Rapid Response RN

Treating hyponatremia, a condition characterized by low sodium levels in the blood, can be both complicated and quite risky.. Disruptions to the delicate balance of sodium in the body can lead to a spectrum of outcomes, from an asymptomatic presentation to life-threatening seizures, coma, and death.

Through the patient story of Mrs. Saltman, host Sarah Lorenzini explains the role of sodium in the body, breaking down the science of osmosis and electrolytes so nurses can better understand the causes of hyponatremia. She goes over the three levels of hyponatremia that are categorized by blood tonicity and volume status, and how each level impacts the diagnosis and management of hyponatremia. 

Sarah also dives into the nuances of treating hyponatremia, including the risks of rapid sodium correction, the importance of knowing a patient’s baseline, the underlying cause of their condition, and more.

This episode will provide nurses with the knowledge needed to recognize the signs of hyponatremia and navigate the risks of treatment. Tune in now!

Topics discussed in this episode:

• Introduction to Mrs. Saltman’s case
• The pathophysiology of hyponatremia
• Causes of hyponatremia
• Types of hyponatremia: hypertonic, hypotonic, and isotonic
• Hyponatremia treatment strategies and their risks

Takotsubo cardiomyopathy, also known as “broken heart syndrome,” is hard to diagnose because its symptoms mimic more common conditions like acute coronary syndrome. This stress-induced cardiomyopathy presents a mysterious challenge to nurses, as you’ll hear in today’s patient story.

Host Sarah Lorenzini shares the case of a patient who went from experiencing shortness of breath and nausea to a serious cardiac emergency. She breaks down the patient’s initial presentation, their quick decline featuring hypoxia and flash pulmonary edema, and ultimate diagnosis of takotsubo cardiomyopathy.

In this episode, Sarah dives into the pathophysiology of takotsubo cardiomyopathy, covering how emotional or physical stress leads to the condition. She goes over its symptoms and treatment, as well as the role of nurses in managing the condition.

Tune in now to find out how you should be handling similar cardiac emergencies!

Topics discussed in this episode:

• Takotsubo cardiomyopathy: a patient case study
• The pathophysiology of takotsubo cardiomyopathy
• Diagnosing takotsubo cardiomyopathy
• How to effectively treat takotsubo cardiomyopathy
• Final takeaways for nurses

Listen to Episode 82: Sympathetic Crashing Acute Pulmonary Edema: That Time My Patient Went From Stable A-Fib RVR to Intubated in 30 Minutes! https://podcasts.apple.com/ca/podcast/82-sympathetic-crashing-acute-pulmonary-edema-that/id1535997752?i=1000637926574

Mentioned in this episode:

Rapid Response Academy Link

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

Part two of our crashing asthmatic series continues with a comprehensive look into what exactly happened in last week’s nightmare patient case. 

Host Sarah Lorenzini dives into the pathophysiology of status asthmaticus, explaining the physiological changes in the airways during severe asthma attacks and what makes these cases resistant to standard treatment. She also breaks down treat options for patients approaching the asthma spiral of death, from pharmacological interventions to last-resort interventions like ECMO.

This episode highlights the key role of nurses in the care of status asthmaticus, including the importance of recognizing the red flags like “silent chest” and managing patient anxiety.

Tune in to learn everything you need to know about caring for a crashing asthmatic!

Topics discussed in this episode:

• The pathophysiology of asthma
• Signs of asthma exacerbation
• Treating a progression of asthma symptoms
• The danger of silent chest
• Advanced interventions for status asthmaticus 
• Tips for sedation and intubation
• Understanding your role as a nurse

Read this article that supports the use of magnesium for asthma:

https://pubmed.ncbi.nlm.nih.gov/24865567/

Read this article that shows magnesium does not help in asthma cases:

https://pubmed.ncbi.nlm.nih.gov/1536485/

....and there are so many more conflicting studies like these ☝️

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:

Rapid Response Academy Link

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

Severe asthma leads to cardiac arrest in today’s gripping patient story. Brooklyn, an ER Nurse joins host Sarah Lorenzini to discuss a nightmare case of a young asthmatic patient and her team’s desperate fight to stabilize him.

Despite various interventions, from albuterol, magnesium, BiPap, ketamine, and more, the patient's condition deteriorated, requiring intubation and ultimately transfer to an ECMO center to save the patient’s life. This episode highlights the challenges faced by smaller hospitals with fewer resources and the heroic care this patient received despite so many challenges.

Check out part one of our series on caring for the crashing asthmatic!

Topics discussed in this episode:

• Initial treatment of Brooklyn’s asthma patient
• The patient’s escalating condition and challenges in care
• Unpacking every tool in the asthma treatment toolbox
• Managing complications from autopeep to pneumothorax to cardiac arrest
• Key takeaways from this patient case

Mentioned in this episode:

Rapid Response Academy Link

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

Do you know how to recognize a wide or narrow pulse pressure and what each finding tells you about your patient? Following last week's discussion on the shock index, host Sarah Lorenzini introduces pulse pressure as another essential tool in the nurse's assessment arsenal.

In this episode, Sarah outlines how to measure and interpret pulse pressure. She shares two patient stories to illustrate how variations in pulse pressure can indicate different underlying conditions: The case study of Mrs. D highlights the implications of narrow pulse pressure, and the case study of Mr. S explores wide pulse pressure.

Through these examples, Sarah emphasizes how pulse pressure can be a key indicator in patient assessments while also clarifying its limitations. Listen in now!

Topics discussed in this episode:

• The case study of Mrs. D
• Measuring and interpreting pulse pressure
• Causes of narrow pulse pressure
• Causes of wide pulse pressure
• The case study of Mr. S
• Limitations to pulse pressure
• Using pulse pressure as a diagnostic tool

Mentioned in this episode:

AND

Looking at HR or Blood Pressure alone as determinants of how stable the patient is can lead us astray.  The Shock Index allows us to detect when patients are declining… while they are still compensating. Shock Index = HR/SBP… but how can we use this tool? 

A patient’s vital signs can appear normal, meanwhile they’re on the brink of shock. This was exactly the case of Mr. Fields, a patient admitted to the ER after falling off his tractor. Initially, his vitals didn't raise alarms but there were signs pointing to a more serious situation — including a shock index of greater than one.

In this episode, host Sarah Lorenzini dives into the critical role shock index plays in determining how sick patients are and improving their outcomes, especially in emergency settings. She breaks down the calculation of shock index, its limitations in screening for all types of shock, and practical applications in patient care.

Tune in now to explore how you can apply this vital tool in the assessment and treatment of patients!

Topics discussed in this episode:

• The case study of Mr. Fields
• Understanding shock index
• How to calculate shock index… the easy way
• Clinical applications of shock index
• Limitations of shock index

Learn more about shock index: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6698590/#:~:text=Shock%20index%20(SI)%20is%20defined,sepsis%2C%20and%20ruptured%20ectopic%20pregnancy

Mentioned in this episode:

Rapid Response Academy Link

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

Are you familiar with BRASH syndrome? The complex interplay of Bradycardia, Renal Failure, Atrioventricular Block, Shock, and Hyperkalemia forms a collection of clinical signs known as BRASH syndrome. One condition leads to another which leads to another, heightening the severity of symptoms. Fortunately, it’s easy to manage if you know what you are treating.

In this episode, Sarah Lorenzini breaks down the pathophysiology of BRASH syndrome as she examines a patient case study. Starting with its hallmark features and expanding into the synergistic effects of AV nodal blockers, hyperkalemia and renal failure, she provides insights on recognizing the signs of BRASH syndrome early and the importance of understanding the interplay among its components.

Sarah outlines the treatment priorities for BRASH syndrome and highlights the importance of identifying the root cause of symptoms to prevent a cascade of complications leading to shock.

Tune in to strengthen your knowledge of BRASH syndrome!

Topics discussed in this episode:

• Case study analysis of a BRASH patient
• Components of BRASH Syndrome
• How BRASH developed in Sarah’s patient
• Treatment and management of BRASH Syndrome
• The role of calcium in treatment of BRASH

You can learn more about BRASH Syndrome at the Internet Book of Critical Care Website:

https://emcrit.org/ibcc/brash/

Mentioned in this episode:

Rapid Response Academy Link

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

Timing is everything when it comes to strokes because every second without treatment impacts patient outcomes. If you’ve ever wasted time debating whether or not to call a stroke alert, you don’t want to miss this episode with Dr. Eric Wilson RN, AGNP-C, DNP, NREMT-P!

During his conversation with host Sarah Lorenzini, Eric emphasizes the urgency of recognizing stroke symptoms early, highlighting unilateral deficits and speech issues as red flags for immediate action. He guides listeners through the assessment of patients using the NIH Stroke Scale, and dives into treatment options and diagnostic procedures.

Eric and Sarah also discuss the role of nurses during a stroke alert, including when one should be called and what nurses can expect. Tune in now to learn how you can rock your next stroke alert!

Topics discussed in this episode:

• Identifying stroke symptoms and calling a stroke alert
• Assessing the patient and preparing for a stroke alert
• The NIH Stroke Scale
• Criteria for thrombolytic treatment
• Who makes a good candidate for thrombectomy
• Treating patients who don’t qualify for a thrombolytic

Mentioned in this episode:

AND

Cardiac output equals heart rate times stroke volume… but what does that really mean and how does it apply to the bedside? This formula (CO = HR x SV) is crucial for nurses to understand in the application of vasopressors and inotropes, so why is it so difficult to memorize their role in improving cardiac output?

This episode is dedicated to breaking down these life-saving medications so you can not only memorize their expected effect on vital signs, but more importantly, understand how they work in the body. Host Sarah Lorenzini provides a comprehensive lesson in these three classes of medications: vasopressors, inopressors and inodilators. She covers how each affects heart rate and stroke volume, diving into the alpha and beta adrenergic receptors that impact cardiac output.

Sarah also shares memory aids to help you remember these concepts and apply them to your clinical decision making.

Tune in now to learn the basics of vasopressors and inotropes!

Topics discussed in this episode:

• The role of sympathomimetics to improve cardiac output
• Adrenergic and vasopressin receptors
• Vasopressor types and medications

Mentioned in this episode:

AND

Did you listen to Joey’s story in last week’s mystery episode? If you did and guessed rhabdomyolysis as his diagnosis, congratulations! Joey’s muscle injury from playing a little too hard at football camp resulted in a release of muscle proteins that ultimately caused his kidneys to shut down, which led to his diagnosis and treatment for rhabdomyolysis.

In this episode, host Sarah Lorenzini examines the complexities of the condition, from its pathophysiology to causes and treatment options. You’ll learn the hallmark signs of rhabdomyolysis, the not so obvious signs and symptoms to be aware of, and what to consider when caring for patients.

Tune in for a detailed exploration of rhabdomyolysis!

Mentioned in this episode:

Rapid Response Academy Link

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