Rupinder (Rup) Sahsi, MD 🧠💭
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hotsahs.sahsi.net
Rupinder (Rup) Sahsi, MD 🧠💭
@hotsahs.sahsi.net
6.1K followers 4.6K following 910 posts
👨‍⚕️ Emerg MD • 🚑 EMS Asst Director • 🇨🇦 Canadian • 💨😷 Clean air enthusiast • 🌎🔥🥵 Climate pessimist • 👨🏽‍💻 Geek with bad code • ☕ Coffee achiever • 🗣️ Syllable abuser • 🤬 Profane misanthrope • 🩺 #MedSky • 👍🏽 Just this guy, y'know?
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hotsahs.sahsi.net
"Despite decades of extensive documentation exposing the Israeli State’s systematic use of torture, these grave violations have been
persistently disregarded, fostering a culture of impunity that enables
repeated and flagrant breaches of... fundamental human rights."

www.bmj.com/content/391/...
In the BMJ: "Opinion: Torture and health worker complicity in Israeli detention sites." Follow link for full text.
November 10, 2025 at 12:45 AM
hotsahs.sahsi.net
"The 30 key EM:POWER Recommendations below are distilled from the corresponding sections of the report."

caep.ca/key-recommen...
The 30 key EM:POWER Recommendations are distilled from the corresponding sections of the full report. See website for full text.
October 21, 2025 at 7:03 PM
hotsahs.sahsi.net
"CAEP commissioned the EM:POWER Task Force to probe the system and its many stakeholders, identify underlying problems and propose a framework for system redesign. Their work took over two years and forms the basis of this report."

caep.ca/executive-su...
EM: POWER roadmap infographic for tackling emergency department overcrowding.
October 21, 2025 at 7:03 PM
hotsahs.sahsi.net
CASCADES Canada has fantastic patient and prescriber educational materials on their site.

cascadescanada.ca/action-areas...

The main site has lots of other good ideas that support the healthcare community in transitioning towards high-quality, low-carbon, climate resilient care.

🧵 I'm
Sustainable Inhaler Alternatives chart from CASCADES Canada, graded by environmental impact. Note the up-front caveat that switching inhalers should never be forced, especially in situations where doing so could affect level of symptom control and frequency of exacerbations.
October 7, 2025 at 11:14 PM
hotsahs.sahsi.net
"There is new evidence in children 12 years of age and adults that PRN budesonide/formoterol decreases exacerbations in comparison to PRN SABA, with different levels of evidence in those with very mild versus mild asthma."

🧵
Controller Therapy ICS/LABA Advair MDI fluticasone/salmeterol 125/25; 250/25 mcg Zenhale MDI mometasone/formoterol 100/5; 250/5 mcg Consider substituting: ≥ 6 years old: Advair Diskus fluticasone/salmeterol 100/50;250/50; 500/50 mcg ≥ 12 years old: Symbicort Turbuhaler budesonide/formoterol 100/6; 200/6 mcg ≥ 18 years old: Breo Ellipta fluticasone furoate/vilanterol 100/25; 200/25 mcg
October 7, 2025 at 11:14 PM
hotsahs.sahsi.net
"Metered-dose inhalers (MDIs) are a significant contributor to health care’s climate emissions. They contain high levels of hydrofluorocarbons that, when released into the atmosphere, act as potent greenhouse gases."

🧵
Controller Therapy ICS Qvar MDI beclomethasone 50; 100 mcg Flovent MDI fluticasone propionate 50; 125; 250 mcg Alvesco MDI ciclesonide 100; 200 mcg Consider substituting: ≥ 6 years old: Flovent Diskus fluticasone propionate 100; 250; 500 mcg ≥ 6 years old: Pulmicort Turbuhaler budesonide 100; 200; 400 mcg ≥ 12 years old: Arnuity Ellipta fluticasone furoate 100; 200 mcg
October 7, 2025 at 11:14 PM
hotsahs.sahsi.net
"Dry powder and soft mist inhalers (DPI and SMIs) do not contain propellants and have a substantially smaller carbon impact."

🧵
Reliever Therapy SABA Ventolin or Teva-Salbutamol MDI salbutamol 100 mcg Consider substituting: ≥ 6 years old: Bricanyl Turbuhaler terbutaline 0.5 mg ≥ 6 years old: Ventolin Diskus salbutamol 200mcg ≥ 12 years old with Asthma: Symbicort Turbuhaler budesonide/formoterol 100/6; 200/6 mcg doses
October 7, 2025 at 11:14 PM
hotsahs.sahsi.net
Here's Ontario's plot. Anticipate schools to drive respiratory transmission rates higher.

There's still a fair amount of entero/rhinovirus (12.1% positivity) and a hint of parainfluenza (1.2%) so it isn't "all COVID" out there, but 9.0% for SARS-CoV-2 makes it worth considering if symptomatic.
Plot of SARS-CoV-2 percent positivity in Ontario compared to the number of tests performed per week.
September 22, 2025 at 12:05 PM
hotsahs.sahsi.net
Hrm.
Plot of the rate of ascent of SARS-CoV-2 detections over the last three weeks (Canada).
September 22, 2025 at 11:42 AM
hotsahs.sahsi.net
I don't think "highlight" is the word I'd have chosen.

health-infobase.canada.ca/respiratory-...
Highlights for the week ending September 13, 2025 (week 37) SARS-CoV-2 (COVID-19) - 9.6% - percentage of tests positive Upward trend.
September 22, 2025 at 11:38 AM
hotsahs.sahsi.net
Complete loss of Starlink connectivity confirmed in Cambridge, Ontario - part of what sounds like a global outage pattern.
Screenshot of Starlink app showing disconnection a service outage in my area (Cambridge, ON).
July 24, 2025 at 8:27 PM
hotsahs.sahsi.net
It's sparky outside.

#onstorm #cbridge #watreg #dlws @instantweather.bsky.social
June 28, 2025 at 2:03 AM
hotsahs.sahsi.net
I've never had an issue with either hearing my patients or being heard by them through masks, even in a noisy emergency dept.

In the rare instance when they are hearing impaired and lip-reading dependent, I just use Google Live Transcribe with the font size cranked up.

My mask stays on.
This program is closed captioned for the hearing impaired
June 27, 2025 at 11:36 PM
hotsahs.sahsi.net
Playing with long exposure at Niagara Falls.
Long exposure image of the water going over Niagara Falls, which smooths out the water for an interesting effect.
May 31, 2025 at 12:50 AM
hotsahs.sahsi.net
The front yard duck now comes with bonus front yard ducklings.
Duck nest in our front yard, now containing freshly hatched (still wet) ducklings. Only a matter of time before they make the march to the nearby pond.
May 17, 2025 at 8:17 PM
hotsahs.sahsi.net
'𝙒𝙝𝙚𝙣 𝙀𝙫𝙚𝙧𝙮 𝙎𝙚𝙘𝙤𝙣𝙙 𝘾𝙤𝙪𝙣𝙩𝙨'

This Ontario-wide campaign aims to educate the public about 9-1-1 abuse.

Please remember 𝟵-𝟭-𝟭 𝗶𝘀 𝗳𝗼𝗿 𝗲𝗺𝗲𝗿𝗴𝗲𝗻𝗰𝗶𝗲𝘀 𝗼𝗻𝗹𝘆. Let's keep the lines clear so help is available for us all when we need it.

Pass it on, and learn more at: wheneverysecondcounts.ca
CLEAR THE LINE 9-1-1 is for life-threatening emergencies. Non-emergency calls to 9-1-1 can delay someone from getting help in a real emergency. Keep 9-1-1 lines open for all of us when we need urgent help. wheneverysecondcounts.ca
May 9, 2025 at 1:32 AM
hotsahs.sahsi.net
5% of 43.1million?

Less than 2.2million.

(it would be 2 million without projecting for population growth)

How does a cap at 5% not represent a reduction in both absolute numbers and relative proportion compared to today?

What would this meme have you believe?
Mark Carney just announced that he will cap the number of foreign students and foreign workers in Canada at 5% of the population. For context, that's two million people, which is the amount we already have right now. HE'S NOT REDUCING THE NUMBERS AT ALL
May 5, 2025 at 3:57 AM
hotsahs.sahsi.net
Is that number accurate?

This image is from a StatsCan report noting 2.4mil work or study permit holders at the beginning of 2024.

There are more recent StatsCan numbers that estimate 2.6mil foreign work or study permit holders in the country right now-ish.

www150.statcan.gc.ca/t1/tbl1/en/t...
The total number of NPRs living in Canada increased for the ninth quarter in a row to reach a record high of 2,793,594 on April 1, 2024. Of these NPRs, 2,430,282 were permit holders (work or study) and their family members and 363,312 were asylum claimants, protected persons and related groups (with or without work or study permits).
May 5, 2025 at 3:57 AM
hotsahs.sahsi.net
Estimates of the current proportion of the Canadian population made up of international students and temporary foreign workers in 2025 is 7.2-7.3%.

With a population of 41.5 million, that comes out to just over 3 million in absolute numbers.
The government is set to follow the 2025–2027 immigration levels plan announced in October 2023, which proposes to cap the combined population share of international students and temporary foreign workers at under 5% by 2027. As of now, this group makes up 7.3% of Canada's total population of 41.5 million.
May 5, 2025 at 3:57 AM
hotsahs.sahsi.net
Here's another politiki-meme that floated past me. It prompted me me to do a little poking around.

Sounds awful at first, right? Politicians? Lying? You're joking.

But, hang on a sec... 🧵
Mark Carney just announced that he will cap the number of foreign students and foreign workers in Canada at 5% of the population. For context, that's two million people, which is the amount we already have right now. HE'S NOT REDUCING THE NUMBERS AT ALL
May 5, 2025 at 3:57 AM
hotsahs.sahsi.net
New deployment for old camera hardware: DUCK CAM

This momma duck built a nest in our yard. Now we can peek in on her and her eggs without my kids scaring the quack outta her each time.
Serene looking duck hen continues her long sit on her nest full of eggs.
May 4, 2025 at 12:21 AM
hotsahs.sahsi.net
Robin Cam 2025 is go.

Some noobs have already made an appearance!
Robin nest. They return to the same spot every year, so we pointed a camera at it. You can see one chick, but I think there's another one in there, as well as an unhatched egg.
May 2, 2025 at 9:41 PM
hotsahs.sahsi.net
Exceptionally disturbing.

This isn't a "transparency initiative" as much as a weapon.

It's an attack on any body that brings friction to the injection of partisan talking points - including alternative facts and outright falsehoods - into the domestic infosphere.
Targeting the “censorship industrial complex” Both GEC and R/FIMI, its pared-down successor office, focused on tracking and countering foreign disinformation efforts from Russia, China, and Iran, among others, but GEC was frequently accused—and was even sued—by conservative critics who claimed that it enabled censorship of conservative Americans’ views. A judge threw out one of those claims against GEC in 2022 (while finding that other parts of the Biden administration did exert undue pressure on tech platforms).
May 2, 2025 at 6:41 PM
hotsahs.sahsi.net
Meme in my feed points at Reuters reports of a Japan-Qatar deal on LNG (true) but claims the Canadian govt has refused similarly lucrative LNG export deals with Japan (not true).

Alberta just made such a deal, and there are apparently more on the way.

www.canadianenergycentre.ca/reliable-jap...
Canada is now Japan’s second-largest supplier of propane, according to World Bank data, where uses include automobiles, electric power generation and petrochemical feedstock. “The long history of reliability in the supply of propane from Canada serves as the basis for the high expectation for Canadian LNG to Japan,” said IEEJ chair Tatsuya Terazawa. “We see LNG from strategic partners like Canada as important to our energy security and our country’s efforts to significantly reduce our dependence on coal as well as to provide dispatchable power to deal with the intermittency of renewable power.” During a recent trade mission to Japan, leaders from Canadian organizations Energy for a Secure Future and the First Nations LNG Alliance signed a memorandum of understanding with IEEJ to advance energy trade. “There is a real commitment between the three organizations to work together to support Canadian LNG projects being successfully built and getting our product to markets in Asia that need energy security and low-emission energy options,” said Shannon Joseph, chair of Energy for a Secure Future. “It is an extremely positive thing.”
May 2, 2025 at 6:03 PM
hotsahs.sahsi.net
Hmmm. This could take a while.
The process will require 21 MiB more space. 168 MiB to be downloaded. [1/111] Fetching png-1.6.44.pkg: .......... done [2/111] Fetching py311-sqlite3-3.11.11_7.pkg: ..... done [3/111] Fetching py311-anyio-4.7.0.pkg: .......... done [4/111] Fetching unbound-1.22.0_1.pkg: .......... done [5/111] Fetching php82-session-8.2.27.pkg: ..... done [6/111] Fetching wpa_supplicant-2.11_2.pkg: .......... done [7/111] Fetching py311-cryptography-42.0.8_5,1.pkg: .......... done [8/111] Fetching jpeg-turbo-3.0.4.pkg: .......... done [9/111] Fetching freetype2-2.13.3.pkg: .......... done [10/111] Fetching lighttpd-1.4.76_1.pkg: .......... done [11/111] Fetching py311-service-identity-24.2.0.pkg: ... done [12/111] Fetching opnsense-update-24.7.12.pkg: ..... done [13/111] Fetching hostapd-2.11_1.pkg: .......... done [14/111] Fetching py311-pandas-2.1.4,1.pkg: ..
May 2, 2025 at 1:44 PM