Rapid Response RN

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 op...

A 60-year-old patient recovering from surgery suddenly develops double vision. His vital signs are normal, his speech is clear, and he has no obvious one-sided weakness. But something isn't right.

What could cause such a dramatic neurological change? And what can we do to prevent permanent damage?

Put your critical thinking skills to the test and see if you can solve this mystery before the full case breakdown in Episode 167 of the Rapid Response RN Podcast!

"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...

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:

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:

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.

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.

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 di...

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...

"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...

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!

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 m...

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...

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 wh...

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...

Pulmonary embolisms don’t always announce themselves... sometimes they ambush.

One minute your patient is walking with physical therapy, the next they’re hypotensive, hypoxic, and coding. This re-released early episode dives deep into why PE patients can look deceptively stable… right up until they aren’t.

In this episode, I revisit one of my earliest case-based teachings on pulmonary embolism, updated with an added segment on vasopressin use in obstructive shock from PE. Through real bedside stories from my time as a rapid response and ER nurse, we break down the physiology behind PE-related collapse...

Some of the most common respiratory myths are still showing up at the bedside. But it's not your fault — most of us were never taught what an oxygenation problem versus a ventilation problem looks like in real time.

In this episode, Melody Bishop RT explains how respiratory therapists think through oxygenation and ventilation to choose the right intervention and recognize when a patient is ready to breathe on their own. We’re calling out the old dogma and myths that can delay treatment and worsen patient outcomes!

Topics discussed in this episode:

Rural nursing is anything but simple. They have limited resources, fewer specialists, and often have to send patients hours away from their families for a higher level of care. But all that is changing as new tech like Zeto brings monitoring right to the bedside and keeps more patients close to home.

In this episode, ICU nurse leader Kristen RN shares how point-of-care EEG has empowered her team to catch subclinical seizures sooner and make faster, more informed clinical decisions. From buy-in to implementation, you'll hear how she advocated for her community and successfully integrated this technology...

Your pneumonia patient is hypotensive, tachycardic, and not responding to fluids… what did you miss? It could be sepsis-induced cardiomyopathy, a common under-recognized shock state you could see at the bedside.

In this episode, Dr. Mahmoud Ibrahim MD and host Sarah Lorenzini use a case study to highlight how nurses, intensivists and the ICU team can work together to recognize the signs of sepsis-induced cardiomyopathy early and give patients a better chance at recovery. You'll learn the diagnostic clues that your patient’s heart is in trouble, how to approach controversial treatments like sodium bicarb, and what has...

Every five years, resuscitation guidelines get a refresh. This year, a few have changed, many have stayed the same, and some are creating major controversy.

In this episode, Dr. Ashish Panchal, Chair of the AHA Emergency Cardiovascular Care Committee, helps us unpack what’s new, what might surprise you, and the science behind each decision. You'll learn why there’s serious debate around epinephrine dosing, what changes matter most for the bedside, and how these updates will change the way you and your team respond to the next code!

Topics discussed in this...

Differential diagnosis is part physiology, part detective work. Especially in heart failure, where similar vital signs can mean very different things.

In this episode, Natalie RN is back on the show to break down two pediatric cases that looked almost identical on arrival to the ED but their workups led to two very different treatment plans. She shares the assessment findings, diagnostics, and clinical clues that helped them uncover what was really going on.

Learn how to connect the dots and find the right intervention when presentations look identical!

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Every trauma nurse knows this feeling: your stable patient suddenly starts to decompensate and instinct tells you there’s more to the story. Today’s case starts with a stable, post-arrest patient and ends in a full-blown tension pneumothorax.

Hear why this patient went from stable to crashing in minutes, how delayed recognition changed the course of care, what diagnostics and assessments could have caught earlier. Trauma Pete breaks down the tell-tale signs, how it differs from a simple pneumothorax, and why it's so easy to miss in trauma patients.

In this epis...

This is one of those cases that tests you in every way as a nurse. A toddler is pulled out of a pool and rushed to the ER, unresponsive and deteriorating fast. Today, Nurse Amber walks us through the critical moments that followed and how this case inspired her to turn her grief into a positive resource for nurses.

We discuss what was going on at the alveolar level in this patient, the interventions Amber and her team performed, and the emotional aftermath of working on critical pediatric patients. You’ll learn what to prioritize, the signs of...

Some conditions hide in your genes, without any symptoms. One of these conditions is genetic arrhythmogenic cardiomyopathy, an inherited condition that can lead to sudden cardiac arrest — even if you feel completely fine.

In this episode, Sarah and Leslie talk about their shared diagnosis of FLNC cardiomyopathy — from how this gene mutation affects the function of the heart to how they're managing this rare condition. You'll hear how Leslie's ICD has saved her life more than once, how it feels to be shocked back to life, and the resilience that's helped them move forward.

This is a...

What happens when a trauma patient isn’t just a trauma patient? In today’s episode, we’re diving into “Trauma Plus” — those high-stakes situations where comorbidities, medications, environmental exposures, or underlying medical emergencies complicate recognition of decompensation and change everything about how we care for our patients.

I’m joined by Flight Nurse Gwenny, who brings her expertise from the field to walk us through three complex trauma cases where things aren’t what they first appear to be. You’ll hear her real-time thought process as she navigates evolving scenarios and shares her assessment priorities, differential diagn...

Why would a healthy newborn suddenly stop eating and start vomiting? When a fussy baby comes into the ER, it's easy to assume it's nothing urgent — like colic or gas. But in today's case, there were small signs that pointed to something more.

This episode unpacks the high-risk condition and treatment of neonatal cardiogenic shock with Natalie Pleiman, pediatric nurse and clinical coach. From the early (often misleading) signs to critical assessments, you'll learn what makes cardiogenic shock different in neonates (specifically ductal dependent lesions), what to look for in patient labs, and how to manage the ri...

One unstable patient, three departments, and every nurse on alert... Let's break down what really happens during a high-risk STEMI. This episode follows the case of a 62-year old patient from ER to the Cath Lab to the ICU. Nurses Sarah Vance and Caitlyn Nichols help us explore the role of nurses in each stage of care, from stabilizing the patient to placing an Impella device.

We cover everything from IV placement and medications to monitoring patients through each phase of care. Learn how to prepare patients for the Cath Lab, manage complications like V-fib and bleeding...

Often, the first symptom of hypertrophic cardiomyopathy is sudden death. But sometimes, we get a warning— and that’s where clinical judgment at the bedside saves lives.

Today, Sarah goes over the case of her patient Ben, a 20-year-old experiencing syncope and chest pain. As his condition quickly deteriorated, the team had to carefully manage the patient before reaching a diagnosis of hypertrophic cardiomyopathy. Hear what pointed them to this diagnosis, why some standard interventions can be dangerous in HCM cases, and the critical decisions made during his treatment.

Listen now for a de...

Remember when we used to use stacked shocks for ventricular arrhythmias or load patients up with high doses of epinephrine and bicarb? Over the last 25 years, resuscitation guidelines have evolved and it’s our job to stay updated on the current protocols.

Here to help us break down what’s changed and what still works is Dr. Ashish Panchal, Chair of Emergency Cardiovascular Care for the AHA and host of the In the Heart of Care podcast. We discuss how a common cardiac arrest scenario would be treated from 2000 to today, highlighting key guideline changes like the shif...

Think of a case where you ignored your intuition, leaned on your training, and followed protocol… but something still felt off. Today, we're talking about how to balance evidence-based practice with those gut instincts that can change patient outcomes.

Dr. Vicki Good, DNP and Andrea Schmitt, hosts of the Voices in Nursing Podcast, share stories that highlight why intuition is just as important as clinical data and why nurses need to confidently speak up. You’ll learn how to develop your own intuition, teach others to trust their instincts, and the value of hindsight wisdom in building a da...

Do you ever look back on a case and see the signs you missed? Wonder why you got stuck on the wrong thing and didn’t see the patient clearly? Nurse Gwenny is back on the show to share a case that highlights the dangers of making assumptions in trauma care.

We discuss the subtle signs of the patient’s deterioration, why they were so easy to miss, and what we can learn from the case. You'll learn how anchoring bias can cloud your judgment, how to assess shock index, and which critical tool is underused in trau...

Rapid response teams provide so much more than reducing morbidity and mortality!  Think about how quickly things can spiral without the support of RRTs.

As the former director of specialty teams, Jaclyn Bond MSN-LM, MBA-HM has seen how a rapid response program can improve outcomes while also improving nursing job satisfaction and promoting retention. We talk about the MANY benefits of rapid response teams, including fewer code blues, more confident nurses, and their impact on hospital culture.

Learn how to advocate for these teams at your facility, collect data that will help you build your c...

You’re 30,000 feet in the air when you hear, “Is there a medical professional onboard?” Answering that call is a little more complicated than you might think.

In this episode, Alexandra Jabr, PhD, EMT-P joins Sarah to discuss what happened during their first in-flight medical emergencies — what surprises came up, what resources they had, and how they responded with limited supplies. They share what they learned about caring for patients mid-flight, from the most common in-flight emergencies to the legal considerations of volunteering. Tune in to find out how you can prepare and respond if you ever hear tha...

The flight team may be on the way, but your work isn’t done yet. Flight medic Sam, host of the Nine One One Nonsense podcast, shares what the ideal patient handoff looks like between hospital staff and flight crews, and why those final moments at the bedside matter more than you think. You’ll hear real-life examples of where in-hospital care teams often go wrong and how you can help create a safer, smoother transfer.

Sam also shares what it’s really like to be part of a flight crew — the challenges, team dynamics, and common misconce...

What began as a stroke alert turned into a different kind of emergency: aortic dissection. Today's patient case study follows a series of clinical decisions that saved an elderly man from a fatal misdiagnosis. Christian Guzman APRN walks us through the case — from the patient’s misleading symptoms to the diagnostic tests that showed something more was going on.

We dive into the anatomy, pathophysiology, and clinical signs of aortic dissection, including how the location of tears changes the presentation of symptoms. From emergency treatment strategies to post-op care, you’ll learn how to navigate the nuances of man...

One minute she was the nurse—then she became the emergency. Today, Shenell RN of the All One Nurse podcast shares her story of a ruptured ectopic pregnancy that sent her into emergency surgery on shift — and the second ectopic pregnancy that followed just a year later.

We talk through the symptoms she felt that day, how methotrexate treatment impacted her recovery, and the range of symptoms that can make it hard to tell what’s really going on. Shenell also opens up about the emotional toll of pregnancy loss, her journey to have her rainbow baby, and ho...

Rapid response nurses don’t just handle codes — they help prevent them from happening. Contrary to popular belief, Rapid Response Nursing is not just sprinting from code blue the next and neither is ER nursing.  While there are a lot of similarities between these two specialties in Nursing, there are a lot of differences too. In this episode, Aidan RN shares what it was like to transition from the fast-paced ER to the world of rapid response.

We discuss what sets rapid response apart, the mindset shifts that helped him make the switch, and break down cases where...

Imagine working as a nurse, but you must stay attached to battery packs to stay alive. That’s the reality for Tiffany Davis Cannon, RN—full-time nurse, mother, and LVAD patient. After being diagnosed with peripartum cardiomyopathy, she had to adapt to life with an LVAD—but it’s been anything but easy.

In this episode, Tiffany candidly shares the emotional and physical challenges of living with an LVAD, how her experience changed her approach to nursing, and what she wants other nurses to know about caring for LVAD patients. Tune in to hear how she’s embraced h...

Would you know how to identify a blood transfusion reaction? This is one of those nightmare cases because we just expect that when we give blood transfusion, the patient will get better… but what about when they get worse?

In this reboot episode, host Sarah Lorenzini shares evidence-based research to shed some light and insight into this very rare, but potentially life threatening situation.

In today’s episode, Sarah goes over a case study of one of a rapid response patient she dealt with where she discovered there was a blood transfusion reac...