Rapid Response RN

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-fibThe physiology of ventricular fibrillation and re-entry tachycardiasMisconceptions about defibrillationTransthoracic impedance and how to reduce itAnterior-lateral vs. anterior-posterior pad placementDouble sequential defibrillation: evidence and objectionsKey findings from the DOSE VF trialAmerican 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.2020.02.010D. 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.2023.07.1077International Liaison Committee on Resuscitation. (2025). 2025 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR).Mentioned in this episode:CONNECT 📸 Connect on Instagram: https://www.instagram.com/therapidresponsern/ 📚 Check out my course: https://www.rapidresponseandrescue.com/learnmore 🧑‍💻Check out my website: https://www.rapidresponseandrescue.com/ 📬 Subscribe to my newsletter: https://www.rapidresponseandrescue.com/login 🎁 Affiliation and discounts: https://www.rapidresponseandrescue.com/therapidresponsern ✅ Earn CE’s for listening to podcasts through RNegade: https://rnegade.thinkific.com/?ref=d9d541 SAY THANKS 💜Leave a review on Apple Podcasts: https://podcasts.apple.com/ca/podcast/rapid-response-rn/id1535997752 💚Leave a rating on Spotify: https://open.spotify.com/show/55LQqeDg6XFeixvZLEp4xE ⏱️ To get the FREE Rapid Response RN Assessment Guide and the coupon code for $10 off the cost of the course, message Sarah on Instagram @TheRapidResponseRN and type the word PODCAST! This episode was produced by Podcast Boutique https://www.podcastboutique.com

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 patientTreatment priorities for the intensivist and nurseSigns that point to more than just sepsisWhy fluids aren’t always the answerBlood pressure management: vasopressors and inotropesPathophysiology of sepsis-induced cardiomyopathyHow a sepsis-induced cardiomyopathy diagnosis changes treatmentThe vasopressin debate for sepsis-induced cardiomyopathyClues your intervention isn’t working and what to do nextHow to prepare the patient for high-risk intubationWhat you need to know about administering sodium bicarbWhy collaboration matters at every step for patient recoveryConnect with Dr. Ibrahim:Instagram: https://www.instagram.com/icuboy_meded/Facebook: https://www.facebook.com/share/1Dg1ZTyfsN/TikTok: https://www.tiktok.com/@icuboy_mededThreads: https://www.threads.com/@icuboy_mededX: https://x.com/icuboy_mededLearn more about the different phenotypes in sepsis induced cardiomyopathy:https://journal.chestnet.org/article/S0012-3692(25)05143-8/abstractMentioned in this episode:Rapid Response Academy Winter 2026 Cohorthttps://www.rapidresponseandrescue.com/rra

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 symptomsDifferential diagnosis and early clinical cluesWhat to look for in your clinical assessmentPathophysiology of pulmonary hypertensionPathophysiology of dilated cardiomyopathyKey physical exam and diagnostic differencesDilated cardiomyopathy interventionsWhy it’s hard to diagnose pulmonary hypertension in the ERNurse priorities when managing patients in the CVICUManaging pulmonary hypertension crises and reducing PVRPearls and pitfalls of treating these conditionsConnect with Natalie:https://www.instagram.com/chatwithnat_rn/Listen to Chat with Nurse Nat on Spotify:https://open.spotify.com/show/7Jh2qe44KipudVKkdXFwWHListen to Chat with Nurse Nat on Apple Podcasts:https://podcasts.apple.com/us/podcast/chat-with-nurse-nat/id1815541418Mentioned in this episode:AND If you are planning to sit for your CCRN and would like to take the Critical Care Academy CCRN prep course you can visit https://www.ccrnacademy.com and use coupon code RAPID10 to get 10% off the cost of the course!

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 patientFirst treatment priorities: ventilation, airway, and warmingThe pathophysiology of drowningMisconceptions about suctioning in drowning patientsThe nurse’s role: documentation and respiratory managementPatient monitoring and signs of deteriorationThe emotional burden of pediatric fatalitiesHow the Get Vitals app supports nurses’ mental healthLearn more about the Get Vitals app:Website - www.getvitals.careInstagram -@getvitalsnowMentioned in this episode:Listen to the In The Heart of Care Podcasthttps://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.Topics discussed in this episode:Recognizing subtle signs of trauma decompensationAssessing geriatric trauma patients with limited compensatory reservesManaging trauma patients on anticoagulationUnderstanding how hypothermia worsens bleeding and coagulopathyIdentifying and interrupting the trauma “triad of death”Balancing trauma care with underlying medical emergenciesAvoiding anchoring bias when a patient’s story doesn’t add upPrioritizing assessments and interventions during flight transportBuilding a mental checklist for “Trauma Plus” patientsConnect with Nurse Gwenny:Youtube:https://www.youtube.com/channel/UCLhEo_HaDEkPFA_cpQPAz2wInstagram:https://www.instagram.com/nursegwennyrn/TikTok:https://www.tiktok.com/@nurse.gwenny?_t=8qUUMwXhv5P&_r=1Purchase her books:https://www.nursegwenny.com/shopMentioned in this episode:Listen to the In The Heart of Care Podcasthttps://link.cohostpodcasting.com/6598429e-e927-45b0-9b57-7dd34a09d803?d=seASyqjs7

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 patientER nurse priorities for STEMI patientsInitial treatment and stabilizationWhy “M.O.N.A.” is an outdated practicePreparing the patient for the Cath Lab teamCath Lab nurse responsibilities and role during PCIHigh-risk PCI vs. standard PCIManaging common complicationsTransitioning from Cath Lab to ICUICU nurse priorities for post-PCI patientsImpella placement and monitoringManaging reperfusion arrhythmiasLong-term care and getting patients off the ImpellaPatient and family educationConnect with Sarah Vance:https://www.instagram.com/iseeu_nurse/Connect with Caitlyn Nichols:https://www.instagram.com/icunursingnotesbycaitlyn/Mentioned in this episode:Listen to the In The Heart of Care Podcasthttps://link.cohostpodcasting.com/6598429e-e927-45b0-9b57-7dd34a09d803?d=seASyqjs7

Remember when we used to use stacked shocks for ventricular arrhythmias or load patients up with high doses of epinephrine and bicarb? Over the last 25 years, resuscitation guidelines have evolved and it’s our job to stay updated on the current protocols.Here to help us break down what’s changed and what still works is Dr. Ashish Panchal, Chair of Emergency Cardiovascular Care for the AHA and host of the In the Heart of Care podcast. We discuss how a common cardiac arrest scenario would be treated from 2000 to today, highlighting key guideline changes like the shift to neuroprotective strategies, high-quality CPR, and post-arrest care.Tune in to stay current and hear how science continues to shape the way we save lives!Topics discussed in this episode:How AHA guidelines are developedDr. Panchal’s research and impactEarly 2000s resuscitation guidelines“Save the brain” approach in the 2010sHow medication use has evolved, like epinephrineThe current focus on high-performance CPR and neuroprotective strategiesPost-arrest care and survivorshipBalancing clinical trends with scientific validationHow nurses can stay current on AHA guidelinesCheck out the In the Heart of Care Podcast here:https://rqipartners.com/podcast/Mentioned in this episode:Listen to the In The Heart of Care Podcasthttps://link.cohostpodcasting.com/6598429e-e927-45b0-9b57-7dd34a09d803?d=seASyqjs7