dvpw

20+

[RagingAsn @RagingAsn_]

EN Translation by @RagingAsn_

영어 번역입니다!
다음에 또 봐요!
#UmaTranslations

[×PAN1KAZ3 | VGEN Open :} @pan1kaz3]

yoink the harpy
#elgrass #umamusume

[Gattai @ShinGattai]

Taiki Shuttle

[Kuyen @akuminosan]

＃カレンブーケドール
＃ウマ娘
＃umamusume

[のの @07nono06]

一目惚れフラッシュ
#ウマ娘 #イラスト

[삥쮸 @u3pri]

#ウマ娘
ドゥラメンテ

[隣歌 ♨️² @k20_draw]

🟥

[Keggs @akeggle]

"SUMMON AN EVEN LARGER MAN"

[Chronozbergh☕ @Starbind_S]

The Gemini Experience.
#ウマ娘

[한다 @HaNd_A___]

#バリオル
#바리오르

[Mushroom | VGEN OPEN @mushroom_rt]

The Absolute Cutest
#umamusume #ウマ娘 #pixelart #ドット絵

[tor1goe @tor1goe]

ヴ

[nueco＠6/7 コミティア156「く18b」 @nueco]

スイーピー描けた！！
#ウマ娘 #Umamusume

[Josh Farkas MD 💊 @PulmCrit]

ARISE-FLUIDS has arrived and it's awesome 🥳

For over a decade, the Surviving Sepsis Guidelines recommended that septic patients get at least 30 cc/kg fluid. In the United States, these guidelines were weaponized into performance metrics, pressuring clinicians to prescribe arbitrary volumes to every patient.

Evidence-based clinicians have LONG known that this guideline lacked evidentiary support. For example, I've attached a picture of a blog I wrote about this back in 2017. Despite the lack of evidentiary support and some evidence of harm, the Surviving Sepsis Guidelines INSISTED on perpetually recommending 30 cc/kg fluid resuscitation.

We finally have a prospective RCT demonstrating that mandating early administration of 30 cc/kg fluid (as compared to early vasopressors) doesn't help and may actually cause harm.

It's important to note that all of the hard endpoints in this trial were neutral (e.g., mortality, days free of organ support).

I still think that 30 cc/kg fluid is a pretty reasonable volume of fluid for *most* patients. But the study does suggest that giving too much fluid may promote edema - so we should be *thoughtful* about this intervention rather than mandating it for every septic patient.

Based on the subgroup analysis, the fluid-conservative strategy may have helped the subgroup of pneumonia patients the most. This is statistically nonsignificant but aligns with my expectation. ARDSy patients often don't respond well to fluid. (In contrast, I really doubt that a liter of fluids in either direction matters for most urosepsis patients.)

This is a great example of the over-reach of guidelines and protocoled medicine. People get all upset about practice variation, so sometimes they try to stomp it out using guidelines and protocols. But these guidelines are highly fallible, so what may occur is that you standardize care in a way that harms everyone equally. 🤦‍♂️

[実村みほ @Miho_Mimura]

とりあえず花嫁カフェの大ラフです！

[Runa @rumina_runa]

almond eye

[②円 @itiennimai2]

画質がクソで悲しいので単体

[がゃじ肉 @sorekara_64]

ギャル②
#ウマ娘 #タニノギムレット