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Dr. Mel Herbert provides a crucial update on the Invictus Board Review program alongside critical pearls for identifying and managing deadly necrotizing infections. These rapidly progressing infections require immediate recognition, prompt treatment, and surgical intervention to prevent death from these tissue-destroying processes.

• Necrotizing infections include necrotizing fasciitis, Fournier's gangrene, Ludwig's angina, and malignant otitis externa
• Key warning signs include pain out of proportion to physical findings, rapidly progressive spread, dishwater discharge, and woody edema
• "La belle indifference" describes patients who appear strangely calm despite severe infection
• Polymicrobial infections often start as normal infections before turning necrotizing days later
• Monomicrobial forms (often Strep A) progress extremely rapidly in otherwise healthy individuals
• Seawater exposures can introduce deadly Clostridium or Vibrio species through minor skin breaks
• Treatment priorities: rapid diagnosis, fluid resuscitation, antimicrobials, and immediate surgical debridement

The full Invictus Board Review program and OSCE preparation materials will be available soon to address declining emergency medicine board exam pass rates and provide continuous education for practicing clinicians.