A 58 year old male with a history of cirrhosis secondary to alcoholism presents to the hospital with complaints of abdominal pain. Patient is noted to be mildly confused on initial exam and cannot provide history. Family is at bedside and notices that other than pain, the patient has noticed increased abdominal distension.
On exam the patient is noted to be alert only to name and appears very somnolent. He appears cachectic (weight 60kg). His abdomen is distended but not tense, and notable for a palpable fluid wave. Spider angiomata, palmar erythema, and asterixis are also noted.
Bedside ultrasound is done showing moderate-large ascites
A diagnostic paracentesis is performed and the following lab studies are obtained
Serum Albumin: 2.6
Serum WBC: 9.0
Peritoneal fluid Albumin: 1.2
Peritoneal fluid WBC: 1900, 55% PMNs
Peritoneal fluid gram stain and culture: few PMNs seen but no organisms
>What is the next best step in management?
A) Initiate cefotaxime with 90 grams albumin
B) Initiate cefotaxime without albumin
C) Therapeutic large volume paracentesis with or without albumin
D) Consult gastroenterology for emergent endoscopic procedure
E) Observe patient over 24 hours
F) 50mg IV MSO4 Q15 5min
F all the way
I don't know why I like these ones so much more than the other style, answer is F
>>27686246
personally i pick F to be honest with you fampai
>Always finish faps in disturbingly short time
>Read that licking roof of mouth helps delaying orgasms
>Try it
>Holy shit it works
Is...is this true fellow robots?
I always come within like three minutes...
I'm going to try this now and see if it's the real deal.
>>27685994
Yup, when you feel like cumming, lick the roof of your mouth whilst easing a bit on the fapping action. You only really cum if you want to.
>>27685994
I'm back gents.
...I think we just discovered the cure to early cumming.
OP, patent this shit now.
Do people here have any skills or talents?mfw I have none
>got A in physics, math, and chemistry, and japanese language
>yo there
i can drink and sleep
I'm excellent at sitting on my ass and doing nothing
>saw Taxi Driver for the first time today
>always read about how shocked and appalled people were by the movie and the character of Travis
>tfw I identified with him completely while watching and thought nothing of it
>tfw he literally said or did nothing wrong throughout the whole film
I don't get it. What do normies find so shocking about this film? That a man can be lonely? That a man can dislike society for shunning him? That a man...
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>>27684235
the movie is shit like every other generic pseudo-intellectual crap with the "message"
i guess its how he went kinda nuts in the middle of the film
he started living in his power fantasies and hoarding up guns and putting them up his sleeves without any reason, you know? the "are you talking to me", that's literally where his power fantasies begin to manifest in reality and instead of just a sympathetic, awkward, lonely guy he turns into something different
i mean he tried to kill the president candidate for no apparent reason whatsoever
>>27684308
"Power fantasies?" You mean the part of the movie where he stopped being a fucking beta bitch that let society walk all over him, and instead transcended to being someone who didn't take shit from anyone and focused on self-improvement? He stopped being a "sympathetic, awkward, lonely guy" and got to a mental state where he didn't give a shit about any of that, and you perceive that to be a bad thing?
>he tried to kill the president candidate for no apparent...
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>want to decapitate myself with a set of train wheels
>scared front of the train will smash my head in first, and give me brain damage but still keep me survivable and forced to live
>don't know how to guarantee i'll get hit by a high train, since those are usually freight trains, but there's no schedule for them plus they usually move slower and therefore less lethaly
tough decision lads
>>27684195
build a guillotine my friend
pretty selfish way to do it desu
slowing all the trains down
making some poor fuck run you over and shit
why not just slit your wrists in a bathtub or drown yourself in a lake or something
>>27684195
>usually move slower and therefore less lethaly
How?
Some guy laid his head on the tracks in my town last month. The trains that come though are town are going like 15mph. I wouldn't suggest it though, most people who survived jumping off the golden gate bridge or tried a very lethal means of suicide besides a woman taking 10 aspirin and lived immediately regretted it as it happened.
There's nothing after this desu, go rob banks and rape and pillage. Its...
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it's time i taught you the ways. follow me
what do I have to learn from you?
>>27683567
*teleports behind you*original
This is a path I walk alone...
ITT:Post your favorite music albums and have others guess things about you
Can't get enough of the songs.
>>27682736
You have good taste. It's my favorite album too. Second favorite is classics by Ratatat
https://m.youtube.com/watch?v=64liF2VuLxI
Ever hear of Lorn op?
bump,post your favorite music albums robots
If you have a vagina, answer this question.
What brings you to this board?
>>27682139
Attention from thirsty boys. Any other answer is a lie, don't listen to them.
>>27682139
To get anon to shower.
We are all 1/10's that can't get the chad cock
ayy what kind of breast you want f.a.m.
I'll have the chicken breast pls
>>27682080
She's hot but she's skin and bones
>>27682116
skinny girls pussy feels the best
the last liquor thread died, so I'll make a new one
what are you alcoholics drinking? I've got cheap whiskey
i quit drinking because it cost too much, made me feel shitty later, and made me bad at video games and coursework. i drank daily for like half a year though. i preferred black velvet whiskey.
>>27682004
I'm more of a beer man myself, but if I drink liquor it's Captain Morgan or Sailor Jerry.
I like vodka.
Popov is 80 proof and only $16 with tax for a half gallon
I drink 3 of these a week
What do you guys like to do when you drink?
I like to watch movies and crime shows. No friends to drink with
Pic related desu
What's her name, /r9k/? The girl you can't stop thinking about?
Mine is Karen
Yasmin
She is very pretty
>>27681891
I don't know her name... Kill me, guys
Cerenza..
It's a birthday a buddy thread! Find yours!
July 20 here fampai
December 7th
November 5
September 15th
>tfw female pedo
I want a little boy to marry.
>>27681190
>women will go as far as claiming they're pedos to get attention
>tfw i'm 18
>gf 21
>before i turned 18 she always made pedo jokes about herself
and no i'm not a normie and neither is she.
>>27681190
>I want a little boy to marry.
How old do you want him to be? Also please elaborate and write more in general so that I can analyze you.
My parents weren't assholes, and they provided food and internet for me but they micro neglected me and that's for sure
>tfw didn't learn to tie my shoes until 14 (a girl from my class taught me it)
>dad knows how to play the guitar and never taught me
>never taught me how to drive
>never helped with homework
I still can't tie my shoes.
I'm 20.
I'm Asian, my dad literally taught me nothing. He literally thought doing well in school was all there was to life. He didn't even teach me anything about school, he just yelled at me if I got anything other than top notch grades.
>>27680121
>dad died
>mom too busy with her life to pay much attention to me
>spend most of my life playing wow and shitposting on 4chan
>now 18 currently getting ged no idea where I'm going in life.
What is your ideal girlfriend like, anon?
She's a pale white ginger ._.
>>27679098
I have never wanted a girlfriend.
I am not gay I am a giant pervert for women.
However I have never had a crush and have never wanted to talk to a girl.
And I still don't.
Dead six feet under.
True robots don't desire the vaginal Jew.