YouTube LinkDr. Sean Nordt delivers a comprehensive pharmacology lecture on antidepressants, their mechanisms, and the management of toxicity cases in emergency settings. The board-certified emergency physician, pharmacologist, and toxicologist walks through the complex pharmacology of psychiatric medications, focusing on their potentially deadly complications and how to recognize and treat them.• Cyclic antidepressants cause toxicity through fast sodium channel blockade, leading to QRS widening and ventricular dysrhythmias• Sodium bicarbonate is the cornerstone treatment for cyclic antidepressant toxicity, working by increasing pH and altering cardiac binding• SSRIs and SNRIs have distinct adverse effect profiles, with SNRIs posing greater risk in overdose scenarios• Bupropion overdose commonly causes seizures and QRS widening through cardiac gap junction blockade• MAOIs can cause hypertensive crisis and severe serotonin syndrome, especially with tyramine-rich foods or drug interactions• Serotonin syndrome is characterized by hyperreflexia and clonus, distinguishing it from neuroleptic malignant syndrome• Treatment approaches differ for serotonin toxicity (benzodiazepines, cooling), NMS (supportive care), and malignant hyperthermia (dantrolene)• Antiemetics like metoclopramide and promethazine can cause extrapyramidal effects treatable with anticholinergics
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Household Poison Pearls
YouTube LinkUpdates on the Invictus medical review courses with "baby Invictus" for oral exams coming soon and a comprehensive border review course in development. Dr. Sean Nort shares vital insights on common household ingestions, challenging assumptions about what substances actually pose dangers to children.• Household bleach (3% sodium hypochlorite) ingestion typically requires only reassurance and discharge home• Industrial bleach is more concerning due to higher concentration• Most cosmetics, window cleaners, soaps and detergents have minimal toxicity• Laundry pods can cause more significant caustic burns and sometimes reduced consciousness• Silica gel packets are extremely safe despite "do not eat" warnings• Poison control centers are the best resource for managing potential ingestionsVisit invictusreviews.com to learn about our expanding medical education resources and upcoming course offerings.
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Necrotizing Infections For Exams
YouTube LinkDr. Mel Herbert provides a crucial update on the Invictus Board Review program alongside critical pearls for identifying and managing deadly necrotizing infections. These rapidly progressing infections require immediate recognition, prompt treatment, and surgical intervention to prevent death from these tissue-destroying processes.• Necrotizing infections include necrotizing fasciitis, Fournier's gangrene, Ludwig's angina, and malignant otitis externa• Key warning signs include pain out of proportion to physical findings, rapidly progressive spread, dishwater discharge, and woody edema• "La belle indifference" describes patients who appear strangely calm despite severe infection• Polymicrobial infections often start as normal infections before turning necrotizing days later• Monomicrobial forms (often Strep A) progress extremely rapidly in otherwise healthy individuals• Seawater exposures can introduce deadly Clostridium or Vibrio species through minor skin breaks• Treatment priorities: rapid diagnosis, fluid resuscitation, antimicrobials, and immediate surgical debridementThe full Invictus Board Review program and OSCE preparation materials will be available soon to address declining emergency medicine board exam pass rates and provide continuous education for practicing clinicians.
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Trach Emergencies
YouTube LinkTracheostomy and laryngectomy emergencies demand specific knowledge and immediate action to prevent devastating complications. Jess Mason delivers critical pearls on managing occluded, dislodged, and bleeding tracheostomies that are essential for both board exams and clinical practice.• Cuffed tracheostomies have a pilot balloon and are required for positive pressure ventilation• Uncuffed tracheostomies are more common in established patients but cannot be used with ventilators• Occluded tracheostomies should be managed with oxygen first, followed by suctioning and inner cannula cleaning• Dislodged tracheostomies require immediate replacement to prevent stomal narrowing• Bleeding tracheostomies may signal a tracheo-innominate artery fistula, especially with "sentinel bleeds"• Laryngectomies fundamentally differ from tracheostomies in that they have no communication between mouth/nose and lungs• You can ONLY manage a laryngectomy patient's airway through their stomaVisit us at Invictus for comprehensive board review resources that deliver continuous education through videos, audio, written summaries, question banks, and live events designed to help you maintain mastery of emergency medicine throughout your career.
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Pediatric Status Epilepticus: A Primer
YouTube LinkStatus epilepticus has been redefined from 30 minutes to just 5 minutes of continuous seizure activity, aligning better with current treatment approaches that emphasize early intervention. This includes recognizing non-convulsive status, which often presents as a prolonged postictal state with subtle eye movements or gaze deviation.• Systematic assessment includes history of seizures, medications, shunts, trauma, potential ingestions• Lab evaluation should include glucose, electrolytes, calcium, pregnancy testing when applicable• Initial treatment involves two doses of benzodiazepines via IV, rectal, buccal, or intranasal routes• Simplified dosing: midazolam/diazepam 0.2 mg/kg (max 10mg); lorazepam 0.1 mg/kg (max 4-5mg)• Second-line agents include levetiracetam (60 mg/kg), fosphenytoin (20 PE/kg), or valproate• For refractory status, consider ketamine, phenobarbital, or continuous infusions after intubation• Propofol is generally avoided in children under age 3 and carries risk of propofol infusion syndromeSeason two of "The Pit" is in production with writers writing, actors acting, and producers producing. It's scheduled for release in January of next year.
Get ready for something new in the board review universe! A free podcast featuring the legendary Mel Herbert and crew. We're diving into the essentials for crushing the Emergency Medicine board exams—whether you're just starting out or mastering the advanced stuff. Brought to you by the same brilliant minds behind EM:RAP, CorePendium, and UCMax. 🚀Coming soon to: Invictus.reviews
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