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Dr. Abhishek Shukla (Geriatrician) explains ventilator removal A ventilator is started when a patient is unable to breathe adequately on their own or when oxygen supply to the body is critically low. In this case, the patient was brought unconscious, gasping for breath, with no pulse and no blood...

28,184 views • 3 months ago •via X (Twitter)

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I joined Erin Burnett OutFront / Erin Burnett last night to discuss hantavirus and the cruise ship outbreak. Some thoughts: THE SITUATION ON THE SHIP IS SERIOUS My first thoughts were about the good doctor who was on-air right before me, and the rest of the people still on the ship. Hantavirus is serious with a long incubation period, several have died already, and this strain spreads human-human (not just rodents). The ship's doctor got sick, and this doc stepped up to treat people on the ship. He described protections he was taking (goggles, gown, hand-washing), but they were insufficient because there is evidence this virus spreads beyond "close contact", which means ventilation and filtration are important. THE RISK AND THREAT TO GENERAL PUBLIC IS LOW Despite the situation being serious on this ship, the system is working the way it should. Health officials are investigating and tracing, severely ill passengers are being treated, passengers who left the ship are notified and in quarantine. For the general public, the threat is low. THERE IS EVIDENCE OF HUMAN-HUMAN SPREAD AND TRANSMISSION BEYOND "CLOSE CONTACT" I've read a lot of people say this can only be spread via "close contact", but there is evidence that is not the case. The best information we have about hantavirus spreading human-human (Andes strain, same one as the cruise ship outbreak) comes from a meticulous study about a past outbreak that wasn't a cruise ship. I read the paper (and the supplement, which is where the good info always is...). There are many examples of transmission without "close contact": Patient 1 --> Patient 4 "did not have any physical contact and simply said “hello” to each other as they crossed paths" Patient 1 --> Patients 3 & 6 "seated at different tables and spatially separated by 1–2 m" Patient 2 --> Patient 11 "No direct or close contact between the two patients was reported." Patient 8 --> Patient 28 "Patient 8 shared a room with Patient 28 and her relative. Patient 28 and Patient 8 did were not in close contact." OTHER IMPORTANT DETAILS IN THAT PRIOR OUTBREAK -In that outbreak, one person infected 5 at a birthday party. One of those infected then infected his wife. He died, and his wife infected 10 more at her husband's funeral/wake. -They got the outbreak under control by strict isolation and quarantine, with people having to stay home for 40 days with no contact with others. CHALLENGES, AND WHAT I'M WATCHING -The long incubation period (several weeks) means it will take some time to know if others get sick, or if we have had any secondary transmission after the boat (29 people from the boat already returned home, but are still within the incubation period). -There is one report of a flight attendant hospitalized/ill, but it's not clear if they have hantavirus. Someone with hantavirus boarded a flight *but was removed from the plane before takeoff* because they were so sick. So, if transmission did happen, it happened in that one hour while the plane was on the ground.

Joseph Allen

44,368 views • 4 months ago

American Surgeon shows the actual letter from UnitedHealthcare DENYING a patient in emergency condition from receiving care “This is a woman who was in the emergency room with pulmonary embolisms” “I think we all knew this would happen. I had another patient come in and share with me that UnitedHealthcare denied her inpatient's day. So this is a patient who had shortness of breath and some chest pain, and she just knew that something wasn't right in her body. She had a family history of blood clots and she'd had a deep flap surgery a couple of weeks ago. She went to the hospital and they saw her and they found that she had a life threatening condition known as pulmonary embolisms. So she was admitted to the hospital and taken care of really well by the doctors there. And they ordered all the right things. After a couple of days, she was discharged. She got a letter from UnitedHealthcare explaining that they didn't agree with the level of her care and that they would not cover it. So I'm gonna share some of the language of that letter with you, and I want you to know that my patient that we talked about previously who had her surgery denied had almost exactly the same letter shared. So there's some troubling things in this letter. I think this term is really interesting. United is saying they reviewed the request for inpatient admission. So let's all just pause and consider that. This is a woman who was in the emergency room with pulmonary embolisms, and the doctor wasn't really requesting anything. They were saying this patient needs to be in the hospital. But an insurance company sees this as a request, and that's part of this prior auth environment that we're living in. So I think it's important as patients and as physicians to just acknowledge that this is our reality now. Someone can think that there's a good medical decision for you and can write orders and wanna do the right thing for you, but your insurance company is seeing that as a request and deciding whether or not they wanna do it. One of the criteria that this insurance company used to decide whether or not to accept or deny this request was whether it's medically necessary. And it's so interesting that we're letting insurance companies and the doctors who work for insurance companies determine what's medically necessary and not just the doctor in front of the patient in the emergency room. So this is a really bold statement from UnitedHealthcare for my patient. They say you did not have to be admitted as an inpatient to the hospital for this care. I think we all need to just reflect on that. An insurance company is telling a patient and her doctor that they disagree with the plan of care to keep that patient safe. I know that this is boiling down to whether it's an inpatient admission or an observation admission, and that's really about money. But what I wanna point out to you is they're making medical decisions. This insurance company is actually weighing in and disagreeing with a doctor who made a medical decision to admit this patient for her safety. So this specific sentence, when a doctor or facility treats a patient above the recommended level of care, we cannot cover it. What the heck? That's what we do. We go above and beyond as physicians. It's clear that insurance companies don't, and they're actually saying it here.”

Wall Street Apes

115,739 views • 1 year ago

EMT Harry Fisher: "They were paying me $1,000 a shift [to bring patients to hospital 'death camps']...When I learned what I literally was doing, I tried to coach them, like, 'Hey, they're going to try to put you on a ventilator. I haven't seen anybody come off of these vents." This clip of Fisher (Harry Fisher), an EMT paramedic, military veteran, and co-author of Safe and Effective...For Profit, is taken from an interview with Joe Oltmann () posted to the UntamedNation (Untamed Nation) Rumble channel on October 21, 2025. ---------------Partial transcription of clip---------------- "I never saw anybody come off the tube. Like whenever I was, I worked New York City, lower Manhattan ICU and ER. I picked up contracts there because they were paying us stupid money to work these contracts, which is another reason I realized, oh, okay, well, if you're going to pay a paramedic $1,000 a shift, so a 12 hour shift, they were paying me $1,000 a shift and putting me up in New York City. I can only imagine what the bigwigs were getting paid with the federal dollars. "When I learned that what, what I literally was doing, I tried to coach them, like, hey, they're going to try to put you on a ventilator. I haven't seen anybody come off of these vents. I suggest you just, you know, it's, you're going to have anxiety because that's typically why we would get the calls or why they would come in is anxiety. And they would have low saturations. It was, something called happy hypoxia, which is very strange that it's very seldom talked about. But a super low sats and the patient looked normal. The patient wasn't acting like they were sickly. "But still with the, with the way that a lot of these hospitals were running, they would go off basically the monitor and intubate the patient, put them on a ventilator and the patient would die within days. They would also give them Remdesivir and you know, other, other drugs. "But which one was it doing the killing? My thoughts on it. Just my opinion as a lowly paramedic, since these people were compensating really well at super low sats with whatever they had going on inside them, I think we were oxygen and poisoned. We were causing oxygen poisoning because that'll start shutting down your organs. Just if I give someone too much oxygen for too long, you'll start shutting down organs. You'll inevitably kill them if you give them, if you over oxygenate a patient for too long, and that's what these, all these people seem to have in common."

Sense Receptor

52,048 views • 11 months ago

Dr. Abhishek Shukla (Geriatrician) explained about ABG (Arterial Blood Gas Analysis) Student: Sir, I am a Nursing second-year student. I often see ICU patients undergoing ABG tests. A strip comes out, and doctors discuss acidosis, alkalosis, CO₂, and oxygen levels, but honestly, I still don’t understand how to read it. Why is ABG done so frequently, and how can I learn to interpret it? Dr. Abhishek Shukla: Very important question, Riya. ABG stands for Arterial Blood Gas Analysis. It helps us quickly understand what is happening inside a critically ill patient’s body. If a patient is unconscious, drowsy, breathless, or deteriorating, ABG tells us whether the problem is due to oxygen, carbon dioxide, acid-base imbalance, or severe infection. It requires only 0.5 ml of arterial blood, usually taken from the radial artery, and the result comes within one minute. The first thing to check is pH. Normal pH is 7.35–7.45. If it is below 7.35, it means acidosis; above 7.45 means alkalosis. Severe acidosis can become life-threatening. Next is pCO₂ (35–45 mmHg). If it rises very high, like 90, it means the patient is retaining carbon dioxide. This can lead to unconsciousness and is called Type 2 Respiratory Failure. Then check pO₂, which tells us about oxygen. If oxygen is low while CO₂ is normal, it is called Type 1 Respiratory Failure. After this, review electrolytes—especially sodium and potassium. Low sodium can cause confusion, while high potassium can disturb the heartbeat. Finally, look at lactate, glucose, and creatinine. High lactate may suggest sepsis, and high creatinine may indicate kidney failure. So always remember the ABG rule: pH first, then CO₂, then oxygen, and finally electrolytes. #ABG #ABGTest #ArterialBloodGas #MedEd #ClinicalSkills#ABGInterpretation #AcidBaseBalance #BloodGasAnalysis #NursingStudent #NurseLife #NursingNotes #AIIMSNORCET #mednotes #drabhishekshukla #geriatriccare

Association of International Doctors. (India).

47,852 views • 3 months ago

Had the chance to speak on CTV News about the epidemic of burnout among health care workers. It is not surprising at all that this is happening. We all want to work hard to save lives, but hopeless work in a collapsing system is what leads to burnout. Let me try to illustrate some of the challenges we face. Recently I arrived to my evening shift; I saw 18 ambulances outside, with patients waiting to be offloaded into a department with few free beds. Our 'Infinity Hallway' is full again with stretchers lined up as far as the eye can see. I get inside, all of our acute resuscitation beds are occupied, our ICU is full, and another ambulance crew is taking a patient to another hospital's ICU. We get an alert from EMS that a person in their 40s has collapsed, is unresponsive, and is five minutes away. Just from that description, this person likely needs a ventilator and an urgent CT scan, but we had no beds. Immediately we try to find a spot, checking just which other really sick patient we can shuffle somewhere else. Do we move the 50 year old on high flow oxygen for Covid? Or the heart attack patient waiting for the cath lab to free up, and it goes on. The strain of constantly weighing these lives, trying to eke out space from nothing, weighs heavily on all of us. One exhausted nurse, who helped intubated 5 patients earlier in the day muttered under their breath that they're going to quit after this. I hope she's not serious, she's one of our best. We somehow manage to find space, the crew doing the patient transfer came early, and we used that bed. But what if 2-3 more came at the same time? Most busy ERs looks like pandemonium to an outsider, but there's method to the madness that usually can process a huge number and variety of patients, treat them and occasionally accomplish miracles. But all of this is impossible if you completely burn out the highly trained staff on the ground.

Kashif Pirzada, MD

107,085 views • 2 years ago