YouTube Link

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.

YouTube Link

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.

YouTube Link

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.