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Nitin Arora Profile picture
@aroradrn
Aug 10, 2020 • 3 tweets • 2 min read • Read on X
Very interesting insight into the low numbers of #COVID19 deaths in India

TL:DR
Only ~18% of deaths in India have a Medical Certificate for Cause of Death (MCCD)

So official numbers perhaps need to be multiplied by 5.

The seen and the unseen? @b50?

#iceberg

1/3 Image
Also worth reading

science.thewire.in/health/india-m…

2/3
I definitely remember never completing/seeing MCCD during my time in India. Would confirm death and give a certificate with date & time
No cause

Maybe the program just hadn’t made it my small town in Punjab

I’ve just learned that the program officially started in 1990.

3/3

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More from @aroradrn

Nitin Arora Profile picture
Jan 7, 2021
I’m going to tag this as a little tutorial for @MichaelYeadon3 who keeps saying that there’s no problem from the suppliers of medical ‘gasses’

Most hospitals in the U.K. run their O2 supply from a Vacuum Insulated Evaporator (VIE)

frca.co.uk/article.aspx?a…

1/n
This VIE is essentially a large thermos flask/ vacuum insulated cylinder at -180C
O2 is supplied from (typically) BOC in liquid form; when required, allowed to evaporate into gas, & supplied to hospital outlets.

Most hospitals have a VIE big enough to meet their needs

2/n
The problem is the pipes

Most ~12 bed ICUs have pipes that allow ~400L/min flow

This is Ok because most ventilators don’t use >20l/min; giving useful buffer capacity

Modern non invasive ventilation systems- CPAP, NIV, and High flow nasal Oxygen (HFNO), however, need more
3/n
Read 11 tweets
Nitin Arora Profile picture
Jan 5, 2021
This may sound gruesome to many

But last night, I read the ‘drowning rats experiment’

Rats were put in water. They normally swim well. So the surprise was they seemed to drown quickly. Image
Then the researcher reflected: perhaps there was an imponderable here.

If you think there’s no solution, fight or flight is not an option. So you give up. Image
Then, you think again, when con fronted with ‘HOPE’ these rats kept swimming for hours - 100x more than in the first set. Image
Read 4 tweets
Nitin Arora Profile picture
Oct 30, 2020
Anyone else irritated by the fact that the useful but dull stuff seems to get very little attention

New ICU Trainees want to know about how to manage refractory hypoxia, ventilator settings for asthma

Not relevant for anyone that’s not going to make icu a career

1/n
What almost every Dr working in hospital needs to know about is

Types of O2 delivery devices, limitations, variable vs fixed performance

In the last year, I’ve kept some numbers, and 86% had never heard of Peak Inspiratory Flow Rate. Which is not their fault, obv

2/n
For anyone that’s a medical trainee, they need to properly understand NIV and CPAP

Indications, evidence base, but also how to set it up.

3/n
Read 6 tweets
Nitin Arora Profile picture
Oct 11, 2020
I saw him first on my evening rounds.
A tall, strong man around 60, He’d just come back from major bowel surgery

An epidural top-up helped with pain, and put a smile on his face, and his wife’s

They were very pleased at the lack of a colostomy too

Thread...

1/n
Around 2AM, he went wild.

Trying to pull out lines, hit nurses, run away

Screaming we were going to catch him, kill him and he wanted to go home

He was a danger to himself- was on strong medication to keep his blood pressure up, and had lines and drains

2/n
Took 4 people to hold him down so he could have sedation

ICU delirium is unfortunately very common, and we don’t always know what causes it. However, some risk factors are known- sedation, sleep disturbance, noise, being unwell, bright lights at night, etc.

3/n
Read 8 tweets
Nitin Arora Profile picture
Sep 26, 2020
Today I’m going to talk about something uncomfortable

Do you have friends or colleagues who don’t have children?

Here’s some things not to say

Thread...

1/n
When are you going to start a family?

We are a family... and it’s none of your business

Family ≠ children

2/n
How old are your kids?
Do you have kids?

Believe me: if someone has kids, they’ll tell you within 15 min. If they haven’t said anything: stay out of it.

3/n
Read 10 tweets
Nitin Arora Profile picture
Sep 7, 2020
This is my day of being horrified

Having lived out of India for ~15 years, I had no idea this wasn’t crime fiction

But it seems it’s true!

Read on about ‘Narco-Analysis’ and role of Drs in judicial process

1/n
The World Medical Association says Drs should not be involved in judicial executions

This is probably why we see so many reports of execution by injection going wrong in 🇺🇸

2/ Image
However, from talking to friends, and documentary evidence, it seems Drs are required to be present at execution by hanging in India.

@IMAIndiaOrg doesn’t like this.

qrius.com/ima-role-docto…

3/n Image
Read 11 tweets

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