Rapid Response RN

A patient arrives at the ER, complaining of chest pain that dramatically worsens when she lies down. What could this clue reveal about her condition? In this episode, host Sarah Lorenzini recounts her experience caring for her first pericarditis patient and the subtle yet critical signs that distinguish it from more common cardiac emergencies.

Sarah dives into the tricky nature of chest pain, sharing how the PQRST pain assessment and an EKG played a critical role in uncovering the patient’s condition. She also outlines the diagnostic criteria that help differentiate pericarditis from more serious conditions like myocardial infarction, emphasizing the symptoms that can make diagnosis challenging.

Listen to the episode for insights on recognizing the easily mistaken signs of pericarditis, diagnosing the condition, and providing effective treatment!

Topics discussed in this episode:

• Patient case study of a young woman with chest pain
• Assessment and diagnosis of pericarditis
• Pathophysiology of pericarditis
• Infectious vs. noninfectious causes of pericarditis
• The diagnostic criteria for pericarditis
• EKG characteristics in pericarditis vs. myocardial infarction
• Key takeaways on the diagnosis and treatment of pericarditis

Learn more by reading this Brady et al article about ECG morphology in pericarditis:

https://pubmed.ncbi.nlm.nih.gov/11581081/

Mentioned in this episode:

Rapid Response Academy Link

Wanna check out Rapid Response Academy: The Heart and Science of Caring for the Sick?

Clinical Nurse Specialists are more than just experts in their field.  They are advanced practice nurses who are driven to make system wide changes for both nurses and their patients.

This episode sheds light on the critical role of Clinical Nurse Specialists, the extensive education and experience needed to enter the field, and their unique responsibilities compared to other nursing positions. Nicole openly shares the impact she’s been able to make as a CNS, the challenges she’s faced — and even mistakes she's made along the way. We also discuss the worrying decline in CNS programs, and what nurses can do to secure a CNS position in today's healthcare environment.

Tune in to learn more about what it takes to be a Clinical Nurse Specialist and decide if it's the right fit for you!

Topics discussed in this episode:

• The importance of the CNS role in healthcare
• Differences between a CNS and other nursing roles
• Nicole’s experience implementing an award winning sepsis program
• The experience and skills required to succeed as a CNS
• Challenges of the CNS role
• The future of the CNS role
• Advice for aspiring Clinical Nurse Specialists

Head to Nicole’s website to get 20% off ALL courses and educational materials with code RAPIDRN20!

https://www.nicolekupchikconsulting.com/?ref=30065

Connect with Nicole Kupchik:

https://www.instagram.com/nicolekupchik/

https://www.tiktok.com/@nicolekupchik

https://www.facebook.com/NicoleKupchikConsultingEducation

https://www.linkedin.com/in/nicole-kupchik-mn-rn-ccrn-530b8710/

https://www.youtube.com/channel/nicolekupchik5959

This week's case study features a 5-week trauma injury, a critical care transport, and a pediatric patient with a surprise sepsis diagnosis. Critical Care Transport Nurses Erik and Nykole join host Sarah Lorenzini to discuss the complexities of managing a young patient with an unexpected empyema.

In this episode, you’ll hear Erik's initial assessment of the patient, how the diagnosis of empyema was ultimately reached, and the actions taken to keep the patient stabilized during transport. They cover important topics like fluid overload in pediatric patients, re-expansion pulmonary edema, and therapeutic presence.

Erik and Nykole also share their journey to becoming critical care transport nurses and offer insights on caring for pediatric patients. Listen to this conversation for a behind-the-scenes look at pediatric critical care transport!

Topics discussed in this episode:

• The training required for critical care transport nursing
• Initial patient assessment and history
• What led Erik to suspect sepsis
• The pathophysiology of re-expansion pulmonary edema
• Managing the patient during transport
• Key lessons from the case
• Best practices for pediatric fluid management
• Symptoms and treatment of re-expansion pulmonary edema
• The importance of therapeutic presence in pediatric cases

Mentioned in this episode:

Rapid Response Academy Link

Wanna check out Rapid Response Academy: The Heart and Science of Caring for the Sick?

This mystery case kept everyone guessing, and now it’s time to reveal Mr. James’ surprising diagnosis: serotonin syndrome! But how did he end up with this rare condition? In this episode, host Sarah Lorenzini reviews Mr. James’ case, explains what led him to develop serotonin syndrome, and the signs that pointed to this diagnosis.

If you were stumped by this case, don’t sweat it! Serotonin syndrome is hard to diagnose, but Sarah breaks down its pathophysiology and shares effective treatment methods. Discover key factors that contribute to serotonin syndrome, such as serotonergic medications, and the myriad of symptoms that can affect the patients' autonomic system, neuromuscular system, and mental state.

Tune in now to learn more about serotonin syndrome!

Topics discussed in this episode:

• Overview of Mr. James’ case
• Understanding serotonin and the causes of serotonin syndrome
• Pathophysiology of serotonin syndrome
• Symptoms to look for in patients
• The link between serotonin syndrome and sleep apnea
• Diagnosis and treatment strategies

Watch this video to learn how to assess patients for clonus:

https://youtu.be/4SrhgjGIZ30

Read the article about SSRIs exacerbating sleep apnea: Selective serotonin reuptake inhibitor use is associated with worse sleep-related breathing disturbances in individuals with depressive disorders and sleep complaints: a retrospective study

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927326/#:~:text=Conclusions%3A,be%20confirmed%20by%20prospective%20studies

Mentioned in this episode:

AND

Can you guess what was Mr. James' diagnosis?

Why was he having periods of apnea?

Why was he tachycardic?

Why was he hypertensive?

Why was he so rigid?

Why wouldn't he wake up?

Tune in Friday for Episode 114 to hear the reveal of the diagnosis and breakdown of the pathophysiology and how to treat Mr. James' condition

Awesome nurses don’t always make great preceptors. So what does it take to nurture new talent into capable and confident professionals? This episode delves into fundamental qualities, mindset and teaching strategies necessary to excel in the role of a preceptor.

Host Sarah Lorenzini reflects on her experiences with both good and bad preceptors, sharing insights on how to create a supportive and empowering learning environment that encourages independence. From setting expectations and goals to dealing with difficult trainees, she outlines proven methods to help nurses become an effective mentor. You’ll learn techniques for providing constructive criticism, building up critical thinking skills, promoting self-efficacy in trainees, and more!

Tune in to learn how to become an exceptional preceptor and make a positive impact on the next generation of nurses!

Topics discussed in this episode:

• Qualities of a good preceptor
• How to promote self-efficacy in trainees
• The importance of establishing expectations
• Effective teaching strategies
• Goal setting and building confidence
• How to handle difficult trainees
• Why preceptors are crucial to the profession

Mentioned in this episode:

Rapid Response Academy Link

Wanna check out Rapid Response Academy: The Heart and Science of Caring for the Sick?

The summer heat brings fun in the sun, relaxing days, and even the threat of heat stroke. In this episode, host Sarah Lorenzini explores the spectrum of heat-related illnesses, highlighting the crucial differences between heat stroke and heat exhaustion. She recounts an emergency case of a young man with all the classic symptoms of heat stroke — and the highest temperature of any patient she’s ever seen.

Sarah delves into the complications that can arise from heat stroke and effective treatment protocols for cooling down patients. You’ll learn about the factors that increase the risk of heat stroke, the danger zone of hyperthermia, and how to prevent hypothermia during the treatment of heat stroke.

Listen to this episode to learn more about recognizing and managing heat stroke!

Topics discussed in this episode:

• Heat stroke case study
• Differentiating heat stroke from heat exhaustion
• Signs and symptoms of heat stroke
• Emergency steps for treating heat stroke
• Risk factors of heat stroke

Check out the EM Cases episode about heat stroke:

https://emergencymedicinecases.com/em-quick-hits-september-2021/

Read Dr. Swaminathan's article on environmental hyperthermia:

https://coreem.net/core/environmental-hyperthermia/

Mentioned in this episode:

Rapid Response Academy Link

Wanna check out Rapid Response Academy: The Heart and Science of Caring for the Sick?

When the diseased liver is unable to filter out neurotoxins like ammonia, we can see a spectrum of the neuropsychiatric symptoms of hepatic encephalopathy.  For the final installment in our liver failure series, host Sarah Lorenzini highlights a complicated case of hepatic encephalopathy where critical thinking and interdisciplinary teamwork were key to preventing further complications.

She examines the common signs and symptoms of hepatic encephalopathy, factors that trigger or exacerbate the condition, and challenges nurses face in the diagnostic process. This episode also dives into treatment strategies and how to differentiate between hepatic encephalopathy and alcohol withdrawal.

Tune in to learn how cirrhosis can lead to hepatic encephalopathy, the effect of neurotoxins in the brain, and how you, as a nurse, can manage patient care!

Topics discussed in this episode:

• Assessment of Sarah’s rapid response consult patient
• The team’s interventions and patient outcome
• Pathophysiology of hepatic encephalopathy
• Signs and symptoms of hepatic encephalopathy
• Diagnostic challenges and aggravating factors
• Strategies to manage hepatic encephalopathy
• Hepatic encephalopathy versus alcohol withdrawal

Mentioned in this episode:

AND

Managing liver failure often means walking a tightrope with kidney function. This episode explores what happens when the kidneys begin to fail due to liver disease, a condition known as hepatorenal syndrome. Host Sarah Lorenzini sheds light on this common but severe complication of cirrhosis, sharing a critical case that exemplifies the challenges of diagnosing and treating hepatorenal syndrome.

Tune in to gain a better understanding of the pathophysiology of hepatorenal syndrome, the importance of early intervention, and effective treatment strategies. Listen to part three of this liver failure series now!

Topics discussed in this episode:

• Case study of a patient with suspected hepatorenal syndrome
• Pathophysiology of hepatorenal syndrome
• Diagnostic and treatment strategies for hepatorenal syndrome
• Key takeaways for nurses

A cirrhosis patient has stable vitals, but then starts vomiting blood. What do you do next? This episode delves into a case study that highlights the urgent management of esophageal varices in liver failure patients. Host Sarah Lorenzini reveals how a rapid response call quickly spiraled into a life-threatening emergency, and the critical steps taken to stabilize the patient.

Sarah explains the pathophysiology of cirrhosis and the development of esophageal varices, detailing the pharmacological and procedural interventions that can make the difference between life and death. You’ll get a comprehensive overview of evidence-based treatment strategies, how to manage complications, and the crucial role of nurses in patient care.

Tune in to arm yourself with the knowledge to handle this critical liver emergency!

Topics discussed in this episode:

• Management of a cirrhosis patient with a GI bleed 
• How liver failure can lead to a bleeding esophagus
• Challenges of giving blood transfusions to liver failure patients
• Pharmacological interventions: octreotide, antibiotics, and beta-blockers
• Procedural interventions: endoscopic variceal ligation, TIPS procedure, and balloon tamponade

Listen to Episode 77, “The Trauma, Diamond of Death:” https://podcasts.apple.com/us/podcast/77-the-trauma-diamond-of-death-4-treatment-priorities/id1535997752?i=1000633582257

To learn more about balloon tamponade, check out this breakdown of the procedure: https://first10em.com/balloon-tamponade-of-massive-gi-bleeding/

Mentioned in this episode:

Rapid Response Academy Link

Wanna check out Rapid Response Academy: The Heart and Science of Caring for the Sick?