ischemia

Contractility is the ventricle's ability to generate force at a given preload and afterload.

Ischemia, acidosis, hypoxemia, inflammatory mediators, and even some medications can weaken that contraction.

Sympathetic stimulation and inotropes can increase contractility.

We know this.

A patient doesn't become less deserving because they do not have the financial stability to pay for it, okay? It's because they're alive and they're human and they should be treated with dignity and health equity, okay? A diabetic foot doesn't become less serious because the patient has difficulty navigating the healthcare system.

diabetic foot is always going to be serious okay now what is the hidden delay of cost let's talk about delay so a wound doesn't understand insurance no they don't care wounds the diabetic let's be honest the diabetic foot ulcer does not care about insurance okay it cares if we're treating it removing all the things that need to be removed if the infection can thrive okay Ischemia doesn't wait for the appeal letter.

Pressure doesn't wait for an appointment, okay? Neuropathy doesn't tell the patient, okay, I'm not going to worsen until your insurance covers treatment, okay? And tissue doesn't wait for the healthcare system to catch up.

Remember, timing matters.

But crucially, when Bailey released the tourniquet, The T wave normalized.

Ischemia is a reversible state of distress.

The muscle is crying out for oxygen, but it isn't dead yet.

Reversible.

That's also a natural process, right? That you, that you don't just have this, uh, ischemic area.

Ischemia always means the part that currently has no blood flow.

Which is blocked by a clot, the damaged area is actually even larger in the end, right? Because you have this, this part that has no blood flow which is already dead anyway, and is later remodeled into connective tissue, and then that's resolved.

But then there's still...

Alive, well-perfused bleeding fascia heals rapidly.

Ischemic strangulated fascia dies and turns into a massive hernia.

That mechanical explanation makes perfect sense.

Now, what happens when a patient presents with a massive complex ventral hernia where the edges of the rectus muscle have retracted a foot apart? You can’t just pull them together with five millimeter bites.

People know, right? So I'm blinded.

Now we know if acne was very early, but there was no difference in mortality or am I? And we know from numerous trials, Courage, Berry2D, Ischemia, Stitch, ReviveBCIS, that stent does not lead to, find no benefit for PCI in outcomes.

So it's all quality of life.

And then we have the group, In England, Rasha Alami, Daryl Francis did a placebo-controlled sham study and found no significant improvement in exercise time with a sham control.