Rupinder (Rup) Sahsi, MD 🧠💭

@hotsahs

👨‍⚕️ 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?

4.652 Folgt6.108 Follower937 Posts

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Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· 26d

... it recovered, bounced over to a nearby deck chair, then flew off into the trees.

Bird chilling on a deck chair before flying off.

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· 26d

... but with a quiet cardboard box and a bit of time...

Less covered cardboard box, containing one spooked bird.

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· 26d

Took off the frame and found this little bird with its wing pinned. Juvenile Starling?

A juvenile looking bird with its left wing caught in the metal frame of the fireplace grate.

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· 26d

Intermittent fluttering audible from the fireplace. Cat taking an interest. Moved some furniture to find what looked like feather fluff on the adjacent tile.

Grey underfeather fluffs on black tile next to the fireplace. Uh-oh.

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· 27d

Our home air filtration arsenal is doing a pretty good job of keeping up as the outdoor particle count rises, but the VOC levels are still up.

Graph of PM2.5 concentration indoors (Awair, blue) and outdoors (yellow) today.

VOC levels today, inside and outside. Note the units are different.

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· 27d

A reminder that air filtration doesn't need to be fancy or expensive. #onstorm The clean air delivery rate (CADR) of a box fan filter or full Corsi-Rosenthal box is kinda impressive. cleanaircrew.org/box-fan-filt...

Single-filter single-box-fan DIY air cleaner design.

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· 27d

Armwaving AI generated estimates of what to expect inside if the outdoor PM2.5 level is 300mcg/m3. I don't consider our house "clean room" grade, but if we're hovering around 15-20 right now, I guess our investment in air filtration is paying off.

ChatGPT estimates of the kind of indoor PM2.5 levels to expect under various household conditions when the outdoor level is around 300mcg/m3.

Windows open / very leaky home: 240–300+ µg/m³

Closed, leaky home without filtration: 180–250 µg/m³

Average closed home without filtration: 165–180 µg/m³

Tighter home with good HVAC filtration: 90–150 µg/m³

Properly sized HEPA purifier: 50–120 µg/m³

Well-sealed clean room with strong HEPA: potentially <50 µg/m³

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· 27d

Here. I zoomed in on the indoor curve for you.

Isolated the PM2.5 curve for my indoor air quality monitoring. The screamingly high levels outside are affecting the inside, but our filtration is doing what it can to keep up.

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· 27d

Here's our current PM2.5 data starting at 6am this morning. Even with fairly aggressive filtration of our indoor air, you can see the outside conditions (yellow) are starting to pull up the (blue) indoor curve. #onstorm #smoke

Currently the PM2.5 inside is at 17mcg/m3, but outside it's more like 300mcg/m3 and climbing.

15 is the Canadian indoor residential average (non-smoking households). The Indoor Air Hygiene Institute recommends it stay below 12 with no spikes above 35.

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· 27d

Currently the worst air quality in the world. The. World.

IQAir air quality rankings. Sorry, Ontario, but higher and redder is worse, worse, worse.

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· 27d

I went inside for an hour and I swear it was darker outside when I came back out. Looking north on King, Uptown Waterloo. #DLWS #onwx #onstorm #smoke #nofilter

Orange haze settling on King St. in Waterloo, Ontario. July 15th, 2026 #nofilter

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· Apr 1

Let's go!

Artemis II crew about to embark on the ride to the launch pad.

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· Mar 14

Hmm. (I drive an EV, so I had to look it up)

Gasbuddy graph of average Canadian (blue line) and Ontario (red line) gasoline prices in Canadian cents per litre, with abrupt increase starting at the beginning of March.

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· Dec 27

Wheeee! #yarbo

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· Nov 10

"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.

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· Oct 21

"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.

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· Oct 21

"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.

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· Oct 7

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.

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· Oct 7

"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

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· Oct 7

"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

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· Oct 7

"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

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· Sep 22

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.

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· Sep 22

Hrm.

Plot of the rate of ascent of SARS-CoV-2 detections over the last three weeks (Canada).

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· Sep 22

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.

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· Jul 24

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).

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· Jun 28

It's sparky outside. #onstorm #cbridge #watreg #dlws @instantweather.bsky.social

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· Jun 27

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

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· May 31

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.

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· May 17

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.

Rupinder (Rup) Sahsi, MD 🧠💭@hotsahs· May 9

'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