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Titre
Date
Durée
The Pain of Pericarditis and more
07 Dec 2024
00:06:35
In this episode Mel reviews the positional pain of pericarditis, the leads you DON'T get ST segment elevation and a few more pearls. Invictus Reviews coming soon, next year :)
In the meantime check our our EM and UC education at EMRAP.org
Introduction to the Program
04 Dec 2024
00:06:52
Mel Herbert introduces the new coming soon Invictus Reviews board review platform. More than just another board review course this is a living breathing ongoing project that you will all want to be part of. From the people that brought you EM:RAP, CorePendium, UCMax and some of the most transformative programs in all of medicine.
Pericarditis ECG changes and Shape
12 Dec 2024
00:05:00
Mel goes over the classic ECG ST changes of pericarditis and where they DON'T occur. Also a little talk on morphology, watch the youtube video here.
Test Taking Prep and Skills!
20 Dec 2024
00:29:07
This is a classic lecture by Billy Mallon. How to prepare for exams but MORE importantly how to understand multiple choice questions and the all important foils. This is NOT to be missed content from the master of the game himself.
Guillain-Barré syndrome - Part 1
24 Dec 2024
00:07:41
This will be a short series - you need to know the "foils" go back and listen to the Billy Mallon lecture on how to take the test. We are going to cover the foils so you can CRUSH the exam.
Mastering Medical Board Exams: Strategies and Techniques
13 Jan 2025
00:20:36
Discover the secrets behind mastering medical board exams with Mac Brown, a core faculty member at John Peter Smith Emergency Department. We promise you'll come away with innovative strategies that maximize your limited study time without sacrificing your well-being. Mac introduces his unique "candle making method," a study technique that focuses on building a solid foundation through consistent, small study sessions tailored to your individual learning style. Whether you're a fan of podcasts or prefer question banks, Mac's insights will help you integrate these tools into your routine, making exam preparation a seamless part of your daily life.
In an era where medical exams are shifting toward simulation-based assessments, Mac guides you through advanced techniques to tackle these stress-inducing formats. Learn how to identify and fill knowledge gaps, enhance memorization of critical medical topics, and maintain a balance between study and self-care. As your career hinges on high exam scores, especially in high-pressure roles like those in emergency departments, these strategies become crucial. Join us to glean practical advice and innovative tools that ensure not just passing, but excelling in your medical board exams.
Myasthenia Gravis: Unraveling the Complexities and Crises
20 Jan 2025
00:08:33
A New Era of Board Exam Preparation Awaits and "The Pitt"
21 Jan 2025
00:05:27
This episode explores the intersections of emergency medicine and media representation, highlighting the successes of 'The Pit' and the new Invictus board review initiative. We discuss the importance of medical accuracy in shows, the decline in board exam scores, and the vital role of ongoing education.
• Effect of 'The Pitt' on public perception of emergency medicine • Collaboration between medical experts and writers for accuracy • Discussion on the real stories behind emergency care • Introduction to the Invictus initiative for board exam prep • Focus on continuous feedback and adaptation in education • Strategies for addressing declining board exam scores
Vesicular, Bullous and Sloughing Rashes - A call for feedback
30 Jan 2025
00:35:48
Ok - this is a simple one - a great talk with a link to YouTube - we need your feedback. Go watch the lecture and give you you feedback here on on the YouTube channel please :). Feedback can also go to: mel@emrap.org
Eaton-Lambert syndrome presents a unique clinical challenge, especially when linked to underlying malignancies. In this episode, we delve into the connections between muscle weakness, potential cancer diagnoses, and the importance of early recognition in enhancing patient care. • Case study of a 60-year-old man with muscle weakness highlights critical symptoms • Discussion of differential diagnosis for bulbar muscle weakness • Detailed explanation of Eaton-Lambert syndrome and its association with small cell carcinoma • Examination of pathophysiology involving autoimmune responses • Overview of treatment options focused on addressing underlying conditions • Historical context provided about the original researchers, Eaton and Lambert • Promotion of "The Pit" show highlighting authentic emergency medicine scenarios
Pediatric emergency medicine is highlighted through a detailed discussion on torus fractures, their management, and the implications for treatment approaches. Ilene Claudius provides valuable insights into pediatric care, emphasizing the importance of community feedback and ongoing education for healthcare professionals.
• Ilene Claudius is our expert • Overview of torus fractures and typical causes related to childhood injuries • New evidence on treating torus fractures with minimal intervention • The role of removable splints in pediatric fracture management • Feedback from listeners shapes future podcast content • Discussion of a potential subscription-based educational model • Exciting future projects and upcoming announcements in pediatric care
Travel Pause and Some Updates
13 Feb 2025
00:02:02
Quick note on a travel pause then we will be back at it!
Measles and chickenpox are often confused despite having significant differences in symptoms, severity, and treatment options. We break down the key distinctions between these two infectious diseases, highlighting why measles is significantly more dangerous and why vaccination remains critical for public health.
• Measles starts on head and neck, spreads downward through the body • Measles is highly contagious with an R0 of 18, spreading through respiratory droplets • Patients are infectious for four days before and after rash appears • Serious complications include pneumonia, encephalitis, and potentially fatal SSPE years later • No specific treatment exists for measles beyond supportive care • Chickenpox presents as vesicular lesions, commonly on face, chest and back • Chickenpox is less severe with lower mortality rates than measles • Antiviral treatments like acyclovir are effective for high-risk chickenpox patients • Herpesvirus nature of chickenpox means it can reactivate later as shingles (zoster) • Vaccination has reduced global measles deaths from millions to about 100,000 annually • Current Texas outbreak has already caused two deaths among unvaccinated individuals
Vaccination saves lives. The diseases we prevent are far worse than unfounded concerns about vaccine safety.
Necrotizing soft tissue infections demand immediate recognition and aggressive treatment to prevent devastating outcomes and death. Dr. Mellick reviews critical diagnostic features, treatment protocols, and exam-relevant information about these life-threatening conditions through a series of board-style questions.
• Necrotizing infections in IV drug users present with severe pain, woody edema, and require immediate surgical exploration • Hemorrhagic bullae and crepitus are "hard findings" strongly suggesting necrotizing fasciitis • Clindamycin plus broad spectrum antibiotics are essential to reduce toxin production and address polymicrobial nature • CT scan offers the best combination of sensitivity and availability for diagnosing necrotizing infections • Specific pathogens like Vibrio vulnificus should be considered in patients with exposure to coastal waters • Risk factors include immunocompromise, diabetes, cirrhosis, and injection drug use • Early surgical consultation and intervention are more important than waiting for imaging results
If you're triggered or experiencing PTSD from medical content, please seek help - modern therapies including ketamine can be effective treatment options.
We share exciting updates from our clinical experiences in Kenya and celebrate the authentic portrayal of emergency medicine in the television show "The Pit," which features emergency physician Joe Sachs as a key writer and producer.
• Emergency medicine residency match rates have recovered to 97.9%, approaching the traditional 98-99% fill rate after dropping to 80% during COVID • A case study from Kenya featuring a patient with Guillain-Barré syndrome following measles demonstrates the challenges of global medicine • IVIG therapy indications include Guillain-Barré syndrome, ITP, Kawasaki disease, optic neuritis, and some cases of necrotizing fasciitis • Cost barriers in resource-limited settings often necessitate alternative treatment approaches - the IVIG for this one patient would have cost the equivalent of 1,000 inpatient days • Upcoming Invictus study resources include comprehensive text materials, AI-powered search capability, and thousands of QBank questions • New preparation tools for the revised oral board examination format are being developed to address candidate anxiety
Email us with topics you'd like us to cover in upcoming episodes as we move beyond recent discussions of rashes, chickenpox, and measles.
We explore the clinical management of foodborne and waterborne illnesses, focusing on key differences between viral and bacterial causes that determine treatment approaches. Understanding when to use supportive care versus antimicrobial therapy helps clinicians provide appropriate management for this common presentation.
• The vast majority of diarrheal illnesses are viral, self-limited, and need no testing or treatment beyond oral rehydration • Oral rehydration solutions are preferred over sports drinks, which can worsen diarrhea unless diluted • Homemade solution can be made with half teaspoon salt, six teaspoons sugar, and one liter of water • Anti-motility agents like loperamide should be avoided in children under two and patients with bloody diarrhea • Bloody diarrhea with fever (dysentery syndrome) typically indicates bacterial causes like Salmonella, Shigella, E. coli O157:H7, or Campylobacter • Azithromycin is now preferred over fluoroquinolones for treating bacterial diarrhea due to less resistance • Antimicrobials should be avoided in children with suspected E. coli O157:H7 due to risk of hemolytic uremic syndrome
Watch for more detailed content on managing diarrheal illnesses in high-risk groups coming soon to the pit.
Scott Weingart discusses his journey into physician executive coaching, focusing on helping emergency medicine physicians overcome burnout through mindset shifts and practical skills development.
• Burnout often stems from inner voice negativity that physicians mistake as their core identity • Cognitive distancing teaches docs to separate unhelpful thoughts from themselves • Stoic philosophy helps physicians accept unchangeable situations while finding meaningful challenges • Communication techniques like nonviolent communication transform difficult consultant interactions • "Fundies" (fundamentals) include maintaining basic physical needs during shifts • Optimal pace is sustainable rather than superhuman, like a marathoner not a sprinter • Sleep optimization requires avoiding alcohol after 5 pm and limiting caffeine • Lifelong mastery and continued learning provide meaning and purpose • Group coaching costs around $3000 for 12 sessions over 24 weeks • Meditation practice is "the game changer" for emergency medicine physicians
The work matters and we need to help people stay in the game. If we can't fix the system yet, we need to focus on how to maintain ourselves within it.
How to Never Miss an Elbow Fracture Again: A Radiographic Roadmap
We explore the essential techniques for accurately interpreting elbow X-rays, focusing on key lines, fat pad signs, and common fracture patterns that help reveal hidden injuries.
• Standard elbow series includes AP, lateral, and oblique views, with the lateral being the most critical "money shot" • Two essential lines to draw: anterior humeral line (should pass through middle third of capitellum) and radiocapitellar line (should bisect the capitellum) • Fat pad signs are crucial indicators – posterior fat pads are NEVER normal and always indicate pathology • Pediatric injuries typically involve supracondylar fractures (60% of all pediatric elbow fractures) • Adult injuries commonly involve radial head fractures, with 20-40% showing only fat pad signs initially • Always check and document neurovascular status before and after any intervention • Displaced or comminuted fractures require urgent orthopedic consultation • Simple non-displaced fractures can be splinted with outpatient orthopedic follow-up
Check out the complete lecture and more educational content coming soon to the Invictus Board Review site.
Britt 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 reasoning
Check out the full video version with visuals on YouTube - link in the show notes.
We 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 regions
The full Invictus program is coming soon with continuous updates, comprehensive videos, MCQs, and resources to support physicians throughout their careers.
Understanding Pneumomediastinum: When Air Escapes into Potential Spaces
The Invictus curriculum continues to expand with new lectures, emphasized content, transcripts, and multiple-choice questions, with Matt Delaney now helping with development. We explore pneumomediastinum and pneumopericardium through a simple balloon analogy: two lungs squishing around the heart where air can leak into potential spaces, sometimes tracking into the neck or even dissecting into the pericardium.
• Invictus curriculum growing with new features and comprehensive content for residents • Continuous board review is valuable throughout a medical career • Pneumomediastinum occurs when air leaks into the mediastinum from lungs, esophagus, or trachea • Air can track into subcutaneous tissues or dissect into the pericardium • Most pneumomediastinum cases need no treatment and resolve spontaneously • Tension pneumomediastinum or pneumopericardium may require intervention • Pneumopericardium can cause tamponade requiring drainage • Chris Riley demonstrates varying examples of pneumomediastinum on chest x-rays
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 monitoring
Join us for our upcoming Encore program focused on preparation for the new oral exam, followed by our comprehensive Invictus board review course.
Staph 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 care
Stay 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.
Tracheostomy 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 stoma
Visit 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.
Status 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 syndrome
Season 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.