Invictus Reviews

Submersion, Event! and End of the Pod (for now)


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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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Invictus ReviewsBy Mel Herbert

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