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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 patientAnterior vs. posterior circulationClassic vs. atypical presentations of basilar artery occlusionWhy FAST alone can miss posterior circulation strokesLocked-in syndrome and assessing consciousnessStroke localization: a tour of the brainIV thrombolytics: alteplase, tenecteplase, and bleeding riskWhen to use mechanical thrombectomyCT perfusion: core infarct vs. ischemic penumbra5 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 Mentioned 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! 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

"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-STEMIMitral valve anatomy and the role of the papillary musclesWhy mechanical complications happen days after an MIAcute vs. chronic mitral regurgitationWhy the lungs flood while the organs starveWhy murmurs can be misleadingBiPAP and the risks of intubating a patient in shockAfterload reduction vs. norepinephrineWhen Lasix helps and when it doesn'tMechanical circulatory support: IABP, Impella, and VA-ECMOHow 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 arrestWhy epinephrine both helps and hurtsAmiodarone vs. lidocaine: which is better?Key findings from the ROC-ALPS trialWhy antiarrhythmics don't replace defibrillationThe evidence behind esmolol in refractory V-fib3 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-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 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 nurseThe backstory behind the Rapid Response RN PodcastThe impact of having a rapid response teamHow you can start a rapid response programRapid response education and (lack of) resourcesHiring red flags that override a strong resumeSoft skills nursing school never teachesTrusting 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 disciplineThe nursing choice: fracture or adaptBuilding a life that isn't fully defined by the institutionImportant things we don’t say to each otherWhat patients actually need from their nursesTherapy, medication, and sleep as nursing toolsAn exercise to audit your cup-fillers vs. cup-drainersWhy it’s so important to share your experienceHow 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 hypoxiaPerfusion, pressors, and the limits of MAPTemperature management guidelinesSedation, analgesia, and the paralyzed-but-awake patientDiagnostics: timing, priorities, and what to rule outHow to use neuroprognostication the right wayHow to talk to families without giving false hopeNursing 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 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!

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 patientsClinical signs that your PE patient is deterioratingOxygen therapy: why intubation can be dangerousVasopressor therapy and when to add vasopressinLow-molecular-weight heparin vs. unfractionated heparinPE response teams: when to activate and who should be on the teamWhat you can do when your hospital has no PERTWhen 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

"There has to be a better way." We've all thought it. This episode is proof that nurses can be the ones to make it happen. In this episode, Sarah is joined by Kat Siaron, rapid response nurse and co-author of the RRT STAR study that shows what happens when nurses are empowered to act before a clear stroke diagnosis is made. They walk through a patient case that exposed a dangerous gap in inpatient stroke response, traps like sedation hangover that mask stroke presentations, and how the nurse-led Code Stroke process has drastically improved time to crucial intervention. You'll hear about the step-by-step workflow, where rapid response nurses and physicians fit in, and how you can advocate for change in your hospital. Topics discussed in this episode: The patient case that led to Kat’s RRT STAR studyWhy inpatient stroke times lag behind ER stroke timesThe consequences of ordering stat CT instead of Code StrokeSymptoms and prognosis of basilar strokeThe step-by-step Code Stroke processThe rapid response team's role in stroke activationResults and impact of the studyHow they overcame pushback to drive institutional changeStroke mimics and what to do nextHow to advocate for a nurse-led stroke alert at your hospital Read Kat’s article, “Use of Rapid Response Teams to Expedite Imaging and Treatment for Inpatients With Acute Stroke:” https://aacnjournals.org/aacnacconline/article-abstract/36/4/317/32912/Use-of-Rapid-Response-Teams-to-Expedite-Imaging?redirectedFrom=fulltext Mentioned in this episode: Listen to the In The Heart of Care Podcast https://link.cohostpodcasting.com/6598429e-e927-45b0-9b57-7dd34a09d803?d=seASyqjs7

The stroke guidelines just changed and it’s exciting and nuanced! What you do in the first 30 minutes could drastically change your patient's outcome. In this episode, Dr. Shyam Prabhakaran, neurologist and chief writer of the new 2026 AHA Stroke Guidelines, explains what's changed and how these guidelines are changing practice at the bedside. Stroke treatment decisions are getting faster, more nuanced, and more imaging-driven. Inclusion/exclusion criteria and whether to give thrombolytics, who is a candidate for thrombectomy, and when to touch the blood pressure have all been updated. Know the updates before your next stroke alert! Topics discussed in this episode: Introducing the classic extended window patient caseThrombolytics vs. thrombectomy explainedEMS destination decision: Choosing primary vs. comprehensive stroke centerHow reperfusion time windows have changedAdvanced imaging: ASPECTS and thrombectomy eligibilityTreatment options for patients presenting outside of the 4.5 hr windowBlood pressure management recommendationsWhat nurses should do in the first 15-30 minutesLVO red flags at the bedsidePediatric ischemic stroke Check out the new AHA Stroke Guidelines: https://newsroom.heart.org/news/new-guideline-expands-stroke-treatment-for-adults-offers-first-pediatric-stroke-guidance Mentioned in this episode: Listen to the In The Heart of Care Podcast https://link.cohostpodcasting.com/6598429e-e927-45b0-9b57-7dd34a09d803?d=seASyqjs7

ARDS is one of the more complex syndromes we manage in critical care. More than just pulmonary edema, we are battling stiff lungs, refractory hypoxemia, rising pressures, and frequently making decisions that can either protect the lung or make things worse. In this episode, I’m joined by respiratory therapist Melody Bishop for a deep dive into ARDS ventilator management through the lens of physiology, evidence, and real bedside practice. We break down what’s actually happening in the lung, why some long-held practices have fallen out of favor, and how nurses and RTs can work together to make more precise, lung-protective decisions. If ARDS has ever felt like guesswork, this episode will help it make sense. Topics discussed in this episode:What ARDS looks like at the alveolar level and why surfactant loss changes everythingHow inflammation leads to stiff lungs, poor compliance, and refractory hypoxemiaWhy lung-protective ventilation is about avoiding harm, not chasing perfect numbersMoving beyond tidal volume: how driving pressure reframes vent managementHow RTs use compliance trends to judge whether lungs are improving or failingPEEP selection: why tables are a guide, not the final answerThe physiology behind proning and why it’s one of the few ARDS interventions that saves livesWhy recruitment maneuvers fell out of favor (and what works instead)What nurses should be watching on the ventilator to catch deterioration early Connect with Melody and download her free book:https://melodybishoprt.com/ Mentioned in this episode: Rapid Response Academy Winter 2026 Cohort https://www.rapidresponseandrescue.com/rra

A transplant saves a life… but can also make the body attack itself. That's what Graft Versus Host Disease (GVHD) does, and why nurses need to catch it early. You may have never seen it before, but this episode will tell you what it looks like at the bedside and the early clues you can’t afford to miss. Through a real patient case, Anthony, RN explains why GVHD is easy to overlook, how to think through common differentials, and what matters most when it comes to helping patients stabilize and recover. Topics discussed in this episode: CCOT's rapid response modelThe patient’s condition weeks after allogenic transplantAnthony's assessment and what raised red flagsWhy early symptoms can get misread or minimizedHow Graft Versus Host Disease developsWhy emotional support is crucial to recoveryAcute vs. chronic Graft Versus Host DiseaseImportant early clues of Graft Versus Host DiseasePriority interventions for Graft Versus Host DiseaseHow Anthony’s app can help bedside nurses You can connect with Anthony or learn more about his apps here: https://thehumblenurse.com/ Mentioned in this episode: Rapid Response Academy Winter 2026 Cohort https://www.rapidresponseandrescue.com/rra

You know those moments when something just “feels off?” That’s when you should trust your instincts and speak up because timing can completely change a patient’s outcome. In this episode, Sarah is joined by Dr. Oscar Mitchell, Associate Director of the Center for Resuscitation Science and Director of the Medical Rapid Response Team at the Hospital of the University of Pennsylvania. They break down one septic shock case across two timelines: first, when rapid response is called early and there's still time to intervene, and later, when the patient is already crashing. You’ll hear what a calm, collaborative rapid response call looks like, which signs of deterioration should never be ignored, and how to effectively share your concerns with a provider. This episode is for anyone who might call a rapid response AND for those who respond to emergencies. Topics discussed in this episode: Introduction to the patient and the 5PM timelineWhat the ideal provider–nurse collaboration looks likeEarly signs of deterioration that were missedWhy some nurses hesitate to call rapid responseThe patient’s vitals at 10AM and why rapid response was calledWhy the documented respiratory rate might not be reliableWhy blood pressure can be misleadingSBAR and CUS frameworks for escalationDr. Mitchell’s research on delays in RRT activation and mortalityEarly warning signs you should never ignore Register for the REVIVE Conference and use code RAPID50 to get $50 off! https://www.revive-conference.com/ Check out Dr. Mitchell's research here:https://pubmed.ncbi.nlm.nih.gov/36349290/ Mentioned in this episode: Rapid Response Academy Winter 2026 Cohort https://www.rapidresponseandrescue.com/rra

The science is finally catching up to what clinicians have long known: more fluids aren't always the answer to septic shock. In this episode, host Sarah Lorenzini and Jaclyn Bond MSN-LM, MBA-HM explain what the ANDROMEDA-SHOCK 2 trial reveals about physiology-guided sepsis resuscitation and why fixed-volume fluid strategies can lead to avoidable harm. They break down how dynamic fluid responsiveness testing helps teams stop guessing, and how tools like FloPatch support real-time assessment of carotid flow time and stroke volume. You'll leave with a clearer idea of when to give fluids, when to stop, and how to justify the decision. Topics discussed in this episode: The purpose and key findings of the ANDROMEDA-SHOCK 2 studyWhy dynamic measures of fluid responsiveness matter more than static vitalsWhat recent meta-analysis data shows about physiology-guided fluid strategiesCarotid flow time: what it is, how it’s measured, and how it guides decisionsHemodynamic assessment and bedside limitationsHow FloPatch supports real-time assessment so you can make individualized fluid decisionsSEP-1 2026 guideline updates and why it’s better for patientsHow to apply these principles to your workflow Website: www.flosonicsmedical.com See FloPatch in action: https://hubs.ly/Q03-68Hg0 Mentioned in this episode: Rapid Response Academy Winter 2026 Cohort https://www.rapidresponseandrescue.com/rra