Perla Díaz

Vascular

[Dr Luis Felipe Cabrera Vargas MD FACS @PipeCabreraV]

Mnemonic to remember the order of how to put and release the clamps during carotid endarterectomy to avoid plaque or detritus embolism into the CNS circulation!
ICE 🧊
Put:
1. Internal carotid artery
2. Common carotid artery
3. External Carotid artery
Release:
1. External carotid artery
2. Common carotid artery
3. Internal carotid artery
@SWexner @pferrada1 @TomVargheseJr @BJSAcademy @AmCollSurgeons

[HBO Max Latinoamérica @HBOMaxLat]

Pausa de hidratación. 🐉 #HOTD

[Nilesh tawade @GTawade84]

@ReneLizola

[Toluca FC @TolucaFC]

¡HICIMOS H12TORIA, @ALEXIS_VEGA9 ©️ ANOTA Y NOS DA EL TÍTULO 1️⃣2️⃣! 🏆✨

🐯| ❌⚽️⚽️⚽️⚽️⚽️⚽️⚽️⚽️❌❌❌
👹| ⚽️⚽️❌⚽️⚽️⚽️⚽️⚽️⚽️❌❌⚽️

[La Traumatóloga Geek @traumatogeek]

SÍNDROME DE REPERFUSIÓN: CUANDO LA DECISIÓN CORRECTA ES ELIMINAR LO QUE ACABAS DE SALVAR

Ayer hablé del síndrome de reperfusión en abstracto.
Hoy os cuento el día que tuve que vivir con esa decisión.

Varón, 24 años. Accidente de tráfico.
Brazo fuera de la ventanilla en el momento del impacto. Amputación casi completa a nivel del hombro.
Llega a urgencias consciente, estable, con el brazo colgando por un hilo de tejido.
El equipo se activa. Cirugía vascular. Traumatología. Anestesia.
No faltan medios. No falta técnica. No falta voluntad.

12 horas de quirófano. Reconectamos arterias, venas, nervios, tendones. Todo perfecto. Técnicamente impecable. El brazo vuelve a tener pulso. Subimos al paciente a planta. Nos vamos agotados pero satisfechos.

24 horas después, todo se va al infierno.
El brazo: hinchado como un globo. Cianótico. Caliente.
El paciente: febril, taquicárdico, hipotenso.
Analítica: potasio por las nubes, acidosis metabólica brutal, fallo renal agudo.
Síndrome de reperfusión masivo.
Las toxinas del tejido isquémico habían entrado a la sangre.
Y ahora su cuerpo entero estaba colapsando.

Teníamos dos opciones:
1. Intentar salvar el brazo con diálisis, soporte hemodinámico, UCI durante semanas. Probabilidad de éxito: baja. Probabilidad de muerte: alta.
2. Amputar el brazo que acabábamos de reimplantar 24 horas antes. Y salvarle la vida.

Lo viví como residente, pero es una de las conversaciones más duras que recuerdo:
"Ayer nos dijeron que todo había ido bien."
"Y fue bien. Pero el cuerpo no lo tolera."

Le quitamos el brazo. En 2 horas estaba estable. A los 3 días salió de UCI. Vivo. Sin brazo. ¿La lección profesional? A veces, la decisión médica correcta no es la que parece heroica. Es la que salva la vida. Aunque signifique deshacer todo lo que acabas de hacer.

Reimplantar un miembro es técnicamente posible.
Pero si el cuerpo no puede gestionar la reperfusión... estás firmando una sentencia de muerte.

#LaTraumatologaGeek

[Toluca FC @TolucaFC]

CONFIAMOS Y LLEGÓ LA 11 🏆🏆🏆🏆🏆🏆🏆🏆🏆🏆🏆

[Josh🌨️ FIRE WALDRON FROM NOVA 🧸 @celestialdevils]

Krypto taking Superman to the Fortress of Solitude:

[Dr. Ann Olivarius @AnnOlivarius]

"Not all men" - but so many men helped Gisele Pelicot's husband:

The 73 men who came to her house and raped her.

The 3 men who left - and didn't call the police.

The thousands of men who saw the ads on the website - and didn't call the police.

https://t.co/mNh8QBSmJd

[Perla Díaz @Perlots]

Always be changing dressings 👌🏻

[Dr. Glaucomflecken @DGlaucomflecken]

Hanging out with the vascular surgeon

[Dr. Glaucomflecken @DGlaucomflecken]

Maybe it’s because of my cardiac arrest, but I don’t understand why patients get upset when I say their symptoms are due to aging. 95% of what I diagnose is because we get old. I always bring it up as delicately as possible, but like do you know how lucky you are? I see patients in their 80s and think, “man I hope I get there one day.” So many things in this world can kill you. You’ve beaten the odds. Honestly, congratulations, you’re old.

[Absolute Otorrhinorincus @otorrhinorincus]

CMN Siglo XXI // CMN La Raza

[Prof Ramesh K Tripathi @RKTvascular]

Rules of engagement!

[Michael Stifelman @mdstifelman]

Thank you ⁦@DoctorSotelo⁩

[Raúl Contreras Omaña MD @hepatologo_RCO]

La excreción de #bilirrubina conjugada desde el #hepatocito hacia la vía biliar se realiza a través de un transportador conocido como MRP2 (multi-drug resistence associated protein 2), proceso altamente dependiente de energía que amerita ATP. Es por ello que en condiciones como #FallaHepaticaAguda, #isquemia o #sepsis, en los que las reservas energéticas del #hígado se pierden rápidamente o fallan, la #hiperbilirrubinemia resultante es predominantemente a expensas de bilirrubina directa, lo que hace que muchos clínicos la confundan con procesos obstructivos. #livertwitter #GItwitter #MedTwitter #MedEd

[frank arko @farkomd]

Dependent rubor and elevation pallor. What’s the name of the test and what’s the diagnosis. Permission for video granted for education

[Ron Hekier @ronhekier]

Respecting Fear: Lessons for Surgeons & Life 🧠🏥
Here are three vital lessons on the importance of acknowledging fear, whether you're a surgeon or navigating life's challenges:

1️⃣Lesson 1: Fearlessness can be overconfidence.

I remember an event back in 1997 when I was a med student at Tufts Med and on a surgery rotation at Mass General Hospital. While I was in the OR with the surgical team, a second-year surgical resident came in to discuss a patient, exhibiting confidence in their assessment.

When he walked out of the OR, both the attending surgeon and the fellow shook their heads.
The attending said:
“This guy is at his most dangerous. He thinks because he is now in his second year, that he has a sufficient amount of clinical experience and wisdom. But his overconfidence is borne of ignorance. He doesn’t know what he doesn’t know.”

✅The lesson: Fearlessness without experience often stems from ignorance. That overconfidence can be dangerous.

2️⃣Lesson 2: Fearlessness can be disrespectful

In critical moments like emergency surgery, fear is a sign of respect for the potential for a bad outcome. No patient or their family member would want a surgeon who wasn’t aware and respectful of the high stakes at hand.
Think of the mindset of a pilot landing a passenger plane in a storm. Or a parent with a sick and feverish child.
A heightened sense of awareness bordering on fear signifies concern for what's at stake.

✅The lesson: A lack of fear may imply disrespect for the gravity of the situation.

3️⃣Lesson 3: Fearfulness can be egoism.

Long ago I took a skydiving course, and my manual including a powerful line:
"Good judgment comes from experience. Experience comes from bad judgment.”

As a surgery resident I once scrubbed in a case with two thoracic fellows. They got into bad bleeding in the chest that they couldn’t fix. They held pressure to prevent ongoing bleeding, and the attending, who is a world famous aortic surgeon came in.

He assessed the situation, and quickly and calmly threw a few stitches and repaired the seemingly invisible source of bleeding.

He looked at the fellows and said “You’re probably wondering how I so easily fixed that problem. Well I knew exactly where the bleeding was coming from because I’ve seen it before when I made the same mistake.”

✅The lesson: All the greatest performers in any domain have made mistakes. If you think you won’t make mistakes, you are displaying your ego and a lack of awareness of the challenges of your craft.

tl;dr
Whether you're a surgeon or anyone facing life's challenges, remember these lessons:
Don’t falsely hold onto fearlessness as a macho virtue.

Humility, respect, and modesty should be your guides.

[Perla Díaz @Perlots]

One day you're fine, next day you're crunchy. 🥲

[PsyPost.org @PsyPost]

A new study of over 4,000 men suggests that viewing masculinity negatively is linked to lower mental well-being, challenging the idea that masculine traits are inherently harmful. The research indicates that positive perceptions of masculinity, including… https://t.co/rqq8SWts13

[Necio Lizola MD @ReneLizola]

🔴🔵Parkes-Weber Syndrome.

#IRAD

[Society for Vascular Medicine | SVM @SVM_tweets]

Learn more from @DGlaucomflecken about what vascular medicine physicians and SVM can do: https://t.co/O66DCHkmDj

@RKolluriMD @herbaronowMD @Angiologist @YogenKanthi @adityasharmamd @evratchford
@ASchmaier @shishem @stanhenkin @EditorValerie @EstherSHKimMD @VMJ_SVM