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.
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A kid with a rash, again :)
YouTube LinkStaph Scalded Skin Syndrome presents with terrifying skin desquamation but typically heals without scarring within two weeks. This case demonstrates the classic presentation in a three-year-old child with recent URI, highlighting the typical appearance, clinical course, and management principles.• Staph Scalded Skin Syndrome results from staphylococcal toxins that cleave the epidermis• Most common in young children, often following upper respiratory infections• No mucosal involvement - key differentiating factor from Stevens-Johnson Syndrome• Treatment includes anti-staphylococcal antibiotics and supportive care• Colonization site may be difficult to identify, often in nares or umbilical region• Adults with renal disease are at higher risk due to impaired toxin clearance• Requires burn-like supportive care for temperature regulation and prevention of secondary infections• Historically had 5% mortality, likely lower with modern intensive careStay tuned for our upcoming comprehensive Immunism Medicine Boards preparation resources, featuring videos, questions, summaries, and study guides designed to help you excel on your exam.
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A fever and a Rash
YouTube LinkTry and guess before reading the summary.Stevens-Johnson Syndrome presents a critical dermatological emergency characterized by mucosal lesions and diffuse rash with high mortality if untreated. Recognizing this condition requires understanding its presentation, pathophysiology, and immediate management strategies to improve patient outcomes.• Case presentation of 20-year-old female with fever, mucosal lesions, and diffuse rash• Mucosal involvement is the key diagnostic feature of Stevens-Johnson syndrome• Common triggers include sulfa drugs, anti-epileptics, NSAIDs, and infections like mycoplasma• Positive Nikolsky sign where skin cleaves and sloughs off when pressed• SJS affects less than 10% of body surface area while TEN involves more than 30%• Treatment includes supportive care, fluids, nutrition, and controversial steroids• IVIG, plasmapheresis, and TNF blockers may be beneficial treatment options• Approach treatment similar to severe burns with non-adherent dressings• Secondary infections may require antimicrobials, but not as initial treatment• Eye involvement requires artificial tears and careful monitoringJoin us for our upcoming Encore program focused on preparation for the new oral exam, followed by our comprehensive Invictus board review course.
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Navigating Pregnancy Complications: A Sneak Peek
YouTube LinkBritt Guest's lecture on pregnancy complications with expert emphasis from Matt Delaney. This preview focuses on differentiating normal pregnancy nausea from hyperemesis gravidarum while demonstrating effective board exam question strategies.• Normal pregnancy nausea can be managed with pyridoxine (B6), doxalamine, ondansetron, ginger, and eating smaller frequent meals• Hyperemesis gravidarum causes severe dehydration, weight loss, vitamin deficiencies, and potential complications including Wernicke's encephalopathy• Severe vomiting can lead to mechanical complications like Mallory-Weiss tears, pneumomediastinum, and pneumothorax• Treatment escalation includes IV/IM medications and possibly steroids (with caution in first trimester)• Board-style questions demonstrate proper management of a dehydrated pregnant patient and recognition of molar pregnancy signs• Matt Delaney demonstrates how to work through unfamiliar terms on exams using clinical reasoningCheck out the full video version with visuals on YouTube - link in the show notes.
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Rubella In Question Form
Link to CXR Fundamentals Series on EM:RAPWe explore Rubella (German measles or three-day measles), a disease that remains clinically relevant despite being considered nearly eradicated in the US due to vaccination.• Congenital rubella syndrome can cause severe complications including cataracts, cardiac abnormalities, growth restriction, and hearing loss• Rubella typically presents with cephalocaudal rash, low-grade fever, and arthralgia • The disease is less severe than measles but still concerning for pregnant women• Written documentation of at least one MMR dose is sufficient evidence of immunity• PCR testing provides the most accurate diagnosis during acute infection• Isolation period is seven days after rash onset to prevent transmission• Rubella has a long 17-day incubation period with contagiousness spanning 7 days before and after rash• Droplet precautions are appropriate for hospitalized patients• Management of exposed pregnant women involves isolation and post-delivery vaccination• Global vaccination coverage varies significantly, with lower rates in low-income regionsThe full Invictus program is coming soon with continuous updates, comprehensive videos, MCQs, and resources to support physicians throughout their careers.
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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