Rapid Response RN

How do you recognize a stroke when the usual symptoms are present? No facial droop. No slurred speech. No one-sided weakness.

In this episode, you'll hear the case of a post-op patient with normal vital signs but complaints of double vision. What follows is one of the most devastating types of ischemic stroke: a basilar artery occlusion.

Sarah walks through each decision that led to the patient's full recovery, from the bedside nurse's decision to activate the rapid response team, the the RRT nurse calling a stroke alert, to thrombectomy when thrombolytics weren’t an option. She also breaks down when common symptoms like dizziness should raise concern for basilar artery occlusion, why strokes like this one are so easy to miss with your typical FAST exam alone, and how a tour of the brain helps you predict neurological deficits.

Topics discussed in this episode:

• Why the nurse called rapid response for a post-op patient
• Anterior vs. posterior circulation
• Classic vs. atypical presentations of basilar artery occlusion
• Why FAST alone can miss posterior circulation strokes
• Locked-in syndrome and assessing consciousness
• Stroke localization: a tour of the brain
• IV thrombolytics: alteplase, tenecteplase, and bleeding risk
• When to use mechanical thrombectomy
• CT perfusion: core infarct vs. ischemic penumbra
• 5 important takeaways for your next neuro emergency

The American Heart Association/American Stroke Association's 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke:

https://www.ahajournals.org/doi/10.1161/STR.0000000000000513

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CONNECT

A 60-year-old patient recovering from surgery suddenly develops double vision. His vital signs are normal, his speech is clear, and he has no obvious one-sided weakness. But something isn't right.

What could cause such a dramatic neurological change? And what can we do to prevent permanent damage?

Put your critical thinking skills to the test and see if you can solve this mystery before the full case breakdown in Episode 167 of the Rapid Response RN Podcast!

"I feel like I'm drowning." Four days after a STEMI, a patient who had been recovering well is sitting bolt upright, coughing up pink, frothy sputum, and unable to catch his breath.

In this episode, Sarah walks you through a worst-case scenario complication every cardiac nurse needs on their radar: post-MI papillary muscle rupture causing acute, severe mitral regurgitation. This is one of those zebra diagnoses that you may never see... but if you do, recognizing it early is what gets your patient to the OR alive.

Sarah breaks down the pathophysiology behind the patient's sudden deterioration, the clues that will help you catch a mechanical complication, and how to treat the patient — including which medications help (or backfire), and where BiPAP and mechanical support fit in.

Topics discussed in this episode:

• Case presentation: sudden respiratory distress 4 days post-STEMI
• Mitral valve anatomy and the role of the papillary muscles
• Why mechanical complications happen days after an MI
• Acute vs. chronic mitral regurgitation
• Why the lungs flood while the organs starve
• Why murmurs can be misleading
• BiPAP and the risks of intubating a patient in shock
• Afterload reduction vs. norepinephrine
• When Lasix helps and when it doesn't
• Mechanical circulatory support: IABP, Impella, and VA-ECMO
• How to communicate with a frightened patient

The shock worked. The rhythm converted. And then V-fib came right back. Now what?

Part two of this series explores the physiology and pharmacology driving recurrent V-fib so you can respond confidently when shocks aren’t enough.

You'll learn how the body's sympathetic nervous system response keeps the heart unstable, why epinephrine can both help and hurt, when to reach for lidocaine over amiodarone, and what the research says about the emerging role of esmolol to target the storm itself (not just the arrhythmia).

Topics discussed in this episode:

• The sympathetic nervous system and cardiac arrest
• Why epinephrine both helps and hurts
• Amiodarone vs. lidocaine: which is better?
• Key findings from the ROC-ALPS trial
• Why antiarrhythmics don't replace defibrillation
• The evidence behind esmolol in refractory V-fib
• 3 lessons for codes when ACLS isn't enough

This special episode was recorded and released on the Nurse Gwenny Podcast. We talked about some of those early signs of deterioration that are often missed and how we can speak up and advocate before the patient crashes.

Check out this episode and so many more over at the Nurse Gwenny Podcast

And, you can join the Nurse Gwenny Library to earn CE credits for listening to the show!

Use code: rapidresponsern

to get a discount on your membership:

https://library.nursegwenny.com/bundles/nurse-gwenny-library-membership

Sometimes V-fib doesn't respond to the shock at all. Sometimes it converts and comes right back. Those are two completely different problems.

In this episode, Sarah breaks down the science behind why defibrillation fails, how to recognize the difference between refractory and recurrent V-fib, and respond when shocks aren't working. You'll learn how to start approaching the electrical storm at the bedside — that means understanding transthoracic impedance, optimizing your pad placement, and knowing when to reach for double sequential defibrillation.

Topics discussed in this episode:

• Refractory vs. recurrent V-fib
• The physiology of ventricular fibrillation and re-entry tachycardias
• Misconceptions about defibrillation
• Transthoracic impedance and how to reduce it
• Anterior-lateral vs. anterior-posterior pad placement
• Double sequential defibrillation: evidence and objections
• Key findings from the DOSE VF trial

American Heart Association. (2025). 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation.

Cheskes, S., Dorian, P., Feldman, M., McLeod, S., Scales, D. C., Pinto, R., Turner, L., Morrison, L. J., Drennan, I. R., & Verbeek, P. R. (2020). Double sequential external defibrillation for refractory ventricular fibrillation: The DOSE VF pilot randomized controlled trial. Resuscitation, 150, 178–184. https://doi.org/10.1016/j.resuscitation.2020.02.010

D. Hasegawa, A. Sharma, Y. I. Lee, & R. Sato. (2023). A systematic review and meta-analysis of esmolol for refractory ventricular fibrillation and pulseless ventricular tachycardia. Chest, 164(4 Suppl.), A1568. https://doi.org/10.1016/j.chest.2023.07.1077

International Liaison Committee on Resuscitation. (2025). 2025 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR).

Imagine being able to cut your hospital's code blue events outside of critical care in HALF in just six months. That's exactly what happened when Sarah built her hospital's rapid response team from the ground up.

Nurse Gwenny takes over the show to find out how she did it, from the pitch that got the program started to the skills that actually matter on rapid response teams. She also shares what disqualifies a candidate even when the resume is perfect, why so few resources exist for rapid response training, and how she’s filling that gap herself.

Whether you're hoping to start a rapid response program at your hospital or just want to feel more confident the next time you call one, this episode is for you.

Topics discussed in this episode:

• How Sarah became a rapid response nurse
• The backstory behind the Rapid Response RN Podcast
• The impact of having a rapid response team
• How you can start a rapid response program
• Rapid response education and (lack of) resources
• Hiring red flags that override a strong resume
• Soft skills nursing school never teaches
• Trusting nursing intuition when vitals look fine

Join the Nurse Gwenny Library to earn CE credits for listening to the show!

Use code: rapidresponsern

to get a discount on your membership:

https://library.nursegwenny.com/bundles/nurse-gwenny-library-membership

We all know the many challenges facing the Nursing profession today. Nursing takes so much from us… but it also has so much to offer.

Recorded live at NurseCon at Sea, Sarah sits down with two nurses who hit their breaking point and found a way to keep showing up. This episode goes deep into the messy reality of nursing burnout, from the struggle to put yourself first to the boundaries, mindset shifts, and support systems that keep nurses in the game.

You don't have to manage burnout alone, so don’t miss this one.

Topics discussed in this episode:

• Self-care and resilience as a discipline
• The nursing choice: fracture or adapt
• Building a life that isn't fully defined by the institution
• Important things we don’t say to each other
• What patients actually need from their nurses
• Therapy, medication, and sleep as nursing tools
• An exercise to audit your cup-fillers vs. cup-drainers
• Why it’s so important to share your experience
• How leaders should respond when a nurse is nearing burnout

Learn more about NurseCon at Sea:

https://nurseconatsea.com/

Getting ROSC is not always the win we sometimes think it is. It's what we're looking for the entire resuscitation, but the real challenge begins once we get it… and what we do in the next few hours has a major impact on patient outcomes.

In this episode, Sarah shares a real rapid response case to walk through the physiology, decision-making, and advocacy of post-arrest care. The 2025 AHA post resuscitation guidelines have brought important shifts to post-ROSC management, from how aggressively to oxygenate to when it's safe to prognosticate. Don't miss the full breakdown!

Topics discussed in this episode:

• Oxygenation and ventilation: how to avoid hyperoxia and hypoxia
• Perfusion, pressors, and the limits of MAP
• Temperature management guidelines
• Sedation, analgesia, and the paralyzed-but-awake patient
• Diagnostics: timing, priorities, and what to rule out
• How to use neuroprognostication the right way
• How to talk to families without giving false hope
• Nursing priorities and how to advocate for your patients

Check out the new Post Resuscitation Guidelines:

https://www.ahajournals.org/doi/10.1161/CIR.0000000000001375

Listen to episode 73 — Resuscitate Before You Intubate: How to NOT KILL YOUR PATIENT When You Intubate: https://podcasts.apple.com/us/podcast/73-resuscitate-before-you-intubate-how-to-not-kill/id1535997752?i=1000630431016

Mentioned in this episode:

AND

The AHA just updated the playbook on acute pulmonary embolism. The old classification system is gone. Heparin drips are no longer the default. And if your instinct is to push for intubation, that could be the thing that makes your patient worse.

In this episode, Dr. Mark Creager, lead author of the 2026 AHA Multi-Society Guideline on Acute Pulmonary Embolism, breaks down exactly what's changed, how the new guidelines help teams make better decisions faster, and what nurses need to know about frontline PE management.

Learn what the data says about oxygen therapy, anticoagulation, vasopressors, and the decisions that matter most when your PE patient starts to slide.

Topics discussed in this episode:

• The new A to E classification system and how to categorize patients
• Clinical signs that your PE patient is deteriorating
• Oxygen therapy: why intubation can be dangerous
• Vasopressor therapy and when to add vasopressin
• Low-molecular-weight heparin vs. unfractionated heparin
• PE response teams: when to activate and who should be on the team
• What you can do when your hospital has no PERT
• When to transfer by classification (and when it may be too late)
• The nurse's role in early recognition and escalation

And you can check out the full AHA/ACC 2026 updated PE guideline here:

https://www.ahajournals.org/doi/10.1161/CIR.0000000000001415