128: Psychogenic Non-Epileptic Seizures

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 patient Anterior vs. posterior circulation Classic vs. atypical presentations of basilar artery occlusion Why FAST alone can miss posterior circulation strokes Locked-in syndrome and assessing consciousness Stroke localization: a tour of the brain IV thrombolytics: alteplase, tenecteplase, and bleeding risk When to use mechanical thrombectomy CT perfusion: core infarct vs. ischemic penumbra 5 important takeaways for your next neuro emergency

"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

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

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