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🔴Nice teaching case for the advanced therapeutic fellow ERCP Teaching Pearl 🧠 | Hock-Pull Technique in Supine Position 🛌 Supine patient = altered orientation → technique matters 🔹 Papilla orientation: In supine ERCP, the papilla often appears more inferior/posterior and less en face, with a tendency for the catheter...

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Turki AlAmri |تُرْكي عبدالله الْعَمريَّ MD

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27,045 次观看 • 9 个月前 •via X (Twitter)

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🎯 3 Teaching Pearls from the “Compact Disc” Method for ERCP Cannulation 1️⃣ Visualize the invisible. Imagine stacked CDs inside the papilla to conceptualize the 3D bile duct axis—especially in long oral protrusion (LOP). 2️⃣ Advance gently, not forcefully. Cannulation should feel like passing through the center hole of each CD. Force bends the axis and increases injury risk. 3️⃣ Alignment is everything. Ensure scope position and catheter axis are “face to face” with the imagined duct axis before advancing. Simple concept. #ERCP #Endoscopy #MedicalEducation #AdvancedEndoscopy #Basics #KFHU #BiliaryCannulation

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Throwback to a 🔝 downloaded 📼 from 2020: step-by-step #technique for #supine #PCNL by Guido Giusti and his #ETCE #team. You can find it by clicking the #link below, it’s #OpenAccess!
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When a spacecraft leaves Earth, it doesn’t just fire its engines and head straight to its destination. In many missions, especially those going beyond low Earth orbit, there’s a more subtle and elegant strategy at play, one that uses gravity itself as part of the navigation system. This is often called a gravity assist, or a slingshot maneuver. But in the case of missions like #Artemis II, what’s being used is a closely related idea known as a free-return trajectory. At first glance, it might sound simple: the spacecraft goes to the Moon, loops around it, and comes back. But the physics behind it is anything but simple. Instead of relying on continuous propulsion, the spacecraft follows a carefully calculated path through the gravitational field of the Earth–Moon system. It is launched with just the right speed and direction so that, as it approaches the Moon, the Moon’s gravity bends its trajectory. The spacecraft is effectively flung around the Moon, redirected onto a path that naturally brings it back toward Earth. No major engine burn is needed for the return. Small trajectory corrections may still be required, but gravity does the heavy lifting. That’s the key. This kind of trajectory is not just efficient, it’s also safe. If something goes wrong with the spacecraft’s engines or onboard systems, gravity itself ensures the return. It’s an inherent backup plan, built into the trajectory from the very beginning. The same fundamental idea appears in gravity assists used across the Solar System. When a spacecraft flies past a planet, it can gain or lose speed by exchanging momentum with that planet. From the spacecraft’s point of view, it’s as if it has been accelerated without using fuel. In reality, it has borrowed a tiny amount of orbital energy from the planet itself. That’s how missions like Voyager reached the outer planets, and how probes continue to explore regions far beyond what their onboard fuel alone would allow. But there’s an important distinction. An interplanetary gravity assist is typically used to change speed and direction, often increasing the spacecraft’s energy. A free-return trajectory, like the one used in Artemis II, is designed for something more specific: a path that naturally loops back to Earth without requiring additional propulsion. It’s less about gaining energy, and more about shaping a trajectory that guarantees a return. To understand why this works, it helps to stop thinking in straight lines. In space, motion follows curves defined by gravity. The spacecraft is constantly falling, first toward Earth, then toward the Moon, and then back toward Earth again. What looks like a loop is really a continuous free fall through a changing gravitational landscape. This way of navigating space reveals something deeper. We tend to think of engines as the drivers of motion, but once a spacecraft is on its way, gravity does most of the work. The art of spaceflight is not just about thrust. It’s about knowing when not to use it. #GoodLuck #Artemis NASA Artemis

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I like the Hammer Strength iso-lateral chest/back machine as a change-up for lat pull downs. I keep the weight a little lighter. Go for a big stretch at the top (I don't do this on regular lat pull down) but the weight needs to be light enough you can retract and pull the weight down when you transition. If in doubt, don't go for a big stretch at the top and stick with normal lat pull down movement! Stay Stronk!

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