Raghu Venugopal MD

Canadian Emergency Physician

[Sen. Bernie Sanders @SenSanders]

No, Mr. President. We should not “annihilate” the people of Iran.

That is a war crime. That is barbarism. And it is something the United States must never be associated with.

Let’s be clear: Trump’s war in Iran is illegal and unconstitutional. Congress must end it NOW.

[Nicholas Kristof @NickKristof]

Hard to know what to call this other than an American president musing about whether to commit genocide.

[Raghu Venugopal MD @raghu_venugopal]

93.4 million people live in the Islamic Republic of Iran, many of them regular people that want to live regular lives.

[Aaron Rupar @atrupar]

Trump to the UN: "Do I annihilate the Islamic Republic, and do it quickly? Do I drive them into hell?"

[Raghu Venugopal MD @raghu_venugopal]

President Lula blasts the barbaric American practise of collective punishment - a practise persisting from a more savage human time.

[Scott Robertson @sarobertson_]

Lula: "In Cuba, the world watches in horror as collective punishment is imposed on ten million people by an illegal economic and energy embargo."

[Raghu Venugopal MD @raghu_venugopal]

President Luiz Inácio Lula da Silva couldn't be more scathingly honest.

[Scott Robertson @sarobertson_]

Lula: "The UN is failing in one of its most important missions to rid humanity of the scourge of war. Its credibility has never been lower. Its ability to protect the most vulnerable, those who have no army or arsenals, has never been so weak. We are all held hostage by the inaction of the Security Council for failing to fulfill its role."

[Raghu Venugopal MD @raghu_venugopal]

Minister Anand - I'd be grateful if Canada raised with the UAE the Sudan genocide. There are literal rape camps there for girls and women and men are slaughtered. The UAE is complicit. Minister - please speak for those without a voice and victims of genocide. @AnitaAnandMP

[Raghu Venugopal MD @raghu_venugopal]

I feel I live in a completely different reality where sepsis is quickly detected and aggressively treated. Unfortunately, this article cites the numerator (bad outcomes in the press) but not the denominator (cases well managed daily). 👇👇👇

First - triage alerts me by phone, by text and in person to alert me to a potentially septic patient.

Second - the patient's waiting to see have vital signs visible, and we ER doctors prioritize patients with grossly abnormal vitals. I'll see a patient in a bed, in the hallway, in a chair, in the waiting room, at triage an even physically outside of the ER if they need to be seen.

Third - some EMS clinical trials actually give the 1st dose of antibiotics even before ER arrival.

Next - patients, families and I talk about sepsis on every single shift I do. In the appropriate context, broad spectrum IV antibiotics are rapidly initiated along with fluid resuscitation and search for the sepsis source. Specialists are involved early and when in doubt, a precautionary approach is taken. The management of sepsis is so aggressive that often I see admitting services downgrade and focus the ER's aggressive antibiotic treatment.

Next - if deterioration occurs, steroids, more fluids, more antibiotics, vasopressors and ICU consultation is considered.

What are the real problems behind the cases cited in this article?

-No hospital beds, thus no monitored ER beds
-Not enough available hospital staff to see patients in a timely manner

You can put all the protocols in place but if there is no bed to do it in and no staff to run the protocol - all the smartest protocols fail.

@kkirkup @NightShiftMD @OntariosDoctors @OntarioHealthC @ONThealth @OntarioHealthOH

https://t.co/16xt8KP2cX

[Raghu Venugopal MD @raghu_venugopal]

"This is not going to stop us" - Norm Weddum, President of the Belleville Sons of Jacob synagogue. Mr. Weddum gives a harrowing account of the horror faced by congregants. There's nothing in the world that justifies this violence to the Jewish community.
https://t.co/aokjtZlMzQ

[Raghu Venugopal MD @raghu_venugopal]

Trump favours blood potash that doesn't even exist to sell to him. Premier Moe from the great province of Saskatchewan breaks it down.

[Garry Kasparov @Kasparov63]

Being debunked by Lukashenko is yet another new low for Trump.

[Andrew Coyne 🇺🇦🇮🇱🇬🇪🇲🇩 @acoyne]

From the far right, everything looks far left.

[Ryan Williams 🇨🇦 | The Competition Guy @Ryan_r_Williams]

Jeff Smith is a real hero.

A Belleville Police officer who put himself in harm’s way protecting our community.

Please pray for Jeff, his family and his fellow officers.

Our community is behind you, Jeff. Stay strong. Keep fighting. Come home to your family.

[Pierre Poilievre @PierrePoilievre]

Constable Jeff Smith put his life on the line to protect worshippers at the Sons of Jacob Synagogue in Belleville yesterday, on Yom Kippur.

We thank him for his bravery and pray for his swift and full recovery.

Jewish families in Canada must be able to worship and live free from terror, violence, or intimidation.

[Andrew Coyne 🇺🇦🇮🇱🇬🇪🇲🇩 @acoyne]

Good because nobody is proposing that, either.

[David Frum @davidfrum]

Belleville, Ontario, is a town I know well. I have worshipped at the synagogue that was attacked, an undefended structure built when North American Jews never imagined they might face violence from their neighbors. Such things were nightmares from long ago and across the ocean.

[Rep. Ro Khanna @RepRoKhanna]

Our government is giving $2.8 billon in bombs to Israel.

How about giving that money to the American people so they can afford food and gas?

I'm tired of this Israel first policy. It's time to put Americans first.

[Raghu Venugopal MD @raghu_venugopal]

“This is the problem with Bradford: he just makes things up, even when the facts are readily available” - Jennifer Keesmaat, former City of Toronto Chief Planner

[Jennifer Keesmaat @jen_keesmaat]

This is demonstrably false.

As Chief Planner, I conducted a rigorous line-by-line review of the department’s budget every year. I was required to. The same practice continues across City divisions: expenditures are scrutinized and justified in detailed, publicly available budget briefing notes.

Why make a claim that the public record so clearly disproves?

This is the problem with Bradford: he just makes things up, even when the facts are readily available.

Does he simply assume no one will bother to check?

[Scott Robertson @sarobertson_]

Mark Carney: "We stand against all forms of violence, all forms of hate. And may this House continue to come together to support the Jewish community in Canada and all Canadians to live their full lives."

[Raghu Venugopal MD @raghu_venugopal]

Since this is in the open press, it's to generate discussion. Mr. Paikin and Mr. MacDonald cite MaDonald's unique tough case. Paikin picked the hardest case possible and willfully ignores the broader reality. 👇👇👇

To balance it, I'll add in 25 years, I can't remember an orthopedist denying my referral.

As an ER doctor, here's the reality for the vast majority of my orthopedic referrals. Depending on the case, orthopedics will see the patient in realtime, the next morning, in 1-2 days or within about a week. It depends on the problem, the ability of the patient to go home safely and the ability of the patient to mobilize. Paikin cites none of this reality.

Here's the balanced reality. For my ER patients, orthopedics operates the same day, the next day or within 7-10 days, depending on the case. Paikin cites none of this reality.

The reality is - in a big city like Toronto, access to orthopedic surgery - from ER - couldn't be easier after a proper work-up and careful referral. That's the context to understand which doesn't diminish from the hardship MacDonald faced. Paikin gives none of that context. Paikin picked about the hardest case in all of orthopedic surgery to highlight and either doesn't know or doesn't care to balance his story out.

And while I'm an ER doctor and could be accused of only focusing on emergent episodic care, I've met complicated patients coming to the ER that need very specialized follow-up and were lost in the system. That's where a doctor has to get on the phone, get on hospital email and advocate and help the patient through the system. It sometimes needs me to call back a patient 3-4 times. I've done it. I've done that for unique cases. It's not easy for a complex case, but sometimes that is what is needed.

There's no easy answer or sugar-coating Mr. MacDonald's reality and his hardship which is real. It sounds like he's been fighting a battle largely alone to get the surgical care that he needs. I'm frustrated to learn Mr. MacDonald doesn't have a better quarterback in the system. But Mr. Paikin does no favours by unbalanced reporting. @spaikin

https://t.co/oS4mXDUDj4