If you think no one is getting rich off of ivermectin, definitely don't watch this video from FLCCC founder Dr. Fred Wagshul.
For just $276 (cash only, no insurance), this quack will prescribe ivermectin "no questions asked." Don't worry he's got "plenty of product."
Yikes! 1/
His website makes it really clear.
You just fill out this form (including your SSN) and send it to a not at all sketchy gmail address.
Then you pay $211 for a 3 minute phone call and get your prescription. Plus $75 for a followup. Then $75 recurring every 6 months. 2/
There are quite a few 🚩 on this website.
Aside from referring to $276 telehealth prescriptions for ivermectin as "preventive maintenance" this pulmonologist is also apparently an expert in... interstitial cystitis?
So pulm and urology under one roof. Not at all sketchy. 3/
Also apparently you can get treatment for "overgrowth of normal flora" that doesn't "for most people" doesn't cause any urinary symptoms... sounds like this pulmonary clinic is totally on the up and up.
Just ask all these people hanging out on the beach... in Ohio? 4/
But despite weirdly effusive testimonials all over the website... definitely don't ask his clients what they think. 5/
The testimonials on the website (also a big 🚩btw) also suggest quackery:
- patients placed on long standing antibiotics to treat chronic infections
- another person who was “rushed to the hospital and put on an exfoliating mask” 6/
Bottom line: sketchy organization (FLCCC) referring patients to a very sketchy doc’s (Washgul) $276 ivermectin teleHealth pill mill.
7/7
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Did he have a head CT? What did it show?
Did he have stitches? Tetanus shot?
The NYT ran nonstop stories about Biden’s health after the debate but can’t be bothered to report on the health of someone who was literally shot in the head?
To the people in the replies who say it’s impossible because of “HIPPA” 1. I assume you mean HIPAA 2. A normal presidential candidate would allow his doctors to release the info. This is exactly what happened when Reagan survived an assassination attempt. washingtonpost.com/obituaries/202…
My advice to journalists is to lookup tangential gunshot wounds (TGSW).
Ask questions like:
- what imaging has he had?
- what cognitive assessments?
- has he seen a neurosurgeon or neurologist?
- he’s previously had symptoms like slurred speech, abnormal gait - are these worse?
If you intubate you need to read the #PREOXI trial!
-n=1301 people requiring intubation in ED/ ICU were randomized to preoxygenation with oxygen mask vs non-invasive ventilation (NIV)
-NIV HALVED the risk of hypoxemia: 9 vs 18%
-NIV reduced mortality: 0.2% vs 1.1%
#CCR24
🧵 1/
Hypoxemia (SpO2 <85%) occurs in 10-20% of ED & ICU intubations.
1-2% of intubations performed in ED/ICU result in cardiac arrest!
This is an exceptionally dangerous procedure and preoxygenation is essential to keep patients safe.
But what’s the *BEST* way to preoxygenate? 2/
Most people use a non-rebreather oxygen mask, but because of its loose fit it often delivers much less than 100% FiO2.
NIV (“BiPAP”) delivers a higher FiO2 because of its tight fit. It also delivers PEEP & achieves a higher mean airway pressure which is theoretically helpful! 3/
Results from #PROTECTION presented #CCR24 & published @NEJM.
- DB RCT of amino acid infusion vs placebo in n=3511 people undergoing cardiac surgery w/ bypass.
- Reduced incidence of AKI (26.9% vs 31.7% NNT=20) & need for RRT (1.4% vs 1.9% NNT=200)
Potential game changer!
🧵 1/
I work in a busy CVICU & I often see AKI following cardiac surgery.
Despite risk stratification & hemodynamic optimization, AKI remains one of the most common complications after cardiac surgery with bypass.
Even a modest reduction in AKI/CRRT would be great for my patients. 2/
During cardiac surgery w/ bypass, renal blood flow (RBF) is reduced dramatically. This causes injury, especially in susceptible individuals.
But what if we could use physiology to protect the kidneys?
Renal blood vessels dilate after a high protein meal increasing RBF & GFR! 3/
77 yo with respiratory distress, RR 30, SpO2 80% on non-rebreather at 15 lpm
CXR & TTE are unrevealing
pH 7.58 / PaCO2 24 / PaO2 >500 / HCO3 22
MetHb 0% CarboxyHb 0%
The ABG looks like this:
The answer is sulfhemoglobinemia.
Sulfhemoglobinemia is a *permanently* modified hemoglobin associated with exposure to TMP/SMX, dapsone, phenazopyridine, & other amino & nitro compounds.
It has an altered oxy-hemoglobin dissociation curve.
2/
Sulfhemoglobinemia is easily confused with methemoglobinemia. Both have very dark colored blood & present with cyanosis. Diagnosis typically requires a specialized lab.
Spoiler: you may have heard that SulfHb is green. It isn’t really. You’re thinking of Vulcans’ blood.