Coming Soon: Invictus.Reviews

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We reframe “drowning” as submersion incidents and lay out a simple path from shore to safe disposition. Hypoxia drives arrest, observation prevents misses, and ECMO has a clear role when ventilation fails or hypothermia persists.

• replacing drowning with submersion incidents
• hypoxia as the primary cause of arrest
• selective C‑spine precautions based on mechanism
• ECMO for refractory hypoxemia or hypothermia
• normal chest X‑ray can mislead after aspiration
• strict four to six hour observation window
• discharge only if fully asymptomatic with normal vitals and exam
• admit for any symptoms, abnormal gases, dysrhythmia, or abnormal imaging
• use NIV for symptomatic, alert patients; intubate if needed
• avoid steroids and routine antibiotics; exception for sewage exposure
• active rewarming as a core treatment step
• board strategy: read stems literally and match management to symptoms

Our oral board review course is going to be out soon, like really soon. The written board review will be delayed until early next year; we’ll restart a new and better podcast with more people in the Invictus part of things—stay tuned.

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Dr. 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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Updates 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 ingestions

Visit invictusreviews.com to learn about our expanding medical education resources and upcoming course offerings.