Source / episode info
- **Episode:**270
- **Title:**Divine Intervention Episode 270 – USMLE Step 2CK Rapid Review Series 43 (and upcoming 2CK Course 11/6-7).
- **Published:**2020-10-22
- Source:Episode page
One-liner
This episode provides high-yield rapid review on critical care emergencies, including differentiating heat stroke causes, managing malignant hypothermia (MH), distinguishing neuroleptic malignant syndrome (NMS) from serotonin syndrome (SS), and treating various hypertensive crises.
High-yield summary
- Heat Stroke Management: For physical exertion-related heat stroke, use ice water immersion. For drug/medication-induced heat stroke (e.g., acetaminophen overdose, sympathomimetics), use evaporative cooling mechanisms (fans).
- Malignant Hypothermia (MH): This is an autosomal dominant disorder caused by mutations in the ryanodine receptor (a calcium channel) that triggers during exposure to volatile anesthetics or succinylcholine. Treatment involves stopping the trigger and administering dantrolene.
- NMS vs SS: NMS is associated with dopamine blockers, decreased deep tendon reflexes (DTRs), and no myoclonus. Serotonin Syndrome (SS) is caused by multiple serotonergic agents, and is characterized by increased DTRs and myoclonus.
- Hypertensive Emergencies: In the setting of MAOI use and tyramine ingestion, administer a reversible, non-selective alpha blocker like phentolamine. For CCF exacerbation, nitrates (e.g., nitroglycerin) are preferred vasodilators.
- Myoglobinuria/Rhabdomyolysis: If urine shows 4+ blood but few red blood cells per high power field, suspect myoglobinuria, which can cause acute tubular necrosis (ATN).
Learning objectives
- Differentiate the clinical presentation and management of various hyperthermic emergencies (heat stroke).
- Identify the triggers and first-line antidotes for malignant hypothermia.
- Distinguish between neuroleptic malignant syndrome, serotonin syndrome, and other causes of altered mental status/rigidity.
- Select appropriate antihypertensive agents based on the clinical setting (e.g., pregnancy, CCF exacerbation).
- Interpret abnormal urine findings suggestive of myoglobinuria or albuminocytologic dissociation.
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