Invictus Reviews

IVIG, The Pitt, and Invictus Updates

• Mel Herbert

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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.


Speaker 1:

Hey party people. It's time for some updates. So when we left, I think I'd gone to Kenya, had a great time there, saw a lot of patients, learned a lot of stuff. Amazing clinicians over there in East Africa amazing. A couple of things here on the list of things to talk about. First of all, the pit. Are you watching the pit? You should be watching the pit. It's the best representation of emergency medicine that there has ever been. It is incredibly realistic. It is so good. It is also very triggering. So be careful if you're watching the Pit, particularly if you're a seasoned doc. It's going to bring up stuff about COVID and just the stress of the job. But it is incredible accurate representation. I am very proud of it.

Speaker 1:

We at MRAP are official collaborators and I now, foolish, am taking up a much bigger role there in the writer's room doing all the medical stuff with Joe Sachs, who was probably one of the most underrated emergency physicians ever. He was on ear, he's on the pit, he's one of the producers, he's one of the lead writers and he's what makes it so good in terms of the medicine. Amazing. Now I'm going to be there to help Joe out. He was actually my attending at UCLA 30 plus years ago. He's a board certified residency trained ER doc. Go Joe, you're doing an amazing job. Next thing is the match. The match this year saw I think it was 97.9% of ER spots were taken, which is really great, because a couple of years ago it got down to 80%. It was crazy Because of COVID, because of a lot of factors, it wasn't looking great. Traditionally, emergency medicine has been very competitive in the 98 to 99% range. We seem to be back at that level and I'm very excited about that. That's really important.

Speaker 1:

So let's do a quick case and then I want to talk about some other things as well. So when we were in Africa, we saw a gentleman mid-30s who'd had measles who now presented with some weakness and that weakness initially was in his legs but then was in his face and he had difficulty phonating. And I'm wondering what you think might be going on here. We've talked about it. We've talked about Hero and Victus, we've done a couple of these. We're going to move on from this because you know it's time to do other stuff. But he had a case of Guillain-Barre and probably had some mixture of traditional Guillain-Barre because he had this ascending paralysis, but he also had facial weakness, so some of the Mellifisher variant that was going on there as well.

Speaker 1:

One of the things it brought up is how do we treat this? And the treatment is IVIG. Well, that's one of the treatments, ivig. And it sort of brought up the question of what are the other indications for IVIG. We actually didn't use IVIG because in Kenya it's incredibly expensive and we worked out that would be the equivalent of about a thousand inpatient days for the hospital. So we just treated him symptomatically and at last we checked on him. He actually was getting better.

Speaker 1:

But IBIG do you know the indications for IBIG? This will come up in a series of questions. So just some of the big ones I think are Guillain-Barre is a big one, itp, kawasaki disease. It can be used in optic neuritis. Necfas is an interesting one. So it is actually indicated in NECFAS. If you think it's that pure strep, a form that can be difficult to work out and probably doesn't work in the sort of a mixed microbial form. But if you've got that pure strip, a form classically that would be a young person without immune suppression who's developed neck fast, ivig might be useful there. How does IVIG work? I don't know. It comes from theoretically healthy people. It has lots of antibodies and it does some stuff with immune modulation and other things, but when I read about how it works, I think that most people don't actually know. But remember some of these classic indications for IVIG.

Speaker 1:

And then the other thing I should say is CorP is the textbook that we're going to be using for Invictus. It is an incredible textbook and it's revised constantly. We've got the pharma chapters. We're now developing this AI search, which is amazing, so that's where we're getting the information from. And one of the things we're doing before we release this Invictus thing to the world, which hopefully is going to happen by the late summer, is that I'm creating a bunch of QBank questions, like hundreds, probably thousands of them, and these QBank questions are really to help you remember stuff, less than trying to be exactly like the exam. There are other people that do that very well but these questions are going to be really useful for getting you up to speed with the knowledge, because what you should be doing is you should be reading Excellent, watching and listening Excellent, doing lots of questions Excellent and that will help you consolidate all this knowledge, and we're going to have a series of study guides to help you get through the exam.

Speaker 1:

The other thing I should say is that we're also developing for the new oral exam, which is producing a lot of anxiety for a lot of people. So there's a new oral exam coming and it's very different from the old exam and we are already got a massive people together and we're going to be shooting that soon in the studio and hope to release it also later in the summer so that you'll have this really great overview of what to expect for that exam and how to do it and lots of cases. All right, that's probably enough for now. Next time I join you, let's do some q bank questions and you can also email the link down below and, uh, give us any stuff you want us to cover. We've been doing sort of rashes and chicken pox and measles and all this stuff. I want to move on and do some other stuff soon, all right?