STAT Stitch Deep Dive Podcast Beyond The Bedside

Hey guys I cuss a few times in this episode. To ER is to be the BEST! :) this episode is about me discussing the possible certification material I will upload later. the certifications I currently hold as an LVN are as follows and these are the certification materials I will be uploading: -ACLS -BLS (not really a cert right? LOL) -PALS -ABLS -ASLS -Letter of completion TNCC If you guys want me to upload different courses and materials send them to me at Statstitch@gmail.comor leave a comment or review on apple podcast or whatever platform you're listening from.

This episode CONTAINS NO EDUCATIONAL MATERIAL. This episode details how the subjects are set up. Season 1= Health Assessment Season 2- Medical Surgical Season 3- Pharmacology

🫀 Core Concepts Cardiac arrest = electrical failure (VF/pVT) or mechanical/perfusion failure (Asystole/PEA). On the floor/ICU, arrests are often preceded by resp failure or hypovolemia → RR <6 or >30, HR <40 or >140, SBP <90 → activate Rapid Response. ACS pathway: plaque → rupture → thrombus → ischemia/MI. STEMI = full occlusion, NSTE-ACS = partial; ischemia makes myocardium irritable → VF. ACLS boosts chances of ROSC + neuro recovery.🧷 Chain of Survival (STEMI) Recognize → EMS/transport + prearrival notice → ED/cath dx → reperfusion. Goals: PCI ≤90 min from first medical contact; fibrinolysis ≤30 min from ED arrival. Your job: zero delays.🔄 Rhythms & Management⚡ Shockable: VF / pVTPatho/ECG: VF = chaotic, no QRS; pVT = wide, fast, pulseless. Do: CPR → Shock (biphasic 120–200 J; mono 360 J) → 2 min CPR → rhythm check. If still shockable: Shock → Epi 1 mg IV/IO q3–5 min. Next cycle: Shock → Amio 300 mg (then 150 mg) or Lido 1–1.5 mg/kg, then 0.5–0.75 mg/kg (max 3 mg/kg). Treat H’s/T’s; rotate compressors q2 min; minimize pauses. 🧠 Why: Defib ends electrical chaos so native pacemakers can resume.🫢 Nonshockable: Asystole / PEAPatho/ECG: Asystole = flat (check leads/gain); PEA = rhythm, no pulse (severe preload/mechanical problem). Do: CPR → Epi 1 mg IV/IO q3–5 min ASAP → NO shock → relentless H’s/T’s search (Hypovolemia, Hypoxia, H+, Hypo/Hyper-K, Hypothermia; Tension pneumo, Tamponade, Toxins, Thrombosis pulm/coronary). 🧠 Why: Vasoconstriction ↑ aortic diastolic P → ↑ CPP during CPR; fixing the cause is the win.🐢 Bradycardia (symptomatic, HR <50)Airway/O₂/monitor/IV/12-lead. Atropine 1 mg IV q3–5 min (max 3 mg). If ineffective: TCP, Dopamine 5–20 mcg/kg/min or Epi 2–10 mcg/min. ⚠️ Often ineffective in Mobitz II/3° block w/ wide QRS and transplant → pace early. Sedate for TCP if conscious.🚀 Tachycardia (HR >150)Unstable: Synchronized cardioversion NOW (sedate if possible). Stable narrow regular (SVT): vagal → Adenosine 6 mg, then 12 mg rapid IV push. Stable wide regular: consider Amio 150 mg over 10 min (or procainamide). ⚠️ Never AV nodal blockers (Adenosine/BB/CCB) in irregular wide-complex (likely pre-excited AF) → can provoke VF.💊 Meds (adult highlights)Epinephrine: Arrest 1 mg IV/IO q3–5 min; Brady 2–10 mcg/min. Flush 20 mL + elevate limb. Amiodarone: VF/pVT refractory 300 mg, then 150 mg; maint 1 mg/min ×6 h. Lidocaine: 1–1.5 mg/kg, then 0.5–0.75 mg/kg (max 3 mg/kg). Magnesium: 1–2 g for torsades. Atropine: 1 mg IV (max 3 mg). Adenosine: 6 mg → 12 mg rapid push + flush.

🫀 Why Patients Die (and How ACLS Saves Them) Cardiac arrest = no effective circulation → global ischemia. Survival hinges on CPP (aortic diastolic − RA pressure). • High-quality CPR (≥2 in/5 cm, 100–120/min, full recoil, CCF ≥80%) maintains CPP; every pause tanks CPP. • Defibrillation for VF/pVT stuns chaotic myocardium → pacemakers can resume an organized rhythm (ROSC). Shock early.Rhythms & Management🔹 Shockable: VF / pVT ECG: VF = chaotic; pVT = fast wide-QRS + no pulse. Algorithm (cycle):Start CPR, attach defib.Shock (biphasic 120–200 J per device; mono 360 J).CPR 2 min → rhythm check. Gain IV/IO.If still shockable → Shock → Epi 1 mg IV/IO q3–5 min (give after the next rhythm check/shock).Next cycle if shockable → Shock → Amio 300 mg IV/IO, then 150 mg (or Lido 1–1.5 mg/kg, then 0.5–0.75 mg/kg; max 3 mg/kg).Treat H’s & T’s, monitor ETCO₂. Rotate compressors q2 min. Nursing: Have antiarrhythmic drawn before shock; “All clear—shocking.”🔹 Nonshockable: Asystole / PEA (mechanical/perfusion problem)ECG: Asystole = flat line (check leads/gain). PEA = organized rhythm without a pulse. Algorithm: • CPR 2 min, Epi 1 mg IV/IO q3–5 min ASAP. • No defib. H’s & T’s hunt: Hypovolemia, Hypoxia, H+ (acidosis), Hypo/Hyper-K, Hypothermia; Tension pneumo, Tamponade, Toxins, Thrombosis (pulm/coronary). Nursing: Do not interrupt CPR >10 s; assign someone to etiology search (history + ultrasound).Meds Epinephrine (α-vasoconstrictor → ↑aortic diastolic → ↑CPP) • Arrest dose: 1 mg IV/IO q3–5 min (VF/pVT & Asys/PEA). No arrest contraindication. • Do not stop CPR to push meds; flush 20 mL + elevate limb 10–20 s.Amiodarone (Class III; stabilizes myocardium) • VF/pVT refractory: 300 mg, then 150 mg IV/IO. • Post-bolus hypotension/brady can occur (less relevant during arrest).Lidocaine (Class Ib; ↓automaticity) • VF/pVT alt: 1–1.5 mg/kg, then 0.5–0.75 mg/kg (max 3 mg/kg).Magnesium sulfate (torsades) • 1–2 g IV/IO diluted (~10 mL) over ~20 min (use if torsades present).During arrest • No advanced airway: 30:2. • Advanced airway: 10 breaths/min (q6 s) with continuous compressions. • Avoid hyperventilation.Post-ROSC targets • Ventilation: start 10/min; SpO₂ 92–98%; PaCO₂ 35–45 mmHg (avoid hyperoxia/hyperventilation). • Hemodynamics: SBP ≥90 or MAP ≥65. – Fluids 1–2 L NS/LR → if needed: NE 0.1–0.5 μg/kg/min, Epi 2–10 μg/min, or Dopa 5–20 μg/kg/min. • TTM: comatose after ROSC → 32–36°C for ≥24 h (don’t delay PCI for STEMI). • Confirm ET tube with capnography.

⚡ ACLS Deep Dive: Rhythms with a Pulse (Brady & Tachy) ⚡1️⃣ Core Concepts — When to Shock, When to Chill 💥 Synchronized Cardioversion: For unstable rhythms with a pulse — unstable SVT, AFib, flutter, or monomorphic VT. Sedate if possible. ⚡ Unsynchronized (Defibrillation): For pulseless VT/VF or unstable polymorphic VT (if rhythm can’t be timed safely). 🧠 Rule: If they have a pulse but are tanking → cardiovert. No pulse → shock.2️⃣ Bradycardia Algorithm 🫀 (HR < 50 + symptoms) 1️⃣ Atropine 1 mg IV bolus, repeat q3–5 min (max 3 mg). 2️⃣ If ineffective → TCP (Transcutaneous Pacing) or Epinephrine 2–10 mcg/min / Dopamine 5–20 mcg/kg/min. 3️⃣ Don’t delay pacing for ECG — treat first. 🚫 Atropine traps: – Doesn’t work in Mobitz II or 3° AV block w/ wide QRS — pace instead. – Ineffective in heart transplant pts. – <0.5 mg may paradoxically slow HR.3️⃣ Tachycardia Algorithm 🔥 (HR > 150) 💣 If Unstable (shock, hypotension, chest pain, AMS, HF): → Immediate synchronized cardioversion (follow device energy levels). 💤 Sedate if conscious unless rapidly deteriorating. 📈 If Stable:Narrow QRS, Regular (SVT): Vagal maneuvers → Adenosine 6 mg rapid IV push, then 12 mg if needed.Wide QRS, Regular/Monomorphic: Expert consult → Amiodarone 150 mg IV over 10 min, or Procainamide/Sotalol if available. ⚠️ Avoid AV nodal blockers (Adenosine, CCBs, β-blockers) in irregular wide-complex rhythms (e.g., pre-excited AFib/WPW) — can cause VF!4️⃣ High-Yield Meds 💊 • Atropine: 1 mg IV q3–5 min (max 3 mg). Avoid in advanced blocks/transplants. • Epinephrine (infusion): 2–10 mcg/min for bradycardia after atropine fails. • Dopamine: 5–20 mcg/kg/min if epi unavailable. • Adenosine: 6 mg → 12 mg IV push for regular narrow tachycardia. 🚫 Never for irregular wide-complex rhythms. • Amiodarone: 150 mg IV over 10 min for stable wide monomorphic VT → 1 mg/min x 6 hr → 0.5 mg/min.5️⃣ Airway & Oxygen 🫁 Maintain patent airway; assist ventilation if needed. Give O₂ only if hypoxemic. Monitor continuously.6️⃣ Nursing Priorities & Real-World Moves 🩺 ✅ If unstable → act fast: Atropine, pacing, or cardioversion. Don’t wait for 12-lead. ✅ Confirm mechanical capture with TCP (check femoral pulse — not carotid). ✅ Sedate before cardioversion if conscious. ✅ Get expert consult for stable wide-complex tachycardias. 📞 Call for help early if instability persists or rhythm unclear.7️⃣ Exam Traps & Common Mistakes ⚠️ 🚫 Giving Atropine in 3° block w/ wide QRS — it won’t work. Go straight to pacing or Epi/Dopa. 🚫 Using AV nodal blockers (Adenosine, β-blockers, CCBs) in pre-excited AFib → can cause VF. 🚫 Delaying cardioversion for an unstable tachycardia — act first. 🚫 Forgetting sedation for conscious cardiovert patients. 🚫 Mistaking electrical twitch for a pulse during pacing — always confirm mechanical capture.8️⃣ 2-Min Quick Recall 🔥 1️⃣ Brady: Atropine 1 mg → TCP → Epi 2–10 mcg/min / Dopa 5–20 mcg/kg/min. 2️⃣ Don’t rely on Atropine for Mobitz II, 3° AV block, or transplant pts. 3️⃣ Unstable tachy = cardiovert NOW. 4️⃣ Stable SVT = vagal → Adenosine 6 → 12 mg. 5️⃣ Stable monomorphic VT = Amio 150 mg/10 min. 6️⃣ Never Adenosine or AV blockers in irregular wide-complex. 7️⃣ Always confirm mechanical capture after pacing.

💨 ACLS Deep Dive: Respiratory Arrest (With a Pulse) 🫁1️⃣ BLS Foundation — Keep It Basic, Keep It Alive Scene safe ✅ → Check responsiveness → Shout for help 📣 → Activate emergency response 🚑 → Check breathing + pulse simultaneously (≤10 sec). 💤 If no breathing but pulse present → Respiratory Arrest. 👉 Deliver 1 breath every 6 seconds (10/min) via BVM or advanced airway. 👉 Recheck pulse every 2 minutes (5–10 sec). 👉 If pulse disappears → start CPR immediately.2️⃣ Airway Priorities — The ABCs Still Rule 🫀 Open the airway:Most common obstruction = tongue fall-back.Use head-tilt chin-lift (no trauma) or jaw-thrust (suspected trauma). 💨 Ventilation:1 breath q6 sec (10/min) with visible chest rise.Tidal volume ≈ 500–600 mL (6–7 mL/kg).Avoid hyperventilation — it kills perfusion. 🧩 Adjuncts:OPA: Only in unresponsive pts w/out gag/cough reflex.NPA: Use if conscious, semi-conscious, or intact gag reflex. 🚫 Wrong size → gastric inflation or esophageal placement → ↓ventilation & ↑aspiration risk. 🧠 If opioid overdose suspected: Administer Naloxone per protocol.3️⃣ Ventilation Traps — “Less is More” ⚠️ Overventilation is deadly: 🚫 ↑ Intrathoracic pressure → ↓ venous return. 🚫 ↓ Cardiac output → ↓ perfusion → ↓ survival. 🚫 Cerebral vasoconstriction → ↓ brain blood flow. 🚫 Gastric inflation → aspiration risk. 🎯 Goal: Just enough air to see chest rise — no more.4️⃣ Algorithm Snapshot 🧩 If Respiratory Arrest (Pulse Present): 1️⃣ Open airway (head-tilt or jaw-thrust). 2️⃣ Use OPA/NPA if needed. 3️⃣ Ventilate 1 breath q6 sec w/ 100% O₂. 4️⃣ Avoid excessive ventilation. 5️⃣ Check pulse every 2 min. 6️⃣ If no pulse → switch to CPR. 🧾 Use waveform capnography for ET tube placement & ventilation quality monitoring.5️⃣ Meds & Extras 💉 Epi, Amio, Adenosine = not indicated here. Only drug of note: Naloxone for suspected opioid overdose. Some settings may initiate RSI (rapid sequence intubation) if trained and equipped.6️⃣ Nursing Priorities 🩺 ✅ Maintain airway patency. ✅ Ensure effective ventilations (visible chest rise, SpO₂ monitoring). ✅ Avoid gastric inflation — slow, gentle breaths. ✅ Reassess pulse + airway every 2 min. ✅ Use ETCO₂ to confirm airway placement + monitor ventilation quality. ✅ Activate additional help early if ventilation difficult or ineffective.7️⃣ “Gotcha” Exam Traps 🎯 🚫 Never use OPA in any patient w/ gag or cough reflex. 🚫 Don’t hyperventilate — it reduces cardiac output. 🚫 Don’t skip the pulse check before starting compressions. 🚫 Don’t forget airway adjuncts — tongue obstruction is #1 cause.8️⃣ 2-Min Quick Recall 🔥 1️⃣ 1 breath every 6 sec (10/min). 2️⃣ 500–600 mL or just enough for visible chest rise. 3️⃣ Avoid excessive ventilation — kills perfusion. 4️⃣ OPA = only if no gag; NPA = okay if gag present. 5️⃣ Check pulse q2 min; if absent → CPR. 6️⃣ Use capnography to confirm airway & monitor effectiveness.

🧠 ACLS Deep Dive: Stroke Edition (High-Yield & Real-World) 🚨1️⃣ Stroke Chain of Survival — “Time = Brain” Recognize ➡️ Call 9-1-1 🚑 ➡️ EMS alerts hospital ➡️ Rapid diagnosis ➡️ Treatment (thrombolytics or EVT). Goal: minimize brain injury, maximize recovery. Every minute = 1.9 million neurons lost. ⏱️2️⃣ Critical Drug — Alteplase (tPA) 💉 • Window: ≤3 hr from symptom onset (extend to 4.5 hr in select pts). • EVT (mechanical thrombectomy): up to 24 hr for large-vessel occlusion (LVO). • Dose: 0.9 mg/kg (10% bolus 1 min → 90% infuse 60 min; max 90 mg). • BP goal: ≤185/110 mm Hg before tPA and ≤180/105 mm Hg for 24 hr after. • Absolute no-go: any intracranial hemorrhage on CT/MRI 🚫. • Watch glucose: correct hypo and avoid >180 mg/dL.3️⃣ Airway & ABCs 🫁 Assess airway → oxygen if SpO₂ ≤ 94% or unknown. Stroke pts risk aspiration and hypoventilation — keep suction ready and watch for airway obstruction.4️⃣ Rapid Algorithm (What to Know Cold) 1️⃣ Activate Stroke Team immediately upon EMS notification. 2️⃣ General + Neuro assessment within 10 min of arrival. 3️⃣ CT/MRI ≤ 20 min (best practice: direct to scanner). 4️⃣ Interpret ≤ 45 min → if hemorrhage = NO tPA. 5️⃣ If no bleed → administer tPA (if eligible). 6️⃣ Door-to-Needle: ≤ 60 min (Goal: 85% meet this). 7️⃣ EVT: Door-to-device ≤ 90 min (direct) / ≤ 60 min (transfer).5️⃣ Nursing Priorities & Critical Thinking 🩺 🚨 Activate stroke system immediately when symptoms recognized. 💉 Start IVs early (but don’t delay CT). 💨 Maintain airway + O₂ ≥ 94%. 🩸 Monitor BP closely during and after tPA. 🧾 Document last known well time — it defines eligibility. ⚡ Do NOT delay CT for ECG or labs — “Time is Brain.”6️⃣ Key Contraindications / Exam Traps ⚠️ • Hemorrhage on imaging = NO tPA. • BP >185/110 mm Hg = NO tPA until controlled. • Do not delay CT/MRI for Atropine or Adenosine (if brady/tachy). • Uncontrolled HTN, active bleeding, or recent surgery = 🚫. • Treating stroke mimics w/ tPA can cause ICH — consult stroke expert.7️⃣ Critical Times You Must Memorize ⏰ • General assessment ≤ 10 min • CT/MRI obtained ≤ 20 min • CT interpreted ≤ 45 min • Door-to-needle ≤ 60 min • Door-to-device (Thrombectomy) ≤ 90 min8️⃣ “Gotcha” Moments 🧩 💡 Never give tPA before imaging rules out bleed. 💡 Never “wait for labs” before CT unless they directly affect tPA eligibility (e.g., coags). 💡 Aggressive BP lowering before CT can mask stroke severity — treat only if >220/120 and no tPA planned.9️⃣ 2-Min Quick Recall 🔥 1️⃣ Ischemic = 87% of strokes 🧠 2️⃣ CT/MRI ≤ 20 min → NO BLEED = candidate for tPA 3️⃣ Door-to-Needle ≤ 60 min 4️⃣ Alteplase 0.9 mg/kg (max 90 mg) — 10% bolus, 90% infuse 60 min 5️⃣ BP < 185/110 before tPA; maintain < 180/105 after 6️⃣ O₂ ≤ 94% → supplement 7️⃣ “Time is Brain” — act fast or neurons die.

🔥 ACLS Deep Dive: High-Yield Crash Summary 🔥1️⃣ Chain of Survival – Keep It Simple Recognize 🚨 → Activate EMS 🚑 → Rapid transport + prearrival notice → ED/cath lab diagnosis → Reperfusion 💥. STEMI survival depends on speed. Every second = muscle saved.2️⃣ Shockable vs Nonshockable – Know the Split 💥 VFib & pulseless VT = shock now. 🫀 Asystole & PEA = compress & give epi. Defib/cardioversion breaks lethal rhythms; compressions buy time.3️⃣ Key Meds & Timing ⏱️ • Aspirin: 162–325 mg, chewed, ASAP — blocks thromboxane A₂ to stop clot growth. • Nitroglycerin: Sublingual/translingual; repeat ×3 if SBP ≥ 90 mm Hg and no RV infarct. • Morphine: Only if pain persists after NTG. 🚫 Avoid if hypotensive. • Oxygen: Give only if SpO₂ < 90% or patient is dyspneic/hypoxemic. • Immediate priorities (<10 min): ABCs, IV access, ECG, labs, call cath team.4️⃣ Brady vs Tachy – Pulse Present ⚡ Unstable bradycardia → pace. Unstable tachycardia → cardioversion. Unstable = hypotension, altered LOC, shock, chest pain, or pulmonary edema.5️⃣ Cardiac Arrest Core Logic 🧠 • VF/pVT: Shock → CPR 2 min → shock → epi 1 mg q3–5 min → amio 300 mg bolus (then 150 mg). • Asystole/PEA: CPR + epi; no shock until rhythm changes. Keep compressions ≥ 2 in deep, rate 100–120/min, minimize interruptions.6️⃣ Nursing Priorities 🩺 🚨 Call Rapid Response if HR < 40 / > 140, RR < 6 / > 30, SBP < 90, seizure, ↓LOC, or oliguria. 💡 When to Shock vs Compress: Shock for VF/pVT; compress for asystole/PEA. 💨 Airway: Manage ABCs first — secure airway, ventilate, oxygenate. 📊 Post-ROSC: Target ETCO₂ 35–40 mm Hg, O₂ 94–99%, maintain SBP > 90 mm Hg.7️⃣ Contraindications & Traps ⚠️ • NTG/Morphine: Never in hypotension or RV infarct. • NSAIDs (except ASA): 🚫 During STEMI — ↑ risk of death, reinfarction, rupture. • Aspirin: Must be chewed (not enteric-coated). • Delay of Therapy = Death: 1️⃣ Diagnosis delay 2️⃣ Decision delay 3️⃣ Door-to-balloon delay 4️⃣ Door-to-departure delay8️⃣ Reperfusion Goals ⏰ • PCI (door-to-balloon): ≤ 90 min from first medical contact. • Fibrinolysis (door-to-needle): ≤ 30 min of ED arrival. Miss these → ↑ mortality.9️⃣ Rapid 2-Min Recall 🧩 1️⃣ RRT: HR < 40/>140, RR < 6/>30, SBP < 90. 2️⃣ ACS < 10 min: ABCs, IV, ECG, ASA, NTG, O₂ < 90%. 3️⃣ ASA 162–325 mg chewed. 4️⃣ NTG/Morphine 🚫 if hypotension or RV infarct. 5️⃣ PCI ≤ 90 min, Fibrinolysis ≤ 30 min. 6️⃣ No NSAIDs (except ASA).Bottom line 💀: Stay calm, think algorithmically, don’t delay shocks, and hit those reperfusion windows like your patient’s life depends on it — because it does.

🧠 NEUROLOGY: HIGH-YIELD NURSING STUDY GUIDE ⚡ Your rapid-fire review of the neuro system’s biggest killers and clinical traps. Straight to the point, loaded with red flags 🚨, and built for real-world nursing.🩸 TRAUMATIC BRAIN INJURY (TBI) & ICPMild TBI: GCS ≥13, LOC <30 min. 90% of all neurotrauma.Moderate–Severe TBI: GCS ≤12. Watch for Cushing’s Triad (↑BP, ↓HR, irregular respirations). ➤ ATLS protocol, maintain perfusion, give mannitol or hypertonic saline.Epidural Hematoma: ⚠️ Lucid interval, then coma. Ipsilateral dilated pupil → emergency craniectomy.Subdural Hematoma: Often venous. Elderly/anticoagulated high risk. Treat with surgical decompression.Herniation: Brain shift due to ↑ICP—uncal herniation = blown pupil + contralateral weakness. ➤ Mannitol, hyperventilation, surgical decompression.🧬 CEREBROVASCULAR DISORDERSIschemic Stroke: 🕒 Time = Brain. Sudden neuro deficit (aphasia, hemiparesis, vision loss). ➤ IV rtPA (alteplase) within 4.5 h if no contraindications. Mechanical thrombectomy up to 24 h.Hemorrhagic Stroke: Headache, vomiting, ↓LOC. Often hypertensive or aneurysmal. ➤ Reverse anticoagulation, control BP, consider surgical evacuation.NPH (Normal Pressure Hydrocephalus): Hakim’s Triad — gait instability, dementia, incontinence.🦠 CNS INFECTIONS & SEIZURESBacterial Meningitis: Fever, neck stiffness, photophobia, ↓LOC. Petechial rash = meningococcal sepsis 🚨 ➤ Dexamethasone IV → then ABX, isolate, monitor for sepsis & hydrocephalus.Viral Encephalitis (HSV): Hallucinations, confusion → IV Acyclovir STAT.Status Epilepticus: Seizure >5 min = neuro emergency. ➤ 1st: Midazolam/Lorazepam IV → 2nd: repeat → 3rd: Phenytoin/Valproic/Levetiracetam.Absence Seizures: 5–10 sec “blank stares,” often in kids. Provoked by hyperventilation.Todd Paresis: Transient weakness after seizure (mimics stroke).🧍‍♀️ DIAGNOSTIC & NURSING CRITICALSGCS: Eye, Verbal, Motor — use highest side score.Pupils: Dilated + unreactive = herniation or EDH ⚡Headache Red Flags: Sudden severe onset, fever, neuro deficit, morning vomiting, age >50.Lumbar Puncture: Flat 1–4 h post-procedure. ❌Contraindicated w/ ↑ICP (risk of herniation).CT/MRI: CT = first-line for TBI/SAH. MRI contraindicated in metal implants or unstable pts.💉 CRITICAL LABS & DRUG MONITORINGBacterial CSF: ↑Pressure, ↑WBC (neutrophils), ↑Protein, ↓Glucose, cloudy.Viral CSF: Normal glucose, lymphocytes, clear.Post-Thrombolysis Bleed Risk: Major complication of rtPA.Anticoag Monitoring:Warfarin → INRHeparin → aPTTLMWH → anti-Xa

💊 PHARM STUDY GUIDE: HALOPERIDOL (Haldol) Class: First-generation antipsychotic 🧠 MOA (80/20): High-potency D2 receptor antagonist → ↓ mesolimbic dopamine (helps positive symptoms). D2 block in other tracts drives side effects. 🧭 Dopamine Pathways (clinical relevance):Mesolimbic: D2 block → ↓ hallucinations/delusions ✅. Nigrostriatal: D2 block → EPS/pseudoparkinsonism ⚠️. Tuberoinfundibular: D2 block → ↑ prolactin (galactorrhea, menstrual changes).📋 Indications (common): Schizophrenia; acute agitation (IM lactate); Tourette’s tics; long-term adherence with decanoate IM depot (not IV). Some off-label (e.g., delirium) are used with caution. ⚠️ Boxed/Geriatric Warning: Not approved for dementia-related psychosis; ↑ mortality and stroke risk—avoid unless benefits outweigh risks. ❤️ Cardiac Risks: QT prolongation/TdP; risk higher with IV use and high doses; correct K/Mg, monitor ECG, avoid other QT-prolongers. (IV haloperidol is not FDA-approved.) 🔥 Life-Threatening:NMS: fever, rigidity, AMS, autonomic instability → stop drug, ICU care.Severe hematologic/hepatic events (rare) → check CBC/LFTs if symptomatic. 🩺 Common/Important AEs: EPS (akathisia, dystonia, parkinsonism), TD with chronic use; sedation/orthostasis less than many SGAs due to weaker H1/α1 effects. Use AIMS to screen for TD. Treat acute dystonia/akathisia with anticholinergic or dose change.💊 Formulations & PK pearls:IM lactate: rapid control (peaks ~20–40 min).PO: peaks 2–6 h; bioavailability ~60%.IM decanoate: depot; peak ≈6 days; t½ ≈3 weeks; IM only.Metabolism: hepatic CYP2D6/CYP3A4 → active hydroxyhaloperidol. Poor 2D6 metabolizers: ↑ EPS risk. 🚫 Major Contra/Interactions (high-yield):Avoid with strong QT-prolongers (e.g., pimozide, quinidine; many azoles) → TdP. CYP inhibitors ↑ levels/QT (e.g., ketoconazole + paroxetine combo raised QTc). Ritonavir/fluvoxamine/fluoxetine can elevate levels—consider dose ↓ and ECG. CYP inducers (rifampin, carbamazepine) ↓ levels → relapse risk. Parkinson’s disease: avoid—worsens motor symptoms. 🧑‍⚕️ Nursing/Monitoring:Baseline and periodic ECG, vitals; correct electrolytes.EPS/TD checks (AIMS), fall precautions.Prolactin-related effects counseling.Reassess need regularly in older adults; document non-pharm attempts for BPSD.🎯 Top 5 NCLEX Takeaways:High-potency D2 blocker → great for positive sx, high EPS/TD risk.QT/TdP risk (esp. IV/high dose) → ECG & avoid QT drugs. Not for dementia psychosis (boxed warning). Decanoate = IM only depot; no IV. Watch for NMS—fever + rigidity = emergency

💊 PHARM STUDY GUIDE: AMITRIPTYLINE (Elavil) Class: Tricyclic Antidepressant (TCA)🧠 MOA (80/20): Blocks neuronal reuptake of serotonin & norepinephrine; also anticholinergic, antihistamine, and sodium-channel effects → efficacy + side-effect burden. NCBI📋 Indications (what you’ll actually see):Major depressive disorder Off-label, low dose: neuropathic pain, migraine prevention, insomnia (sedating).⚠️ Red-Flag Side Effects (Prioritize 🚨):Cardiac toxicity – QT prolongation, conduction block, ventricular arrhythmias; overdose can be fatal. Monitor ECG/electrolytes in risk pts. Serotonin syndrome (with MAOIs/serotonergics): fever, agitation, hyperreflexia, diarrhea, tremor, clonus. Stop drug; supportive care; consider cyproheptadine.Anticholinergic crisis – delirium, urinary retention, ileus, hyperthermia (elderly esp.).Orthostatic hypotension & falls (α1-blockade).Suicidality boxed warning in children, adolescents, young adults—highest risk at start & dose changes. 🩺 Nursing Interventions & Monitoring:Baseline & periodic BP/HR, ECG if cardiac risk, electrolyte check (K/Mg) if QT risk. Screen for suicidal ideation early and with any dose change. Watch for anticholinergic effects (bowel regimen, fluids), falls, urinary retention.Assess for drug interactions (see below) and serotonin syndrome.🚫 Contraindications & Dangerous Combos:MAOIs: contraindicated; 14-day washout (risk of hyperpyrexia/convulsions/SS). Strong CYP2D6 inhibitors (e.g., fluoxetine, paroxetine) ↑ TCA levels → toxicity; avoid or adjust/monitor closely. Additive QT-prolonging meds (amiodarone, macrolides, antipsychotics) → arrhythmia risk. Potentiation with other anticholinergics/CNS depressants (falls, delirium). 🎯 Top 5 High-Yield Takeaways:Powerful but not first-line due to side effects/toxicity—reserve for refractory depression or low-dose pain/migraine.Cardiac safety first: screen QT risks, consider baseline ECG. Night dosing, slow titration, and taper to discontinue. Avoid MAOIs; beware CYP2D6 inhibitors (e.g., fluoxetine). Monitor suicidality, anticholinergic burden, falls, and serotonin syndrome. 🧩 80/20 Summary: Think TCA = reuptake block + anticholinergic + cardiac risk. Safe use = low & slow, night dose, ECG when needed, interaction check, taper, monitor mood & SS.

💊 PHARM STUDY GUIDE: VENLAFAXINE Class: SNRI – Serotonin Norepinephrine Reuptake Inhibitor🧠 Mechanism of Action (MOA): Blocks reuptake of serotonin (5-HT) and norepinephrine (NE) → ↑ levels in synaptic cleft → improved mood & anxiety control. Weak dopamine effect.📋 Indications:Major Depressive Disorder (MDD) 🧩Generalized Anxiety Disorder (GAD) 😰Panic & Social Anxiety Disorders 😳Off-label: Menopausal hot flashes 🌡⚠️ Red-Flag Side Effects (Prioritize 🚨): 1️⃣ Serotonin Syndrome (LIFE-THREATENING) – fever, shivering, agitation, hyperreflexia, rigidity, tachycardia, diarrhea, seizures. 👉 Action: STOP drug, supportive care, cyproheptadine if severe. 2️⃣ Suicidal Ideation – especially in <25 yrs or early therapy. 👉 Action: Monitor mood, report new/worsening depression. 3️⃣ Cardiac Events – ↑ BP, HR, QT prolongation, rare TdP. 👉 Action: Monitor VS, ECG, electrolytes; report chest pain or syncope. 4️⃣ Bleeding Risk – ↓ platelet serotonin → ↑ risk w/ NSAIDs, ASA, anticoagulants. 👉 Action: Monitor for GI bleed, bruising, petechiae. 5️⃣ Hyponatremia/SIADH – elderly or diuretic use. 👉 Action: Monitor Na⁺; report confusion, headache, weakness.💉 Common Side Effects (Manage): Nausea 🤢, headache, insomnia, constipation, dry mouth, dizziness, sexual dysfunction. Tip: Take w/ food to ↓ GI upset.🩺 Nursing Interventions:Assess suicidal risk, anxiety, BP, HR regularly.Watch for serotonin syndrome (esp. if on SSRIs, MAOIs, or triptans).Educate: may take 2–4 weeks for full effect.Taper gradually → abrupt stop = withdrawal (dizziness, “brain zaps”).Teach to take same time daily; XR form must be swallowed whole.Avoid alcohol 🍷 → risk of rapid drug release & toxicity.For hepatic/renal impairment → reduce dose 25–50%.💣 Contraindications & Dangerous Combos: ❌ MAOIs, linezolid, methylene blue → fatal serotonin syndrome. ❌ Other serotonergic drugs (SSRIs, SNRIs, TCAs, tramadol). ❌ QT-prolonging agents (amiodarone, ziprasidone, macrolides).📊 Pharmacokinetics Highlights:Metabolism: CYP2D6 (major), CYP3A4 (minor). Inhibitors ↑ toxicity risk.Half-life: Venlafaxine 5 h, metabolite (ODV) 11 h.Excretion: Mostly renal → dose adjust if impaired.🎯 Top 5 High-Yield Takeaways: 1️⃣ Monitor suicidality early & during dose changes. 2️⃣ Never mix with MAOIs or other serotonergic meds. 3️⃣ Swallow XR whole & take with food. 4️⃣ Track BP/ECG & bleeding (esp. if on anticoagulants). 5️⃣ Taper off slowly to avoid severe withdrawal.🧩 80/20 Rule Summary: 👉 SNRIs like venlafaxine boost serotonin + norepinephrine. Know serotonin syndrome, suicidality, BP/QT risk, bleeding, and withdrawal — that’s 20% of content, 80% of what you’ll be tested on.⚡️“Start low, go slow, and watch the glow — serotonin can burn hot.”🔥#PharmNerd 🧠 #EffexorXR #SNRI #NursingSchool #NCLEXPrep #MentalHealth

💊 HIGH-YIELD SSRI OVERVIEW (80/20 Rule) (Selective Serotonin Reuptake Inhibitors)🧠 Core Concept: SSRIs ↑ serotonin levels by blocking reuptake in the synaptic cleft — boosting mood, reducing anxiety, and stabilizing emotional regulation.📋 Top Drugs to Know: Fluoxetine (Prozac) 🌀 Sertraline (Zoloft) 🌊 Escitalopram (Lexapro) 💎 Citalopram (Celexa) 🌤 Paroxetine (Paxil) ⚠️ (sedating, more withdrawal risk)🩺 Main Indications (What You’ll Actually See):Depression (MDD)Anxiety Disorders (GAD, panic, OCD, PTSD, social anxiety)PMDD & Bulimia (Fluoxetine)Panic Disorder (Sertraline)⚡️ Mechanism of Action (Simple): Blocks serotonin reuptake pump → serotonin stays longer in the synapse → improved mood & less anxiety.⏱ Onset: Takes 2–4 weeks for full effect. Educate patients early: “You won’t feel better overnight.”⚠️ Major Side Effects (Know These Cold):Sexual dysfunction (↓ libido, anorgasmia)GI upset (nausea, diarrhea early on)Insomnia or sedation (drug-dependent)Weight changes (gain with Paroxetine)HeadacheSerotonin Syndrome 💀 → mental status changes, hyperreflexia, myoclonus, fever, shivering (esp. with MAOIs, St. John’s Wort, or triptans). 👉 Tx: Stop SSRI, give benzodiazepines, supportive care, ± cyproheptadine.💣 Black Box Warning: ↑ suicidal thoughts in adolescents & young adults (esp. in first few weeks).🚫 Contraindications & Cautions:MAOIs — must wait 14 days between use → risk of serotonin syndrome.Avoid abrupt discontinuation — causes flu-like withdrawal (esp. Paroxetine).💉 Nursing Implications:Monitor mood, anxiety, suicidal ideation early in therapy.Educate on delayed effect & adherence.Watch for serotonin syndrome if combined with other serotonergic agents.Encourage taking same time daily.Sertraline often best for patients with cardiac disease (safe profile).🧩 Clinical Pearls:Fluoxetine = longest half-life (good for poor adherence).Paroxetine = most sedating, highest withdrawal risk.Sertraline = go-to for anxiety & PTSD.Escitalopram = cleanest side effect profile.🧠 80/20 Takeaway: SSRIs = first-line for depression/anxiety. Know onset delay, serotonin syndrome signs, sexual dysfunction, and black box warning.⏳ 2–4 weeks to work. Watch early mood shifts. Don’t mix with MAOIs.✨ Start low, go slow, and monitor the glow (serotonin).

💊 HIGH-YIELD PHARM REVIEW: LEVOTHYROXINE (Synthroid, Levoxyl, Euthyrox)Levothyroxine sodium is a synthetic T4 thyroid hormone—the body’s inactive form that converts to T3, the active hormone responsible for regulating metabolism, energy use, cardiac output, and CNS development. 🧠❤️🔹 Mechanism of Action (MoA): Mimics natural thyroxine (T4) → converted to triiodothyronine (T3) in tissues → restores normal metabolism and energy balance.🔹 Primary Uses: • Hypothyroidism (all causes) • Myxedema coma (IV form – emergency use)🔹 Therapeutic Goal: Normalize TSH and T4 → relieve fatigue, weight gain, bradycardia, cold intolerance, and cognitive slowing.⚠️ Toxicity / Overdose = Hyperthyroidism Symptoms: • Cardiac: Tachycardia, palpitations, arrhythmias, angina, HF, cardiac arrest 🚨 • Neuro: Tremor, insomnia, seizures, anxiety, pseudotumor cerebri • Metabolic: Heat intolerance, weight loss, hyperthermia • Other: Emotional lability, diaphoresis, weakness👩‍⚕️ Nursing Management & Dosing Pearls • Start low, go slow—especially in older adults or cardiac pts (12.5–25 mcg/day) 💗 • Myxedema coma: IV 200–400 mcg bolus + glucocorticoids to prevent adrenal crisis • Pediatrics: Start with 25% of full dose and titrate weekly to avoid hyperactivity • Never use for weight loss in euthyroid pts ❌🍽️ Administration Tips (Oral): • Take on an empty stomach, 30–60 min before breakfast ☀️ • Avoid taking with coffee, fiber, soy, calcium, iron, or antacids—space 4 hours apart • Swallow capsules whole; crush tablets only if allowed and give immediately • Give separately from enteral feedings💉 IV Administration: • Preferred over IM; reconstitute only with 0.9% NaCl • Stable 4 hours—discard remainder • Push slowly (≤100 mcg/min) via Y-site • IV → PO conversion: increase PO dose by 20–25%⚠️ Major Drug Interactions (Must-Know!) • Warfarin: ↑ anticoagulant effect → monitor INR closely 🩸 • PPIs, Antacids, Calcium, Iron: ↓ absorption → separate by 4 hrs • Antidiabetics: ↓ glucose control → monitor blood sugars • Amiodarone: may cause hypo- or hyperthyroidism → monitor TSH/T4 • Semaglutide (oral): ↑ T4 exposure by 33% → monitor for hyperthyroid sx📚 Clinical Pearls: • Absorption: 40–80% (best fasting). • Half-life: ~9–10 days → steady-state 4–6 weeks; re-check TSH after any dose change. • Pregnancy: Safe and essential—dose often ↑ 30–50%; revert postpartum 👶 • Growth: Overuse + GH → early epiphyseal closure in kids. • Gastric Acidity: Required for absorption—watch PPI users!💡 NCLEX Tip: If a hypothyroid patient reports nervousness, palpitations, or heat intolerance → sign of overdose! Hold dose and notify provider immediately.🧩 Summary Mnemonic: L-E-V-O = Low → start low dose Early AM on empty stomach Vitals (esp HR) monitor Overdose = hyperthyroid signs 🚨

This is everything 1st Gen Ceph Drugs. For my RN Program this class includes Cephalexin. First-Generation CephalosporinsExamples: Cefadroxil, Cefazolin, Cephalexin Class: Anti-infective | Pharmacologic: Cephalosporin (1st Gen) MOA: Binds to bacterial cell-wall membrane → cell death (bactericidal).Top Indications1️⃣ Skin & soft-tissue infections. 2️⃣ UTIs. 💉 Cefazolin: peri-operative surgical prophylaxis.Therapeutic EffectResolution of infection — ↓ redness, swelling, discharge, pain, fever.Contraindications / CautionsAllergy: Cephalosporin or serious PCN reaction → risk of anaphylaxis.Renal impairment: Drug is renally cleared → dose-adjust to avoid toxicity.GI disease / Colitis: ↑ risk for C. diff-associated diarrhea (CDAD).Red-Flag Adverse Effects🚨 Anaphylaxis / Severe Allergy: Stop drug → maintain airway → notify provider → prepare for epi/O₂/resus. 🚨 C. diff Diarrhea: Watery, foul stool (can occur weeks later) → discontinue, report immediately. ⚠️ Stevens-Johnson / TEN: Blistering rash ± fever → stop drug → seek emergency care. Common: Nausea, vomiting, diarrhea → give with food/milk. IV: Phlebitis → monitor site; rotate every 48–72 h.Nursing Priorities1️⃣ Always check allergy history (ceph ↔ PCN cross-sensitivity). 2️⃣ Monitor renal function (BUN/Cr). 3️⃣ Watch bowel pattern for CDAD. 4️⃣ Observe for rash or respiratory distress during first doses. 5️⃣ Teach: report rash, diarrhea, or SOB immediately.💊 Quick Recall: “1st Gen = 1st Line for Skin & Surgery.” Kills by breaking the wall; watch for Allergy, Abdomen, and Airway.