McNadoMD

Hunter, ER doc, believer in democracy. I’m here to rant, combat medical misinfo, and get social therapy. Posts aren’t medical advice. This is the only platform I am currently on. If you find “me” elsewhere, it isn’t me.  If you have COVID vaccine questions, I’m always happy to try to answer. Let’s all share good info, facts, and science, and keep ourselves and each other safe!

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Last Notes

2024-08-11 05:22:23

Last rage post tonight…
When a shooting (school, gang, accidental, whatever) happens, and some kid gets aced, you know what that looks like for me?
Ambulance calls in. Full trauma activation. Kid. Whole fucking hospital rolls down.
We work. Blood, trash, needles, noise.
Silence. I recap the case. The resuscitation.
“Anyone have any ideas? Anyone object to calling it?”
Silence.
“What’s the official time?”
“Nineteen thirtyone”
“Time of death, nineteen thirtyone”
“Get them cleaned up”

2024-08-11 04:36:59

- reply

Sorry, for accuracy, the editors note is “The sound of screaming children has been removed”.
https://media.mstdn.social/media_attachments/files/112/941/529/377/492/171/original/f75165784ef285a0.png

2024-08-11 04:32:05

As all of us in the US barrel towards another goat rodeo of an election, I just want to remind everyone that we had a school shooting so fucking horrifying that the news felt the need to edit out the sound from security camera footage. The news clips said “the screams of children have been edited out”.
Fucking think on that.

2024-08-07 13:56:31

Dudes in the GOP are so out of touch with women (like never talk to them ever level) that they think it is a slam to call Walz “Tampon Tim” for requiring free menstrual products in schools. You dumb mother fuckers really never talked to girls in school did you? Did your girlfriends just “hang with friends” for a few days every few weeks? Have you never made a gas station run for tampons on the way to a concert or before a game or in the middle of Social Studies? The fuck is wrong with you?!

2024-08-02 20:14:58

Hate to break it to all these white dudes who are worried about Harris’s ethnic background, but we’re all genetically African. Multiple lines of genetic and fossil evidence make it pretty clear that humans all come from early human ancestors in Africa.

2024-07-27 21:39:20

You know what isn’t hard? It isn’t hard to say stop bombing kids.
Stop bombing kids playing soccer.
Stop bombing kids in tents.
Stop bombing kids in hospitals.
All of you degenerate fucksticks out there deciding that an appropriate target is somewhere full of kids — fuck you. Get eye herpes.
It’s bad when Hezbollah does it. It’s bad when IDF does it. It’s bad when Russia does it. It’s always bad. Every time.

2024-07-27 01:42:08

Crazy that the GOP, so concerned about crime in Mexico, isn’t out here congratulating Biden’s DOJ for arresting a major cartel head in Texas.

2024-07-24 22:42:15

When we’re all reading about polio in US swimming pools, just remember, Israel didn’t have to blow up all of the sanitation and clean water infrastructure in Gaza, but they did anyway.

2024-07-24 00:16:12

People need to listen to @npub1zdp…vqv8 about the mass deportation signs at RNC.
The RNC had to think it was a good idea, budget the signs, design them, order them, hand them out…
Think about it for a bit.

2024-07-23 17:46:57

Chuck Schumer remains an ineffective piece of shit.

2024-07-23 14:32:53

I knew the story of Sonya Massey would be bad, but I figured it was “jumpy cop at the door” bad, not “racist cop shoots homeowner holding pot of water after asking her to turn off her stove, all of which happened after checking her ID, IN HER OWN FUCKING HOME, after SHE CALLED 911 FOR HELP”.
Fuck all y’all who argue there’s no systemic racism.

2024-07-22 04:42:02

Every single time you mention Joe Manchin, it is obligatory to include that his daughter drove the cost of epinephrine autoinjectors (Epi Pens) up by 600% for no reason other than profit, which left children to die from completely treatable anaphylaxis.

2024-07-21 18:43:44

Don’t link to NYT, don’t visit NYT, and going forward, don’t even mention NYT. They sell clicks. Let ‘em starve.

2024-07-21 18:31:13

So, now that we got rid of sleepygenocidejoe (or whatever the fuck), can all of the “I don’t like Trump, but Biden’s too demented” Repubs get behind democracy or just admit they like rapists.

2024-07-21 18:24:50

- reply

@npub1fpr…lyph sure, but also, the party needs to get themselves unfucked and stop this nonsense. If the party leadership isn’t on the news today lining up behind Harris, the election is already over.

2024-07-21 18:23:21

If you motherfuckers want Harris, get on the phone (yes phone) and get calling. Call every dem elected official in your area and give them an earful. Make it clear you won’t support anyone else. Put an end to the fuckery.

2024-07-21 18:14:41

Welp, there it is. Now we get to see if the Dems had a plan, or are as fucking stupid as they seem to be. The next week will be a flood of racist and sexist articles pushing out Kamala, followed by a feeding frenzy of mediocre white men trying to run for the ticket.

2024-07-21 15:30:01

Reminder that Manchin isn’t a Democrat, and is a stooge for big coal and big finance. His daughter is also the person who drove up the cost of Epipens 600%, undoubtedly killing kids with severe allergies.

2024-07-21 15:27:53

If the guy you are voting for constantly praises Xi and Putin because they “rule with an iron fist”, you might not actually be wanting a free country.
Your guns? A dictator will take them.
Your vote? Gone.
Your fireworks? Gone.
Hunting? Not a thing.
Public lands for fishing? Sold off.
Freedom to worship? Nope, gone.

2024-07-20 16:09:02

- reply

@npub1a84…wlgu Alexa, what is “means restriction”?

2024-07-19 13:56:22

So is the media gonna talk about the numerous times Trump forgot names, titles, and other details. You know, like who is the current governor of the state in which he was speaking?
No? Huh. Guess that isn’t a marker of age related debility after all.

2024-07-16 18:33:14

Trump and Vance promise to deport tens of millions of immigrants.
Understand that a rapid mass deportation program requires:
1. Violent raids on families
2. Putting people, including infants, children, the elderly, and the disabled, in holding camps
3. Uprooting American children of immigrant parents
4. A massive paramilitary force that does not currently exist
https://www.nbcnews.com/investigations/mass-deportation-migrants-trump-actually-work-rcna161637

2024-07-16 02:18:11

The only thing anyone needs to know about JD Vance is that he opposes abortion even in cases of rape, incest, or when continuing the pregnancy will kill the mother.

2024-07-15 20:06:09

“Dems need to tone it down”
Oh, also, we’re picking a violence-peddling extremist for VP

2024-07-15 11:46:49

Over the next week we’re going to hear Republicans demand “unity” of the country behind Trump, which of course makes no sense since he isn’t president.
Good time for folks to remember a few facts:
1. Trump’s “spiritual advisor” raped a 12 year old girl.
2. Trump’s name appears in Epsteins flight logs 17 times.
3. Trump has repeatedly made sexually inappropriate comments about his daughter.
4. Trump has been found by a jury to have raped E. Jean Carroll.

2024-07-14 20:13:50

Biden pulling his ads down is fucking stupid. Does anyone for a second think Trump would stop his relentless campaign to undermine democracy if Biden were injured, ill, or dead? Fuck off.

2024-07-14 07:43:42

The GOP stand-in in London interviewed by BBC this morning spun this as a “Repubs are victims of Dem radicalization and vitriol”, so I think we know what to expect stateside today.
A 20 yo white guy registered Republican tried to kill the guy who calls for violence at every rally, but that’s the Dems fault. Hmmmm…

2024-07-13 22:32:11

Political violence of any kind is ALWAYS the wrong answer. Full fucking stop.

2024-07-13 19:15:42

Another day in America…
https://www.nbcnews.com/news/us-news/illinois-woman-called-police-possible-intruder-killed-deputies-attorne-rcna161673

2024-07-11 22:42:33

Folks, there is no “cognitive test” that tells you if someone’s cognition is generally slipping. There are multiple instruments that are used to try to quantify if someone has dementia, but none of them are well validated for screening for mild cognitive decline. Out-of-context scores are often meaningless. So sure, Biden and Trump can take a SLUMS or MOCA or whatever, but as we saw with Trump, the score isn’t necessarily useful at all. It just isn’t how these instruments are validated.

2024-07-11 19:56:54

So when the DNC puts up a new nominee, and Republicans sue to keep them off the ballot, do you really think the Supreme Court will decide that fairly, in a timely fashion, or in a way that might ever be reasonable? You’re trying to hand over the entire ballot process to SCOTUS. Solid work.

2024-07-08 15:33:47

Russia blew up a Children’s hospital in Ukraine, killing patients and staff, and the headline on NBCNews right now is about Biden.
Motherfuckers, the other guy wants MORE blowing up hospitals. More dead kids.

2024-07-08 15:06:43

Gonna say that horribly controversial thing again:
STOP BOMBING HOSPITALS
Thanks.

2024-07-07 04:43:21

Remember in 2020-2021 when hundreds of thousands of lives were saved by a vaccine that was released under emergency use authorization? Remember all the conservatives who sued? Well, with the new world after the SCOTUS Chevron decision, we would never have had that vaccine. My colleagues and I would have continued to get picked off, one by one. We would have continued to watch the dead pile up in ICUs.
Welcome to Trump’s America.

2024-07-06 16:48:02

NBC article about Biden “trying to salvage” his re-election effort.
No, you fuckwits, he is just responding to a concerted media effort to undermine our country.
How about we talk about the guy with 34 felonies, who needed SCOTUS to throw out 200 years of precedent to give him immunity, while he is likely still sitting on national defense secrets? No? Don’t want to talk about that? Huh. Wonder why.

2024-07-06 05:35:19

Y’all — the news out here is running some bullshit about Biden, and snipes at his campaign having noted that he is limiting evening events to make sure he’s rested for the job.
I’m in my late 30s, and work all sorts of fucked up hours, and I can say unequivocally that I would be terrified of a President who doesn’t manage their evening schedule. There are great studies on what sleep deprivation does to decision making. I don’t want the nuclear button guy sleeping 6 hours a night.

2024-07-05 00:14:22

NPR had a discussion of the Roberts court last night, and what amazed me was the lengths the reporters were going to to pretend that anything about his decisions is based on some actual concern for the wellbeing of the country. This guy oversaw Citizens United. He was there for Dobbs. He’s here time and again batting for team christofascism. Let’s stop pretending he’s just a misguided good guy.

2024-07-04 16:44:34

PSA for all y’all ‘Muricans out here:
We do not routinely re-attach blown up fingers and hands. Firework injuries are usually permanent. Now, there is some nuance here, so if you blow your hand up, seek care at an Emergency Room (not urgent care) immediately, but at the end of the day, most of the time your amputated part goes in the red bin, we bandage you up, and surgeon sees you next week to close up the hole.
Anyway, don’t be stupid.

2024-07-04 16:37:23

Today, I’m celebrating a time when people came together to throw off the shackles of an unaccountable monarchy.

2024-07-01 13:44:13

The last time France had a far right government, the Allies had to invade to push Nazis out of Paris.

2024-06-30 03:32:21

You a #duckhunter , well you should read up on the recent SCOTUS decisions. They just made it very hard to protect the wetlands that ducks need to nest. We already face a population decline, but if EPA can’t keep wetlands clean and undeveloped, there will be no ducks to hunt.
#waterfowlhunting

2024-06-29 05:05:39

Y’all ever get DM’s from 800 miles away asking if you can accept a patient for transfer to your little hospital? Nah? Welcome to 2020-21. Trump said it was all bullshit, so Texas just YOLO’d it up. Then they ran out of beds, vents, nurses, drugs. The ER docs were fucking crowdsourcing ICU beds across multiple states. It was all avoidable. All the death. All the panic. All the moral injury, PTSD, HCW suicide, alcohol use. All of it could have been avoided. Trump already failed the crisis test.

2024-06-29 04:50:15

Know what a Trump presidency got me? Pulmonary edema. I go run the ridges at 11k looking for grouse, and when I get in the truck my fucking lungs fluff out and I cough foam going home. Won’t stop me, but that bullshit started in 2021 after I got COVID. We isolated. We did it right. Problem is, I couldn’t let one person die. One in dozens. Unfiltered air screaming out of a BVM right into my face while I bagged her O2 up from 35%. She lived. Worth it. But we could have done better, as a country.

2024-06-29 04:44:15

I was indeed there. I watched it unfold in realtime. I saw them die. I talked to their families. I saw the fear in the eyes of my staff. I sewed masks. I bought PPE for nurses and techs. I spent the sleepless nights reading the data, talking to docs around the world, and plotting the course forward.
I remember what a Trump presidency looked like during a global crisis. I took the frantic phonecalls from two states away. I am not the same.
Motherfuckers forget too easily.

2024-06-29 04:39:13

Hey, so unfortunately you’ve got COVID. We’re going to give you some dex, oxygen, and watch you for a few days. Your inflammatory markers don’t look great, but we’re getting better at this.
I’m sorry, I can’t give you the shot now. You have to get it when you aren’t sick with COVID. It works to prevent disease.
Oh. Yeah, I hear that a lot. Sorry that folks were telling you it was poison. Oh, Trump said use hydroxychloroquine? Yeah, that’s been shown to kill people with COVID. I’m so sorry.

2024-06-29 04:35:21

Room 4. Middle age dude in a weatherbeaten truckers hat. No mask. Hey man, can you put one on please. It’s policy for everyone.
Fuck me? You’re going to kill me and my family? Cool man, thanks. Anyway, ya got COVID. What’s that? No? I’m just trying to kill you to make money? That’s what Trump told you? Cool. Well anyway, best of luck. Here’s some home oxygen and steroids. You don’t want any of that? Aight. Have a nice day sir.
Loving 2020.

2024-06-29 04:31:42

Guy came in short of breath. Probably mid-60s, healthy. Breathing too fast. Blood pressure sucked. Heart rate too high. Put him in bed 2. Right heart strain on ECG. Fuck, there he goes. Code alarm, CPR, TPA, call it. Tell the family. Cry in the ambulance bay for a minute. Motherfucker had the sniffles 2 weeks ago. Never got the shot because people told him it was bad, and besides, this whole thing is a hoax anyway. Trump said it’d be gone last November right?
Chart the crit care. Next case.

2024-06-29 04:11:11

Just remember folks, under the GOP, nothing is regulated except women, free speech, and how close you can protest to a supreme court justice’s home.

2024-06-29 02:42:24

The NYT editorial board wants Biden out. Seems like a good reason to keep him in.

2024-06-28 15:56:40

Here’s my take nobody asked for:
A bunch of people are angry that Biden is president. They’re angry that incumbents have an advantage, so DNC didn’t run a primary. They’re angry that he isn’t a young, ideal, leftist.
Those folks are now serving as a megaphone for the right wing “Biden’s too old” trope. They are very much undermining their own goals so that they can scream “we told you so” based on a debate nobody gives a shit about.
Their ideal candidate is also unelectable.

2024-06-21 14:01:50

It’s too bad the Jan 6th rioters didn’t invade SCOTUS. A bunch of robed shitbags used to being all powerful scuttle-running down the hall while guys in horned hats defecate on the walls would probably have had an impact on cases we’re watching now.

2024-06-19 03:41:04

First case of mumps, huh, neat.
Second case of mumps, hmmmmm.
Third case of mumps, ok, apparently there is sustained community spread of a highly contagious, fomite and droplet transmitted virus. Cool cool cool shit.

2024-06-13 21:01:21

In light of a recent news story, a quick post on #emergencymedicine and bias.
Bias in the ER is real. It is common. It is deadly.
There are many types of bias that can harm patients, but bias along racial/ethnic lines, and bias against people with mental health or substance use disorders are particularly common in my experience.
When a patient presents to the ER, the presumption should be that they have a medical emergency. Assuming otherwise kills.
1/6

2024-06-13 18:32:50

To be clear, SCOTUS didn’t protect anyone’s rights to mifepristone. They just said that the group of misfit shitbag doctors who lied about the data didn’t have standing.
We knew that. We knew that all along. It was the bare minimum.

2024-06-13 02:35:10

Reminder that Donald Trump, who is a felon, admitted this week to authorities in NY that he is in possession of a firearm, and yet ATF has not a goddamn thing to say about it.
Anyhow, kid gloves.

2024-06-10 03:15:50

Why is anonymity in social media important? During the worst of the COVID hellscape in 2020-22, I used a large Twitter following to amplify the absolute fucking disaster we were experiencing in hospitals. I called out the bullshit statements by state and local officials, and was able to use anecdotes from their backyard to do it.
I could not have done that with my name attached. It would have put the jobs of everyone I work with on the line.
Did it work? Yeah. I had numerous press contacts.

2024-06-10 00:46:39

Think any of the folks screaming about antisemitism at Gaza protests are going to say anything about Musk’s embrace of AfD?

2024-06-08 16:13:03

Former USAF experts express dismay at Israeli use of US precision munitions, explaining that the absurdly high civilian death tolls of recent strikes show that IDF is misusing US-supplied munitions.
https://www.iowapublicradio.org/news-from-npr/2024-06-06/israel-used-a-u-s-made-bomb-in-a-deadly-u-n-school-strike-in-gaza
https://media.mstdn.social/media_attachments/files/112/581/877/990/126/309/original/aa1aea7c19578947.png

2024-06-05 14:51:51

Let’s talk American doctor work at home. The majority of physicians do a ton of work after they go home. We open our computer, open the medical record, and complete notes, answer patient messages, and answer work emails. Most of us do this on personally owned computers, or vaguely controlled work-supplied computers.
Why is this important? With MS copilot screenshotting everything, health systems will be forced to ban use of these computers. Now we can’t work at home. Work doesn’t get done.

2024-05-30 18:41:39

People living near the dog food plant here are suing it for smelling like dog food. Dudes, your house was cheap for a reason. That plant has been around longer than most Denver residents have lived in Colorado.

2024-05-28 18:06:49

For the record, per BBC’s reporting a few months ago, there were only two verifiable dead babies from the Oct 7th attacks in Israel, and neither was burned. The attack by IDF in Rafah that incinerated a refugee encampment has killed at least that many, and there are verified photos of babies that were burned horrifically.
If you were horrified at Hamas in October (ya shoulda been!) you should be horrified at IDF today.

2024-05-28 13:20:15

Wonder if any reporters will ask Biden how he feels about Mossad threatening ICC’s prosecutor and her family.

2024-05-27 20:00:44

Burning down a refugee camp is not a tragic mishap, especially if you first burned down the refugees original homes, their hospitals, their water pumps and treatment plants, and their fields. No, it is not a mishap. It is an intentional act of violence against people who have lost everything.

2024-05-26 15:48:23

Remember folks, before Dobbs, Republicans claimed abortion was too unsafe to be performed in a clinic, but now in Florida they think C-sections can be. It was never about safety.

2024-05-26 15:40:20

Florida allowing clinics to perform C-sections outside of the hospital is a horrendous handout to private equity on the backs of women and babies.
For perspective, driving DOWN the C-section rate is literally a quality metric for hospitals. Widespread availability elective C-sections doesn’t improve outcomes, can cause future complications, and of course C-sections are high-risk, often frenetic surgeries. This should not be performed somewhere that doesn’t have NICU and ICU services, period.

2024-05-26 02:30:20

- reply

@npub1f7d…s5uv to be clear, I am also pissed at Biden for his worthless response here. I just also think that the “I’m never voting for Genocide Joe” shit is ridiculous, if one’s goal is to effect positive change.

2024-05-25 21:26:53

I’m just gonna say it — this “Genocide Joe” thing is the dumbest fucking liberal shit I have seen in years.
Joe Biden can do more to *try* to rein in Israel, but Biden doesn’t run Israel. He isn’t CIC for IDF. He isn’t deciding what hospital to bomb. He isn’t deciding what border crossings to close.
You know who is pushing the Genocide Joe narrative? The fucking Russians and the Israelis. Why is that? Well, it’s an election year, and Trump is a hard right, pro-Israel puppet.

2024-05-24 04:50:49

Just saw a photo someone posted on my IG of a toddler from Gaza. Kid was dead. The fingernails are torn, dirt packed deep under them. The kid was trying to dig his way out of a building collapse.
Y’all — the last time I saw something that horrifying it was the fingernail marks in the concrete walls of gas chambers in Nazi concentration camps.
Fucking be better.

2024-05-23 15:59:25

The current SCOTUS continues to do what they’ve been doing since Dobbs. They make one decision that is pretty middle of the road “yep, that’s the right call”, and then the next five or six big decisions are all deeply unpopular, and wildly partisan. They think people don’t see the systematic erosion of democracy, separation of church and state, and equality. They are so fucking removed from actual society that they think this will all blow over.

2024-05-10 20:20:49

So a gun owner gets killed in his own home by a cop raiding the wrong apartment, and yet the NRA doesn’t have a thing to say about it. Huh.
Must be something about the case. Something that just isn’t quite white about it.

2024-05-10 03:59:31

I don’t give a fuck what FDA is gearing up for with respect to fowl fever. What I care about is what HHS and DHS are doing with the National Strategic Stockpile.
If a lethal, contagious respiratory virus gets rolling like it’s 2020, we’ll be shit out of PPE in days, out of ventilators, out of sedatives, out of pressors, our of saline and lactated ringers, and out staff. How do I know? Because we already ran this scenario, and nothing has gotten better.

2024-05-08 22:53:21

- reply

@npub1jdw…awld and now small physician practices are going out of business because they can’t get paid.

2024-05-08 16:50:03

The Rafah issue boils down to how you answer this question as an American:
If a school shooter killed all of the kids in one classroom, then holed up in the gym with every other kid in the school, is it OK for the cops to burn the school down to end the crisis and prevent another one?
That simple.

2024-05-08 13:03:39

Brain worms, or more specifically, beef and pork tape worms (taenia saginata and taenia solium) are not rare in the US. We find the calcified cysts from these on brain CT scans all the time, particularly in communities with large populations of South and Central American immigrants. They don’t make people into racist, antivaccine, profiteering, grifters.
Some people are just bad people. The tapeworms don’t deserve the shade.

2024-05-08 02:27:46

Guys, Republicans around the US used late 2020-2022 to take local, state, and federal governments to court to undermine public health response. They called COVID a hoax. They said the vaccine was deadly. They encouraged crazy people who came into hospitals with guns looking for the hoax.
Biden has fucked up many times, but the level of fuckery isn’t even close. Political realism vs actively trying to kill people for profit.
You can be mad, but don’t be fucking stupid.

2024-04-21 16:20:16

I have taken care of a few sexual assault victims over the years in the ER. Anyone who thinks that raped women should have to carry the rapist’s baby to term is a horrible human being with no ability to understand the feelings of others.
Republicans like Ms. Noem have repeatedly doubled down on abortion bans, saying that rape victims should have to carry their rapist’s baby to term, suffer through childbirth, and deal with all of the emotional, physical, and financial costs of that alone.