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-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 PodcastAnd, you can join the Nurse Gwenny Library to earn CE credits for listening to the show!Use code: rapidresponsernto 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 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).

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 fineJoin the Nurse Gwenny Library to earn CE credits for listening to the show! Use code: rapidresponsernto get a discount on your membership:https://library.nursegwenny.com/bundles/nurse-gwenny-library-membership