dispoe

Fairy tail : SECRET OF THE NUMBER 7 IS LUCY HEARTFILIA!!!

NEW THEORY AND BIG REVEALTIONS MY SUBS:

Why does Mashima like the number 7?
Why the 7.7.777 ?
The answer is here!! :)

And this number represents… LUCY HEARTFILIA!!!
+ Confirmation theory Eclipse is Back!!
Lucy vs Zeref soon ?The Carla’s prediction of 7/7/2017 ?

SO LET’S GO !!!!!!!!

LES SOUS-TITRES FR SONT DISPO ;)

Não, meu coração não é maior que o mundo.
É muito menor.
Nele não cabem nem as minhas dores.
Por isso gosto tanto de me contar.
Por isso me dispo,
por isso me grito,
por isso freqüento os jornais, me exponho cruamente nas livrarias:
preciso de todos.

Carlos Drummond de Andrade

Emergency Medicine Advice

Alright, I made an advice post for Obstetrics & Gynecology that people liked, and I got requests to make more. So, here’s some of my EM advice. As always, I’m not an expert by any means and have my own problems, but these are just my reflections while on clerkships. There’s always a learning curve, so if I can alleviate some of that for others, that’s great! Let me know if these are helpful, because if so, I might go back and reflect on other rotations I’ve done and make more. Now, I rotated at a metropolitan level one trauma center for EM. So, here’s some of my advice:

1. At the start of each shift, be enthusiastic and eager. This goes a long way, and residents/attendings will be more likely to include you on cool things even if it’s not one of your own patients.

2. Let your residents/attendings know that you want to do/assist with any and all procedures. Be enthusiastic about the opportunity to do all of them! Because of this, I got to suture countless lacerations, irrigate and debride abscesses, do vaginal speculum exams, ultrasound heart/lungs/abdomen/pelvis/joints, do a paracentesis, help reduce joints, splint extremities, etc.

3. The ED is fast-paced. Your residents and attendings will be signing up for and seeing patients constantly. When you see a new patient on the board, let someone know immediately that you are going to see that patient, and jump into it! Don’t be forgotten.

4. I liked to pend labs/imaging before presenting my patient to my resident. Even if it was completely wrong, it showed that I actually thought about my plan rather than rambling things off. Also, it provided for great learning opportunities. For the times that my work-ups were correct, my residents liked that the orders were already there. Of course, if your residents/attendings don’t like this, don’t do it.

5. Also related to above, know your assessment and plan before presenting! This is the most important part of the ED. It frustrated me at first, but really you have to consider the big and bad things at all times even if it’s unlikely. For example, for chest pain, always consider ACS, dissection, pneumothorax, PE, etc. For back pain, consider spinal stenosis, cancer, aortic dissection, etc. For headache, consider meningitis, SAH, mass, etc. Even just last night, I had a patient with leg pain and chalked it up to an arthralgia… Nope, it was subtle septic arthritis. Never let your guard down, and have thorough work-ups even if you aren’t convinced by a history. Also, have an idea of what the dispo will be from the first time you see the patient. This may change as labs and imaging return, but keep it in mind.

6. Take ownership of your patients. Read their chart, and know their labs and imaging results before the resident/attending does. Update the team and keep your notes up to date with the latest plan.

7. Don’t be afraid to get on the phone for your patients. Call the lab. Call radiology. Call social work. Sign out the patients to the medicine team for admits. Your resident may do this without you, so ask to be involved if you want to practice.

8. Don’t overwhelm yourself with too many patients at first. Making quality plans for a few patients is better than making mediocre plans for many of them.

9. Check in with your patients multiple times during their stay. Did you give them pain medications? Don’t forget to follow-up if it helped. Ask if the zofran helped their nausea. Are they breathing better after a duoneb? Do they need another? Don’t forget to keep checking on vitals as well.

10. At my hospital, there were 2 rooms we used for codes/traumas. If you have a few minutes, go in there and study where things are. There were times I was asked for a stat OG tube, bougie for an airway, 4x4 gauze, scissors, etc. and it was helpful knowing where things were in stressful situations without being frazzled.

11. For the first couple of codes and traumas you see, get to know how things are done at your hospital. Once you’re more comfortable, ask your resident/attending how you can be helpful. Of course as a student, you won’t be doing anything too crazy, but you can help roll patients, hold a cervical spine stabilization, manage basic airways with supervision, and do CPR if you put yourself out there as willing to help.

12. If you walk into a patient’s room and someone looks sick-sick, tell someone immediately! Don’t take your chances, and it’s better to be on the safer side. If they look like they’re in bad shape, don’t stall the process of getting an attending to lay eyes on them and put in orders.

13. You’ll see a lot of psych crisis evaluations, social issues, and drug abuse. Check your judgement at the door, and don’t be surprised at what comes through the door. If you feel unsafe at any time, tell someone. Take threats seriously.

That’s all I can think of right now. EM is an exciting rotation, and every shift is truly different. Get as much out of it as you can, and have fun getting involved and doing hands-on things! Let me know if you have other advice as well. I’d love to hear.

Fairy tail : SECRET OF GOD ANKHSERAM IS LUCY HEARTFILIA!!!

NEW THEORY AND BIG REVEALTIONS MY SUBS: 

- Secret About God Ankhseram is… Lucy Heartfilia! ( Here finally the clues that confirm my theory!!!! :D )
- The Celestial Spirit World Is The World Of The Dead!

SO LET’S GO !!!!!!!!

AND A SURPRISE IN THIS VIDEO WITH SENPAIFRUIT VOICE’S TO CELEBRATE +4 SUBS!!!!!

THANK YOU SO SO SO MUCH!!!!! <3

LES SOUS-TITRES FR SERONT BIENTOT DISPO ;)

o peso que carrego nos ombros é quase maior que o peso do mundo. e tudo dentro de mim explode um pouco toda vez que me mexo. a pressão que vem de fora me comprime um pouco mais a cada vez que me olham. e eu comecei a minguar, logo eu que sempre me senti pequena estou ficando cada vez menor. e quando eu me dispo já não sei quem sou e nem o que quero. ou talvez eu saiba mas me dizem que não é o certo. por que tem que ser tão difícil escolher o próprio futuro, se o futuro já é amanhã? e por que diabos as pessoas de fora querem decidir o futuro de dentro se não são elas que vão viver? tento olhar para dentro e ouvir minhas vontades e anseios, mas tudo que escuto é a voz deles me guiando por um caminho que não sei se quero seguir. esperam tanto de mim, quando tudo o que quero é ser feliz no simples, com pouco. com aquilo que meu coração escolher, mas como posso ouvi-lo com o som ensurdecedor do mundo de fora tentando calá-lo?

meucalipto e floriversicar contam seus medos ao céu.

“Tiens, ils ont repeint”

Graffitivre tenait à signaler à ses abonné-e-s la parution du livre “Tiens, ils ont repeint” de notre copaing auteur/éditeur, Yves Pagès, aux éditions de la Découverte. Dans ce précieux bouquin, le lecteur trouvera la transcription de plus de quatre milles graffiti de France et de Navarre, écrits de la fin des années 1960 à aujourd’hui. Entre détournements politiques et poésie hasardeuse, ça promet du lol à tous les étages, c’est moi qui vous le dit!
Dispo dès le 25 octobre dans les bonnes librairies. Cours l’acheter.

Há momentos na vida da gente, que a gente se pergunta por que é que as coisas são assim. São nesses momentos, que paramos para refletir sobre o real sentido das coisas… descobrindo assim as certezas e as INcertezas da vida que a gente vem carregando desde de sempre. O interessante disso tudo, é que não é apenas questão de rever os principios, mas é questão de rever a sí mesmo, em quem você se tornou em como você interage com as pessoas, se perguntar por que as coisas são assim não adianta em nada se você não demonstra pra você mesmo o seu brilho, a sua força, a sua garra, o seu carisma, o seu alto astral, o seu vigor, sua juventude. Não basta apenas mostrar pra você mesmo, você deve agarrar isso com tudo, e provar pra todo mundo do que você é capaz e COMO você se dispoe a encarar seu medos e seus tropeços de cabeça erguida, de peito aberto, sem medo, sem preceitos, sem esquecer de quem você realmente é de que como você realmente gostaria de ser. É com esse pensamento que você abre as portas de você mesmo para que o seu verdadeiro EU mostre a todos quem está por dentro e abrindo essa porta, também, é que você consegue trazer pra dentro, interagir com o exterior, absorver as coisas. Nessas horas, temos que ficar atentos e criar um filtro para drenar tudo de ruim e absorvermos somente o bom, o agradavel, o doce. Se você consegue acordar todos os dias, com o brilho nos olhos, disposto a enfrentar seus medos, e dar um tapa nos inimigos, você consegue obter de você mesmo e dos outros tudo aquilo que você sonha, tudo aquilo que você quer. É a capacidade de nos apaixonarmos todos os dias é que nos faz criar asas e alçar vôo rumo a lugares mais distantes, mais bonitos. O fogo inocente dos olhos de uma criança, o brilho curioso, é o que devemos ter para conseguirmos sonhar, viver, sorrir e crescer.
E para finalizar, uma citação, essa é para todos vocês então decore:
“Amanhã será tomorrow” - Falcão.
— 

Pedro Bial.

La dépression.

Alors là il va falloir que je sois précise parce que si je demande aux gens si ils savent ce qu’est la dépression j’aurais un paquet de “oui”. Parce que le mot dépression n’est pas qu’un mot médical, c’est aussi un mot du langage commun, et bien sur le sens est pas forcement le même dans ces deux situations.

La dépression, qu’est ce que ce n’est pas ?

Ce n’est pas :

  • Un coup de mou,
  • Un truc qui passe,
  • De la fainéantise,
  • Un moyen d’attirer l’attention,
  • Un truc qui se soigne par des coups de pieds dans le muscle grand fessier.

Ben alors c’est quoi ?

Eh, bien la dépression c’est une maladie. Non chut ! Ton opinion sur si c’est une maladie ou pas ne m’intéresse pas. En médecine on préfère se concentrer sur un consensus scientifique que sur l’avis des gens. Et le consensus sur la dépression on en a des traces jusqu’à l’antiquité donc si tu veux pas considérer que c’est une vrai maladie tu fais ce que tu veux mais le reste du monde à déjà tranché.

Un peu de statistique :

La dépression c’est 100 millions de personnes par ans dans le monde, plus fréquent chez la femme, souvent observé vers la trentaine et qui est la 1ere cause de handicap dans le monde.

Voila si vous pensiez que c’est “juste un coup de mou” je vous pose ça là pour que vous y réfléchissiez deux minutes.

La patho :

C’est donc une maladie psychique, au sens qu’il n’y a pas d’éléments  somatiques (et encore, là se discute en fait) pour s’orienter.

Le diagnostic va donc être uniquement clinique, pas d’examens complémentaires (radio, scanner, prise de sang, …) pour s’aider.

Au niveau de la cause : eh ben on sait pas trop, il y a pleins d’hypothèses que ce soit au niveau des neurotransmetteurs dans le cerveaux ou au rôle très possible des maladies inflammatoires en passant par la case “prédisposition génétique”. On va donc utiliser notre super joker “c’est multifactoriel”.

La clinique :

Le signe cardinal est la tristesse.

Bon là vous allez me dire “ok merci, sympa d’avoir fait 10 ans d’études pour sortir que les dépressifs sont tristes, t’es bien mignonne mais là tu pouvais t’abstenir”.

Eh ben dans ce cas là je vous demanderais de me dire la différence entre la tristesse et là dépression si vous êtes si malin.

C’est bon on repart ?

  • Alors on a donc la tristesse  : c’est une diminution stable et constante dans le temps de l’humeur (donc pas comme la tristesse de tout les jours qui varie et qui finit par passer),
  • Baisse de l’estime de soi, qu’on retrouve pas non plus dans la tristesse non pathologique,
  • Culpabilité, qui peut aggraver par des pensées tournant autour de la mort voir des idées suicidaires,
  • Perte de plaisir à faire les choses, typiquement la personne arrête de faire son sport, ses loisirs, toussa. Il se force à faire les choses pour les faire,
  • Perte de l’envie à faire les choses. Même si il aime toujours ses loisirs ben il a tout simplement plus la force de les faire. Ces deux derniers symptômes peuvent bien sur se cumuler.
  • Ralentissement psycho moteur : la personne fait tout au ralenti et PENSE au ralenti, on peut observer par exemple un délai d’une dizaine (voir plus) de secondes entre chaque phrase, le patient à son esprit noyé dans du caramel mou,
  • Ruminations : la personne rabâche en boucle des pensées pas agréables sans pouvoir s'arrêter de penser,
  • Des troubles du sommeil (sans déconner ?), typiquement la personne est moins bien le matin, se réveille fatiguée et s’améliore petit à petit le soir,
  • Perte ou gain de poids, baisse de la libido, douleurs de partout, et tout un tas de symptômes “divers”.

Et c’est grave ?

1ere cause de handicap dans le monde mec, rien qu’avec ça tu devrais avoir ra réponse.

C’est une maladie grave car très incapacitante, qui par nature ne facilite pas l’accès aux soins (par ce qu’on est ralenti psychiquement, qu’on a une estime de soi dans les chaussettes et qu’on culpabilise. Un patient  dépressif peut ne voir aucun intérêt à se soigner car “ça ne sert à rien” et il “le mérite”).

Et je ne parle même pas du risque suicidaire qui est le risque majeur de la dépression.

Le traitement :

La dépression est une maladie. La bonne nouvelle c’est que les maladies ça se soignent, ou en tout cas on peut essayer.

Schématiquement selon la gravité peut être proposer une psychothérapie +/- un traitement médicamenteux qui peut être anxiolytique (contre l’angoisse) et/ou antidépresseur.

C’est un traitement qui est long parce que déjà il met longtemps à agir et puis surtout parce qu’on a compris que pris sur de longues périodes il diminue vachement la récidive.

Les différents type de traitements sont très variés mais agissent tous sur les neurotransmetteurs du cerveaux dont l’activité est perturbée dans la dépression.

Voila. En espérant que c’était clair !

Et comme d’hab si vous avez des questions je suis dispo.

Peut-être que je dramatise la chose ou que justement, je me suis voilée la face trop longtemps. On avance dans la vie et les personnes qui nous entoure sont nombreuses. Il n’y en aura que quelques un qu’on pourra appeler ami et avec qui on ne veut jamais perdre contacte.

Mais on ne peut pas tout contrôler. Ce n’est que trop tard qu’on se rend compte que cet ami n’est plus là et que c’est limite perdu d’avance de la rappeler.

Fairy tail 523 +: BIG REVELATION! Lucy VS Zeref/ Secret Hidden In The Chapter Titles !

Yeeeeee!!!! my new theory my subs!!!!!!

it’s here let’s goooooo!!!!! :D

(Les sous-titres en français bientôt dispo ;) )

PS : As many people, I seen the news about the end of fairy tail…

This ad does not really make sense to me because this arc is really bad for an end of fairy tail, there is no logic to this announcement, really I dont know what to say…

I feel this problem with fairy tail since the end of tartaros, everything is too fast and shipped, fights spriggans, End, natsu vs gray … but I would return in more detail about it in video ,

I don’t know yet what will happen to my channel, because I didn’t expect that, so I will try to publish as many theories as I could write, and there are many

So if I don’t answer your messages, don’t be angry with me XD, I would do it as soon as I have time, i promise ;) The theories I would publish will be enormous in revelations and to its climax, really I ask you to prepare yourself because will be my biggest theories,

So while waiting for my subs, take care, And courage to Mashima for this final arc, courage to my subs who may be sad about this news, and hope that the level goes up and that Mashima finishes his manga in beauty;)

Nina <3