Fernando RMA

Humano, esposo, padre y médico
Tirare hate de la vida y de la medicina
Nada es personal.

[Fernando RMA @mcfdomtz]

Creo que después del juego Corea y checa
Con el partido de México
Ya se acabó el y si si.

["El Jefe" Águila @ElJefeAguila]

Todo el Estadio Azteca cantando Mi Mayor Anhelo.🇲🇽

[Lu12 (World Cup Versión) @Lu12_2005]

Miren como Peña Nieto celebro aquel gol de Rafa Márquez vs Croacia en el Mundial de Brasil 2014, ese día se olvido que era el Presidente de la Nación y fue un aficionado mas apoyando a México🇲🇽❤️‍🔥

COMO SE EXTRAÑA A PEÑA NIETO 🥹🇲🇽

[Santiago Gimenez @Santgimenez_]

¿y si si? 👀❤️‍🔥🇲🇽

[Fernando RMA @mcfdomtz]

Y si si.

[Piojo Alvarado Fan Club @Durden]

HIJOS DE SU PUTA MADRE YA ME INTOXIQUÉ DE FE

[Fernando RMA @mcfdomtz]

Mañana será gana México +2.5

[Fernando RMA @mcfdomtz]

@AcidoRinon E izquierdo por que más chingon

[Fernando RMA @mcfdomtz]

Esos Adscritos que les gritan a los resis y les piden favores personales
¿Todo bien en casa?

[Critical Care Reviews @CritCareReviews]

Today's Paper of the Day is:

Protective nutrition strategy in the acute phase of critical illness: why, what and how to protect

https://t.co/JKgcYjlUQ5

Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2026

[Dr. Chacón-Lozsán F .'. @franciscojlk]

💧 Fluid Responsiveness ≠ Fluid Tolerance

For years, critical care clinicians have focused on a fundamental question:

Will this patient increase cardiac output if I give fluids?

A new multicentre study from France and China suggests we may need to ask a second question:

What price will the patient pay for that fluid?

In this observational study of 64 critically ill patients receiving a standardized 500 mL fluid challenge, investigators evaluated not only cardiac index (CI), but also venous congestion using VExUS and pulmonary congestion using extravascular lung water (EVLWI).

The findings are striking.

Before fluid administration, venous congestion could coexist with fluid responsiveness. In fact, many patients remained preload responsive despite already demonstrating evidence of systemic venous congestion.

However, what happened after fluid administration was even more important.

Among fluid responders:

✅ Cardiac index increased significantly

✅ Venous congestion remained largely stable

✅ Only 5% experienced worsening VExUS grade

✅ Lung water remained relatively unchanged

Among fluid non-responders:

❌ Cardiac output barely changed
❌ Venous congestion worsened dramatically
❌ VExUS deterioration occurred in 73%
❌ EVLWI increased significantly
❌ Congestion became evident across hepatic, portal, and renal venous territories

Perhaps the most important physiological message is this:

When the heart cannot convert preload into flow, the fluid has to go somewhere.

And where it goes is congestion.

The study also found a strong correlation between CVP and VExUS, suggesting that while advanced ultrasound provides valuable organ-level information, a carefully interpreted CVP may still remain a useful bedside marker of right-sided congestion.

The ARDS subgroup provides another important lesson.

Even fluid-responsive ARDS patients accumulated more extravascular lung water after fluid administration than non-ARDS patients, highlighting the role of pulmonary permeability in determining fluid tolerance.

This study reinforces a concept that is increasingly central to modern hemodynamic management:

The goal is not simply to identify fluid responsiveness.

The goal is to identify patients who are both:

✔ Fluid responsive

✔ Fluid tolerant

A fluid challenge that increases congestion without increasing flow is not resuscitation.

It is fluid accumulation.

The future of hemodynamic management may lie at the intersection of:

• Fluid responsiveness

• Venous congestion assessment

• Pulmonary permeability

• Organ-specific fluid tolerance

Because the best fluid is not the one that can be given.

It is the one that provides benefit without causing harm.

Reference , 📚
Si X, Critical Care. 2026;30:35.

[José Ramón Fernández @joserra_espn]

A la Hormiga González lo apartaron de Chivas en plena liguilla porque era importante para la Selección. Tan importante que parece que solo tendrá una vista privilegiada desde la banca nacional.

[Nicø 🐐🇲🇨✖ @ElRojiblanco12V]

Raúl Jiménez en la Selección:

[Fernando RMA @mcfdomtz]

Raúl Jiménez. El alérgico del gol.
Ha tenido varias como para definir
En un mundial. Fallar te aleja de avanzar

[Fernando RMA @mcfdomtz]

Solo soy alguien a quien le hicieron daño
He hecho daño
Y ahora con todo diario intento dar la mejor versión de mi.

[Fernando RMA @mcfdomtz]

Nunca tengo problema con dejar propina
Pero que ya te la pidan para llevar es
Excesivo

[Fernando RMA @mcfdomtz]

Pasos sencillos para presentar la ic
1- qué el adscrito al menos la firme
2- saber un poco del paciente o mínimo un buen resumen
3- identificar plan que quiere del px de la especialidad a ic.

[Fernando RMA @mcfdomtz]

Pero también a veces nos mamamos
Llegan por dolor abdominal y cefalea
No es ivu
Y si es evc hemorragico fisher iv

[Fernando RMA @mcfdomtz]

Ya están pensando en semifinales
Y ni la fase de grupos se ha jugado

Por eso luego criticamos tanto cuando no se cumplen las metas que se plantean.

[Fernando RMA @mcfdomtz]

Ya no somos residentes ni becarios
Ya pagamos al sat y tenemos otras proyecciones.
Ya lo que sea de la resi o de la fac
Sino Eres docente o profesor.
NO TE AFECTA NI INTERESA