Your pneumonia patient is hypotensive, tachycardic, and not responding to fluids… what did you miss? It could be sepsis-induced cardiomyopathy, a common under-recognized shock state you could see at the bedside.

In this episode, Dr. Mahmoud Ibrahim MD and host Sarah Lorenzini use a case study to highlight how nurses, intensivists and the ICU team can work together to recognize the signs of sepsis-induced cardiomyopathy early and give patients a better chance at recovery. You'll learn the diagnostic clues that your patient’s heart is in trouble, how to approach controversial treatments like sodium bicarb, and what has to happen before intubation in a dual shock state.

Topics discussed in this episode:

• What the initial bedside assessment says about the patient
• Treatment priorities for the  intensivist and nurse
• Signs that point to more than just sepsis
• Why fluids aren’t always the answer
• Blood pressure management: vasopressors and inotropes
• Pathophysiology of sepsis-induced cardiomyopathy
• How a sepsis-induced cardiomyopathy diagnosis changes treatment
• The vasopressin debate for sepsis-induced cardiomyopathy
• Clues your intervention isn’t working and what to do next
• How to prepare the patient for high-risk intubation
• What you need to know about administering sodium bicarb
• Why collaboration matters at every step for patient recovery

Connect with Dr. Ibrahim:

Instagram: https://www.instagram.com/icuboy_meded/

Facebook: https://www.facebook.com/share/1Dg1ZTyfsN/

TikTok: https://www.tiktok.com/@icuboy_meded

Threads: https://www.threads.com/@icuboy_meded

X: https://x.com/icuboy_meded

Learn more about the different phenotypes in sepsis induced cardiomyopathy:

https://journal.chestnet.org/article/S0012-3692(25)05143-8/abstract

Mentioned in this episode:

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Every five years, resuscitation guidelines get a refresh. This year, a few have changed, many have stayed the same, and some are creating major controversy.

In this episode, Dr. Ashish Panchal, Chair of the AHA Emergency Cardiovascular Care Committee, helps us unpack what’s new, what might surprise you, and the science behind each decision. You'll learn why there’s serious debate around epinephrine dosing, what changes matter most for the bedside, and how these updates will change the way you and your team respond to the next code!

Topics discussed in this episode:

• The history and development of the AHA Resuscitation Guidelines
• Key improvements: algorithms, clear language, and unified care
• Big, fundamental changes in the guidelines
• How choking management guidelines have changed
• The recommended approach for synchronized cardioversion
• New guidelines for post-resuscitation care
• Why there’s controversy around mechanical CPR and DSD
• IV vs. IO access: best practice and key takeaways
• The controversy around epinephrine dosing
• What these changes mean for nurses and code teams

Listen to E140 with Dr. Ashish Panchal:

https://healthpodcastnetwork.com/episodes/rapid-response-rn/140-resuscitation-then-and-now-how-evidence-shapes-every-beat-with-guest-dr-ashish-panchal-md-phd/

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Differential diagnosis is part physiology, part detective work. Especially in heart failure, where similar vital signs can mean very different things.

In this episode, Natalie RN is back on the show to break down two pediatric cases that looked almost identical on arrival to the ED but their workups led to two very different treatment plans. She shares the assessment findings, diagnostics, and clinical clues that helped them uncover what was really going on.

Learn how to connect the dots and find the right intervention when presentations look identical!

Topics discussed in this episode:

• Presentation of two pediatric patients with similar symptoms
• Differential diagnosis and early clinical clues
• What to look for in your clinical assessment
• Pathophysiology of pulmonary hypertension
• Pathophysiology of dilated cardiomyopathy
• Key physical exam and diagnostic differences
• Dilated cardiomyopathy interventions
• Why it’s hard to diagnose pulmonary hypertension in the ER
• Nurse priorities when managing patients in the CVICU
• Managing pulmonary hypertension crises and reducing PVR
• Pearls and pitfalls of treating these conditions

Connect with Natalie:

https://www.instagram.com/chatwithnat_rn/

Listen to Chat with Nurse Nat on Spotify:

https://open.spotify.com/show/7Jh2qe44KipudVKkdXFwWH

Listen to Chat with Nurse Nat on Apple Podcasts:

https://podcasts.apple.com/us/podcast/chat-with-nurse-nat/id1815541418

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Every trauma nurse knows this feeling: your stable patient suddenly starts to decompensate and instinct tells you there’s more to the story. Today’s case starts with a stable, post-arrest patient and ends in a full-blown tension pneumothorax.

Hear why this patient went from stable to crashing in minutes, how delayed recognition changed the course of care, what diagnostics and assessments could have caught earlier. Trauma Pete breaks down the tell-tale signs, how it differs from a simple pneumothorax, and why it's so easy to miss in trauma patients.

In this episode, you’ll learn which patients are the most at risk, how to spot tension pneumothorax early, and why having a systematic approach to decompression make all the difference!

Topics discussed in this episode:

• Presentation of a stable, post-arrest patient
• The patient's rapid decline and first interventions
• Why they misread the signs of tension pneumothorax
• Pneumothorax in intubated vs. non-intubated patients
• The physiology of tension simple vs. tension pneumothorax
• Bedside clues and diagnostic signs of tension pneumothorax
• Early intervention and treatment priorities
• Emergent needle decompression: timing, technique, and follow-up
• Chest tube placement and management: tips, troubleshooting, and air leaks

Mentioned in this episode:

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Listen to the In The Heart of Care Podcast

https://link.cohostpodcasting.com/6598429e-e927-45b0-9b57-7dd34a09d803?d=seASyqjs7

This is one of those cases that tests you in every way as a nurse. A toddler is pulled out of a pool and rushed to the ER, unresponsive and deteriorating fast. Today, Nurse Amber walks us through the critical moments that followed and how this case inspired her to turn her grief into a positive resource for nurses.

We discuss what was going on at the alveolar level in this patient, the interventions Amber and her team performed, and the emotional aftermath of working on critical pediatric patients. You’ll learn what to prioritize, the signs of deterioration that can show hours after rescue, and how to recognize what Sarah calls the “inflammatory cascade of awfulness.”

This episode is an honest breakdown of both the science and humanity of drowning care. Don’t miss this story!

Topics discussed in this episode:

• Initial assessment of the patient
• First treatment priorities: ventilation, airway, and warming
• The pathophysiology of drowning
• Misconceptions about suctioning in drowning patients
• The nurse’s role: documentation and respiratory management
• Patient monitoring and signs of deterioration
• The emotional burden of pediatric fatalities
• How the Get Vitals app supports nurses’ mental health

Learn more about the Get Vitals app:

Website - www.getvitals.care

Instagram -@getvitalsnow

Mentioned in this episode:

Listen to the In The Heart of Care Podcast

https://link.cohostpodcasting.com/6598429e-e927-45b0-9b57-7dd34a09d803?d=seASyqjs7

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Some conditions hide in your genes, without any symptoms. One of these conditions is genetic arrhythmogenic cardiomyopathy, an inherited condition that can lead to sudden cardiac arrest — even if you feel completely fine.

In this episode, Sarah and Leslie talk about their shared diagnosis of FLNC cardiomyopathy — from how this gene mutation affects the function of the heart to how they're managing this rare condition. You'll hear how Leslie's ICD has saved her life more than once, how it feels to be shocked back to life, and the resilience that's helped them move forward.

This is a raw, real, emotional episode about living with a genetic heart condition. Tune in to learn the signs to watch for, when to get tested, and where to find support!

Topics discussed in this episode:

• What is genetic arrhythmogenic cardiomyopathy?
• How FLNC related ACM differs from other cardiomyopathies
• Common symptoms and why some people are diagnosed too late
• Treatment and lifestyle management
• How Sarah and Leslie finally got diagnosed
• Leslie’s first cardiac arrest and its impact
• How Sarah is processing her diagnosis
• What it feels like to be shocked by your ICD
• Types of ICDs: transvenous, SICD, and EV-ICD
• Mental and emotional recovery post-cardiac arrest
• The WomenHeart organization

Find support or volunteer with WomenHeart:

https://www.womenheart.org/

Mentioned in this episode:

CONNECT

Listen to the In The Heart of Care Podcast

https://link.cohostpodcasting.com/6598429e-e927-45b0-9b57-7dd34a09d803?d=seASyqjs7

What happens when a trauma patient isn’t just a trauma patient? In today’s episode, we’re diving into “Trauma Plus” — those high-stakes situations where comorbidities, medications, environmental exposures, or underlying medical emergencies complicate recognition of decompensation and change everything about how we care for our patients.

I’m joined by Flight Nurse Gwenny, who brings her expertise from the field to walk us through three complex trauma cases where things aren’t what they first appear to be. You’ll hear her real-time thought process as she navigates evolving scenarios and shares her assessment priorities, differential diagnoses, and critical interventions.

If you’ve ever cared for a trauma patient and thought, “Something doesn’t add up,” this episode will help sharpen your assessment skills and give you a framework for approaching the next challenging trauma case.

• Recognizing subtle signs of trauma decompensation
• Assessing geriatric trauma patients with limited compensatory reserves
• Managing trauma patients on anticoagulation
• Understanding how hypothermia worsens bleeding and coagulopathy
• Identifying and interrupting the trauma “triad of death”
• Balancing trauma care with underlying medical emergencies
• Avoiding anchoring bias when a patient’s story doesn’t add up
• Prioritizing assessments and interventions during flight transport
• Building a mental checklist for “Trauma Plus” patients

Connect with Nurse Gwenny:

Youtube:

https://www.youtube.com/channel/UCLhEo_HaDEkPFA_cpQPAz2w

Instagram:

https://www.instagram.com/nursegwennyrn/

TikTok:

https://www.tiktok.com/@nurse.gwenny?_t=8qUUMwXhv5P&_r=1

Purchase her books:

https://www.nursegwenny.com/shop

Mentioned in this episode:

Listen to the In The Heart of Care Podcast

https://link.cohostpodcasting.com/6598429e-e927-45b0-9b57-7dd34a09d803?d=seASyqjs7

CONNECT

Why would a healthy newborn suddenly stop eating and start vomiting? When a fussy baby comes into the ER, it's easy to assume it's nothing urgent — like colic or gas. But in today's case, there were small signs that pointed to something more.

This episode unpacks the high-risk condition and treatment of neonatal cardiogenic shock with Natalie Pleiman, pediatric nurse and clinical coach. From the early (often misleading) signs to critical assessments, you'll learn what makes cardiogenic shock different in neonates (specifically ductal dependent lesions), what to look for in patient labs, and how to manage the risks of treatment.

Tune in for insights that will help you on your next pediatric cardiac emergency!

Topics discussed in this episode:

• Neonatal triage: initial assessment and red flags
• Physical exam and early diagnostics
• Differences in neonatal anatomy and physiology
• Preductal vs. postductal vitals
• Signs of coarctation of the aorta
• Assessing for sepsis vs. cardiogenic shock
• The dangers of fluid boluses
• How to effectively administer prostaglandins
• The risk and process of neonatal intubation
• Pathophysiology of coarctation of the aorta
• ICU stabilization to optimize cardiac function
• Key signs of congenital heart conditions
• Natalie’s framework for understanding congenital heart defects

Connect with Natalie:

https://www.instagram.com/chatwithnat_rn/

Listen to Chat with Nurse Nat on Spotify:

https://open.spotify.com/show/7Jh2qe44KipudVKkdXFwWH

Listen to Chat with Nurse Nat on Apple Podcasts:

https://podcasts.apple.com/us/podcast/chat-with-nurse-nat/id1815541418

Mentioned in this episode:

Listen to the In The Heart of Care Podcast

https://link.cohostpodcasting.com/6598429e-e927-45b0-9b57-7dd34a09d803?d=seASyqjs7

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One unstable patient, three departments, and every nurse on alert... Let's break down what really happens during a high-risk STEMI. This episode follows the case of a 62-year old patient from ER to the Cath Lab to the ICU. Nurses Sarah Vance and Caitlyn Nichols help us explore the role of nurses in each stage of care, from stabilizing the patient to placing an Impella device.

We cover everything from IV placement and medications to monitoring patients through each phase of care. Learn how to prepare patients for the Cath Lab, manage complications like V-fib and bleeding post-PCI, and support the next team during handoffs. This is a must-listen for nurses involved in cardiac care!

Topics discussed in this episode:

• Case presentation of a 62-year old patient
• ER nurse priorities for STEMI patients
• Initial treatment and stabilization
• Why “M.O.N.A.” is an outdated practice
• Preparing the patient for the Cath Lab team
• Cath Lab nurse responsibilities and role during PCI
• High-risk PCI vs. standard PCI
• Managing common complications
• Transitioning from Cath Lab to ICU
• ICU nurse priorities for post-PCI patients
• Impella placement and monitoring
• Managing reperfusion arrhythmias
• Long-term care and getting patients off the Impella
• Patient and family education

Connect with Sarah Vance:

https://www.instagram.com/iseeu_nurse/

Connect with Caitlyn Nichols:

https://www.instagram.com/icunursingnotesbycaitlyn/

Mentioned in this episode:

CONNECT

Listen to the In The Heart of Care Podcast

https://link.cohostpodcasting.com/6598429e-e927-45b0-9b57-7dd34a09d803?d=seASyqjs7

Often, the first symptom of hypertrophic cardiomyopathy is sudden death. But sometimes, we get a warning— and that’s where clinical judgment at the bedside saves lives.

Today, Sarah goes over the case of her patient Ben, a 20-year-old experiencing syncope and chest pain. As his condition quickly deteriorated, the team had to carefully manage the patient before reaching a diagnosis of hypertrophic cardiomyopathy. Hear what pointed them to this diagnosis, why some standard interventions can be dangerous in HCM cases, and the critical decisions made during his treatment.

Listen now for a deep dive into the pathophysiology and treatment of hypertrophic cardiomyopathy!

Topics discussed in this episode:

• Case presentation of a young patient with chest pain
• How we got to the patient’s diagnosis
•  Pathophysiology of hypertrophic cardiomyopathy
• Why the patient deteriorated and our treatment approach
• Emergency management of HCM
• Other types of cardiomyopathy
• Key takeaways for bedside nurses

Listen to episode 98, “Broken Heart Syndrome” aka Takotsubo Cardiomyopathy, here: https://healthpodcastnetwork.com/episodes/rapid-response-rn/98-broken-heart-syndrome-aka-takotsubo-cardiomyopathy/

Mentioned in this episode:

CONNECT

Listen to the In The Heart of Care Podcast

https://link.cohostpodcasting.com/6598429e-e927-45b0-9b57-7dd34a09d803?d=seASyqjs7