely I had the computer set up in a wardrobe because I didn’t have a wholeass room for it, and I would unplug it and close the door on it at the end of my shift, it was a real sanity saver. Even if you don’t passionately hate your job, be able to close a door on it. Closing a physical door helps your brain to keep your work compartmentalised away from your home life, and helps you control work-related stress.
16. Do something for someone else. We’re a social species, we have a fundamental need to help others. It makes us feel connected, less isolated, and that’s something we all need right now. If you have a sewing machine, make masks for people who need them. If you have money, drop some of it on gofundme’s to help people who’ve lost their jobs make rent. If you bought too much toilet paper and you’re starting to realise that was a mistake, ask your neighbours if they need any. Live stream a cooking class. Teach someone how to use skype. There is something you can do to help someone else, so find it and do it. You will feel better for it.
17. The corollary to helping is: accept help from others. Helping others is one way we strengthen our social bonds, accepting help is another. Plus right now there’s a lot of ways that accepting help is also helping others. If someone offers to pick up groceries or a prescription for you while they’re getting their own, that’s helping everyone, the fewer people in the stores the better.
18. Avoid platitudes. They’re actually harmful, not helpful. Be sincere, both in expressing your own feelings and when other people share theirs with you. To be perfectly honest I’m pretty bad at this, it’s hard not to make jokes and deflect, but it’s so important right now to communicate authentically. I know how uncomfortable it can be but do your best. When we feel deeply heard and understood, we feel less alone. It’s still ok to be silly and goofy, just be honest and compassionate as well.
19. Mind your temper. Try not to lash out or get drawn into arguments, it won’t make you feel any better. You might get an easy rush and some attention out of it, but afterwards you’ll just feel more isolated than ever, and you risk permanently alienating people around you.
20. Everyone’s process is different. Don’t try to police other people’s emotions. Respect that we’re all processing this at different speeds and in different ways. We’re off the map, in an unprecedented situation, there’s no “right” way to feel about that. Invalidating other people’s feelings is a surefire way to push them away, and we all don’t need any of that right now.
21. Keep taking care of yourself. Keep cleaning your teeth, bathing, changing your clothes, brushing your hair, doing your laundry. Keep taking your meds, doing your exercises, getting enough sleep, eating on time. Not just to avoid a big personal crisis when it’s time to go outside again, but also because you deserve it.
Covid-19 is showing us what’s really important. After this is over, don’t forget about it. Remember service workers, warehouse workers, and other “unskilled” workers keeping the supermarkets running. Remember farmers and factory workers stepping up production to refill the shelves, and truckers hauling the goods. Remember doctors and nurses, orderlies and cleaners, working overtime, understaffed, underprepared, and under-equipped, to care for the sick and dying. Remember artists, writers, musicians, actors, performers, designers, and developers keeping you sane. Remember the garbage collectors and the street sweepers, and the folks who work at power, water, and sewage plants. Remember delivery drivers, couriers, and postal workers. Remember the disability and chronic illness communities reaching out to help you navigate your visit to our everyday reality. After this is over, be kind, and pay it forward. Tip generously, mind your manners, and don’t look down on anyone for their job or ability level. Fight for better wages and working conditions, better accommodations, and better social safety nets. Show up for the people who are showing up for you.
Some of this is excellent advice I haven’t seen from anyone else.