Rapid Response RN

"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 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 Fall 2026 Rapid Response Academy Click here to learn more about the Fall 2026 Cohort of Rapid Response Academy: https://www.rapidresponseandrescue.com/rra

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 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

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). 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

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 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