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Welcome to bighead478’s page.
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submitted by haliburton(191),
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iikeidapw ole)sgia(:po The aeoptremsh si odepsmoc of 8%7 nietorgn nad 21% y.nogex iSecn enyxgo is negeadxch ta hte aaloayllircpil-ve nmbareem, oenrigtn si a ormja cpnmonoet rfo the aolvil'es satte fo nniio.latf If a regal oumvel fo reointng in het nsgul is elpacred twih yexn,og teh gnxeoy amy snbeeyustuql be rbboaesd oint the o,bdol ngrdcuei eht veomlu fo eth aielo,lv nlerutigs ni a form of loeavarl loalsepc nokwn sa oorpasbnit i.eaecsltsat

I ehocs idaecocgrin maed,e ubt I leeebiv ihst si erctniorc acueesb ehter is on thrae arfulie kisr at shit imte, so hte opsreup fo eth EPPE si cnaiyeltr tno ot uhsp out li.udf

bighead478  doesn't there have to be an airway obstruction (mucus, foreign object etc.) in order for this to happen? 100% O2 without any airway obstruction should not cause absorption atelectasis, right? +  
iloveallpotatoes  And Tension Pneumothorax is wrong bc PEEP would furthur exacerbate that. +1  
hyperfukus  @iloveallpotatoes yea i realized that now after getting it wrong :( +  
plzhelp123  @bighead478, they are using a cuffed endotracheal tube and mechanically ventilating this patient which is creating an iatrogenic "obstruction" and as @haliburton mentioned, having a high FiO2 leads to over-absorption by the blood which leads to absorption atelectasis if no other gas is allowed to enter/there is no communication with atmospheric pressure during expiration. Thus, we add positive end-expiratory pressure which keeps alveoli open at the end of expiration to prevent collapse +  


submitted by cantaloupe5(68),
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osHyltgio weohds uacagietvol seoirsnc rdsevpr(ee uctrehiterac fo iadmroycal )isfbre hiwt rluienptoh raioinlfintt wihhc dtenhi thta eth IM aws whniit 24 .uohrs oMst liyelk eausc of edhta niiwth sritf 24 hours fo IM is ht.myrhaari iydaMclaor epurtur ulodw losa be ieblsvi no osrsg caarpnaeep of the ah,rte ihwhc htey irebseddc ni the .esmt

bighead478  in FA it shows softening of the myocardium to happen at 3-14 days. Do you think this was overly misleading people (like me) into choosing myocardial rupture? I understand the histo features are consistent with < 24 hours, but the stem should also match this in every detail +9  
sbryant6  Myocardial rupture would not happen until 3-14 days. Since this shows signs of <24 hrs, the answer is arrythmia. +2  
hello  @bighead478 You have to look at the whole picture. Histo shows preserved architecture, which indicates coagulative necrosis -- coagulative necrosis is a histo finding only in the first 24h. The most common causes of MI-related sudden death are: arrythmia > cardiogenic shock (heart pump problem) > rupture. +  
jcmed  I chose the rupture as well due to the timeline. Somebody gave me this advice the other day, NBME classically will give you an entire vignette leading you somewhere, and the what it asks will be something completely different; or in this case will give you a photo of something and will ask about the photo. They do what they want. +4  
athenathefirst  Anyone knows why it's not a cardiogenic shock if it was within 24 hours? +1  
zevvyt  It says "Mottling" which happens in the first day. If it was 3-14 days it would be yellow (p 302 2019). He can be having angina for 3 weeks leading up to an MI. +  


submitted by frimmy_11(0),
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nioltMgt nad onsfgntie of airtnreo lwla no syupaot tsgsuesg ti was otn ldoer ntah 24 h.sr Deaht mfro flaat mihatahyrr ekil -bifV tsmo nomyocml rcsocu iniwht oen day of hte MI. hTta adsi, oenc asrc ash dfrmoe in oaacdmliyr isuset it, to,o anc asceu rahy.trhima

bighead478  in FA it shows softening of the myocardium to happen at 3-14 days. Do you think this was overly misleading people (like me) into choosing myocardial rupture? I understand the histo features are consistent with < 24 hours, but the stem should also match this in every detail +  
athenathefirst  Anyone knows why it's. not cardiogenic shock since it happened within <24 hours? +