Resus Nurse Podcast

Bret P. Nelson, MD, RDMS, FACEP Courtesy of Bret Nelson Twitter: @bretpnelson Website: SinaiEM.us YouTube: SinaiEMultrasound Bret Nelson is a Professor of Emergency Medicine, Chief of the Emergency Medicine Ultrasound Division at the Icahn School of Medicine at Mount Sinai, Chief Editor of the ultrasound education website, www.SinaiEM.us. He is on the board of directors of the Society for Clinical Ultrasound Fellowships and active in the American College of Emergency Physicians (ACEP)'s Ultrasound Section and is among the authors of ACEP's Emergency Ultrasound Guidelines. Served on the Board of Directors of the World Interactive Network Focused on Critical Ultrasound (WINFOCUS) and was Chair of the American Institute of Ultrasound in Medicine’s Point of Care Community of Practice Authored several books, Manual of Emergency and Critical Care Ultrasound, Emergency Medicine Oral Board Review Illustrated, Atlas of Handheld Ultrasound, and Acute Care Casebook. Dr. Nelson has lectured throughout the

Bret P. Nelson, MD, RDMS, FACEP Courtesy of Bret Nelson Twitter: @bretpnelson Website: SinaiEM.us YouTube: SinaiEMultrasound Bret Nelson is a Professor of Emergency Medicine, Chief of the Emergency Medicine Ultrasound Division at the Icahn School of Medicine at Mount Sinai, Chief Editor of the ultrasound education website, www.SinaiEM.us. He is on the board of directors of the Society for Clinical Ultrasound Fellowships and active in the American College of Emergency Physicians (ACEP)'s Ultrasound Section and is among the authors of ACEP's Emergency Ultrasound Guidelines. Served on the Board of Directors of the World Interactive Network Focused on Critical Ultrasound (WINFOCUS) and was Chair of the American Institute of Ultrasound in Medicine’s Point of Care Community of Practice. Authored several books, Manual of Emergency and Critical Care Ultrasound, Emergency Medicine Oral Board Review Illustrated, Atlas of Handheld Ultrasound, and Acute Care Casebook. Dr Nelson has lectured throughout th

  Sergey M. Motov, MD, FAAEM Courtesy of Sergey M. Motov, MD Twitter @painfreeED Dr. Motov is an Emergency Medicine Physician practicing in the Department of Emergency Medicine at Maimonides Medical Center, Brooklyn, New York. He graduated from Medical Academy of Latvia and completed his EM residency at Maimonides Medical Center. Dr. Motov is an Associate Research Director who is passionate about safe and effective pain management in the ED.  He has numerous publications on the subject of opioid alternatives in pain management, and is actively involved in growing this body of work both nationally and globally   Missed Episode 011? Low Dose Ketamine for Pain - Administration Explained! Click Here Missed Episode 018? Deep Dive on Continuous Sub-Dissociative Dose Ketamine Infusions, Ketamine in Geriatrics?, Ethics & More Click Here A Candid Conversation on having a Hydromorphone-Free ED with Sergey Motov, MD FAAEM This episode was recorded earlier in the year at the same time as the Deep Dive Continuous Sub-D

Nursing Intubation Checklist - Yes, Really. Over the years I’ve developed a personal Nursing Intubation Checklist that I have for myself when preparing for RSI, DSI, or an awake intubation. This has saved my ass while working on very sick patients. Some of my checklist items cross over with the provider’s checklist. I’m sure it will evolve and I will update as needed. You may still be scrambling, but you can save yourself from going into a panic mode if your patient starts crashing and you’re trying to do everything so you don’t need to start compressions - tall order. Generally, I don’t hand over the intubation meds to the doctors until MY checklist is complete. There’s almost always time with DSI and awake intubations. With RSI you may not have as much time and you may need to hand over the intubation meds before finishing your checklist - the patient needs the airway NOW. Do you have a Nursing Intubation Checklist? Looking forward to having feedback and a discussion as to what should be added or taken

Sergey M. Motov, MD, FAAEM Courtesy of Sergey M. Motov, MD Twitter @painfreeED Dr. Motov is an Emergency Medicine Physician practicing in the Department of Emergency Medicine at Maimonides Medical Center, Brooklyn, New York. He graduated from Medical Academy of Latvia and completed his EM residency at Maimonides Medical Center. Dr. Motov is an Associate Research Director who is passionate about safe and effective pain management in the ED.  He has numerous publications on the subject of opioid alternatives in pain management, and is actively involved in growing this body of work both nationally and globally Missed the Low Dose Ketamine for Pain - Administration Explained! Episode? Click Here We wanted to do a Follow-Up Episode about Sub-Dissociative or Low-Dose Ketamine (SDK) Infusions. Then this research got published... Continuous Intravenous Sub-Dissociative Dose Ketamine Infusion for Managing Pain in the Emergency Department Authors: Motov, Sergey; Drapkin, Jefferson; Likourezos, Antonios; Beals, Tyler

Who is Arlene Chung, MD? Courtesy of Arlene S. Chung, MD, MACM Arlene S. Chung, MD, MACM  Arlene is an Associate Residency Director for the Mount Sinai Emergency Medicine Residency Program in New York City. She has a passion for physician wellness and has made advocating for well-being a central focus of her career. She holds leadership roles in multiple regional and national wellness organizations and has lectured extensively on physician wellness, developed mindfulness curricula for students and residents, and published on the current issues surrounding wellness and burnout and possible solutions for the future. Twitter @ArleneSujin What is Airway: True Stories from the Emergency Room? Arlene is also one of the co-founders of a non-profit organization known as Airway: True Stories from the Emergency Room. Airway originally began in 2015 as a series of free New York City-based storytelling events for EM physicians with the mission of creating community, decreasing stigma, and fostering resilience th

"This used to be merely intuition...even a minute or two at low MAPs may be too much and certainly waiting 20 minutes for pharmacy to send up a drip is probably way too long...and your kidneys may actually be getting damaged in that short period of time." - Scott Weingart, MD Who is Scott Weingart, MD? Courtesy of Scott Weingart, MD Scott D. Weingart, MD FCCM FUCEM DipHTFU Scott is an ED Intensivist from New York. He did fellowships in Trauma, Surgical Critical Care, and ECMO. He is currently an attending in and chief of the Division of Emergency Critical Care at Stony Brook Hospital. He is a clinical associate professor of emergency medicine at Stony Brook Medicine and an adjunct associate professor at the Icahn School of Medicine at Mount Sinai. He is best known for talking to himself about Resuscitation and Critical Care on a podcast called EMCrit, which has been downloaded > 19 million times. EMCrit Twitter Team @emcrit What is a MAP? (Mean Arterial Pressure) Average pressure in a patient’s arteries

"I find it very gratifying to treat because you can see the effects of your treatment right in front of your eyes. And your patients can go from very sick to well within a matter of hours." - Marc Probst, MD Who is Marc Probst, MD? Courtesy of Marc Probst, MD Marc Probst, MD, MS is an Academic Emergency Physician at The Mount Sinai Hospital in New York City. Dr. Probst is funded by a career development grant from the National Institutes of Health (NIH). His interests include syncope, shared decision-making, and Halloween. Twitter @probstMD   Diabetic Ketoacidosis (DKA) Biochemical Findings Hyperglycemia Ketosis (High anion gap) Metabolic Acidosis Parameters to treat DKA Blood glucose >250mg/dL Elevated anion gap w/albumin adjustment >10 Serum bicarbonate

Markus dela Cruz, RN Mark is an ED Nurse extraordinaire who turned into a Cath Lab RN. He is also found working in PACU units and still works some ED shifts. Mark also considers himself a foodie and likes exploring Queens, NY. Mark works at a Level 1 Trauma Center that is also a STEMI receiving center in Queens, NY. Fun fact: When I first started working, there were rumors that Mark can get an IV line with a full set of labs on sick patients with NO tourniquet! To this day, I believe this may be more truth than fiction. Disclaimer: This is how Mark and I manage our STEMI patients going to the Cardiac Cath lab for PCI. These are suggestions. Follow your institution’s policies. "The minute that fellow or that doctor opens up that vessel - you see the color returning, pt's vital signs are stabilizing, and the pain is completely gone. I'm having goosebumps telling you this. " - Markus dela Cruz, RN Need to listen to Part 1? Listen to Part 1 of my discussion with Markus dela Cruz, RN where we went over all the ni

Markus dela Cruz, RN Mark is an ED Nurse extraordinaire who turned into a Cath Lab RN. He is also found working in PACU units and still works some ED shifts. Mark also considers himself a foodie and likes exploring Queens, NY. Mark works at a Level 1 Trauma Center that is also a STEMI receiving center in Queens, NY. Fun fact: When I first started working, there were rumors that Mark can get an IV line with a full set of labs on sick patients with NO tourniquet! To this day, I believe this may be more truth than fiction. Disclaimer: This is how Mark and I manage our STEMI patients going to the Cardiac Cath lab for PCI. These are suggestions. Follow your institution's policies. Your Patient's Going to the Cath Lab! How can we ensure the fastest and smoothest transition from the moment your patient is identified as a STEMI and accepted to the Cardiac Cath lab? PCI (Percutaneous Coronary Intervention) is the treatment of choice for a repercussion of a patient having an active MI. It is a life-saving proce

Sergey M. Motov, MD, FAAEM Courtesy of Sergey M. Motov, MD Twitter @painfreeED Dr. Motov is an Emergency Medicine Physician practicing in the Department of Emergency Medicine at Maimonides Medical Center, Brooklyn, New York. He graduated from Medical Academy of Latvia and completed his EM residency at Maimonides Medical Center. Dr. Motov is an Associate Research Director who is passionate about safe and effective pain management in the ED.  He has numerous publications on the subject of opioid alternatives in pain management, and is actively involved in growing this body of work both nationally and globally.  "In the 7 years I've been administering ketamine for this application, I've never had a patient walk into my ER and ask, 'Can I get ketamine?'" - Sergey Motov, MD     Who gets low-dose ketamine for analgesia? Patients who fail initial 3+ opioid doses. Patients generally with chronic pain, neuropathic pain, oncology pain, opioid tolerance, polytrauma. Great medication for treating pain and doesn't

Who is Reuben Strayer, MD? Courtesy of Reuben Strayer, MD Emergency Medicine Physician who works in New York City Author of emupdates.com One of the authors of painandspa.org Twitter @emupdates Created the phrase "ketamine brain continuum" No financial disclosure A Special K Trip Part 3 - Ketamine for Analgesia & Tranquilization And now for the conclusion of the 3-part ketamine series with Reuben Strayer. Today’s episode is Part 3 focusing on Ketamine for analgesia and extremely uncontrollable violent patients. If you haven’t already, go back and listen to Episode 7 where Reuben talks about ketamine and how different dosing can have different applications in the ED setting. In Episode 8, Reuben talks about ketamine for PSA & RSI. Ready to continue with your Ketamine trip w/Reuben? Here we go! Ketamine for Analgesia Who gets ketamine? Chronic pain, poly trauma, oncology pain, etc. Dosing 0.3mg/kg 0.1-0.3mg/kg have been used. No pumps for bolus dose? No problem. Of course, administering

Reuben Strayer, MD Courtesy of Reuben Strayer, MD Emergency Medicine Physician who works in New York City Author of emupdates.com One of the authors of painandspa.org Twitter @emupdates Created the phrase "ketamine brain continuum" No financial disclosure     Ready to continue your Special K Trip? Today's episode is Part 2 out of a 3-part series and will cover the use of ketamine for procedural sedation and intubations in the ED with Reuben Strayer, MD. If you didn't listen to Reuben talk about ketamine, the safety measures of ketamine, or confused by this graphic with different dosing - go back and listen to Episode 7 for Part 1 where this is explained in detail.   Ketamine for Procedural Sedation and Analgesia (PSA) Prep Your Patient Therapeutic Communication - let your patient have whatever fantasy they want and encourage it! Any fantasy can be a reality with ketamine...seriously. If they are in so much pain that they are already freaking out and you're not doing your procedure you can give op

Courtesy of Reuben Strayer, MD Reuben Strayer, MD Courtesy of Reuben Strayer, MD Emergency Medicine Physician who works in New York City Author of emupdates.com One of the authors of painandspa.org Twitter @emupdates Created the phrase "ketamine brain continuum" No financial disclosure       Back in 2015, Reuben gave an amazing talk on the subject of ketamine and its uses in Emergency Medicine at the SMACC Chicago conference.  It has a lot of fun slides too! I recommend listening to Reuben's SMACC talk first, and then listen to this podcast episode and refer to the show notes. This talk got pretty in depth and long so I broke it up into 3 separate episodes. Today's episode is Part 1, an Introduction to Ketamine.  Part 2 and 3 will cover the applications of Ketamine in the ED in detail. Ketamine Ketamine is traditionally used as an anesthetic in the operating rooms. However, in many ED units, it's commonly used as a procedural sedation agent and an induction agent for intubation. We will be talki

  I’m not a powerful Jedi Master with Force Visions and frankly, unable to see into the future. Hello Star Wars fans!   This is a follow-up bonus episode in response to Episode 5 Push Dose Pressors, listeners' questions, and also in light of recent journal articles that recently got published. Timing was completely coincidental when Episode 5 Push Dose Pressor podcast episode was released.   Although I’ve been using push dose pressors for years now, I still researched the topic awhile ago. Frankly, there wasn’t much out there - and there still isn’t. Why? Because it’s not standard of care. But I suspect it will be once there are RCTs and more research and we all know that takes time. Meanwhile, this is a practice that is happening in our Emergency Departments and as ED nurses, we definitely should know about them.   This is the initial reason for a push dose pressor episode on this podcast. Nurses, we are going to be the ones mixing and preparing the push dose pressors, and a good chance we will be adminis

Why Use Push Dose Pressors? To buy yourself some time with your super hypotensive patients!! Ensure your patient's perfusion status while you are trying to: intubate managing transient hypotension preparing a drip preparing a central line Know which medication to use based on clinical presentation of patient. Dr. Scott Weingart's Easy Push Dose Printout (It has photos!) Epinephrine alpha 1&2, beta 1&2 agonist = inopressor (Increase in myocardial contraction, heart rate, and peripheral vascular resistance) Epinephrine Push Dose Concentration 10mcg/mL (1:100,000) vs. cardiac dose (1:10,000) Onset Immediate - 1 minute Duration 5-10 minutes Dose 5-20mcg every 2-5 minutes (0.5-2mL)   Preparation Draw up 9mL of Normal Saline in an empty 10mL syringe (updated - see below) Attach a syringe and draw up 1mL of epinephrine from the pre-filled cardiac dose amp (Epinephrine 100mcg/mL) Shake a little, Place a label: Epinephrine 10mcg/mL Phenylephrine alpha 1 agonist = increase in peripheral vascular resistanc

Malena Fryar "Use your critical thinking skills!” Do any of you remember hearing that being drilled in nursing school? How many of us are actually make critical decisions for your patients or are you deferring all decisions to the providers?  Really think about this. Decisions in triage - nurses do everything in this domain.  Most ED's don't even have a provider up in triage. We seem to do okay in this area.  But then the patient comes in to get worked up and now ALL decisions to the providers.  Why??!  Why do you have to stop making decisions? You know what’s going on - You were trained for this! As nurses, we are the ones at the bedside - who better to answer these questions, than us?! Nursing Autonomy ED nursing is awesome because we have autonomy - why give it away? Aside from the ED, the only other unit that has these privileges are the ICUs. Remember, we deal with ICU/critical patients - why not have the same autonomy? I encourage you to make clinical decisions in your practice. Yes, you may ne

Chief Complaint Pt comes in with a heart rate of 170-200. Complains of palpitations/sob/chest pain/dizziness/or nothing.  Is this SVT or A-Fib? Hint! Today we are talking about SVT. Bedside Checklist Take off clothing waist up. Put on a hospital gown. Immediately place pulse ox, leads, and bp cuff - in that order. If oxygenation is poor with good waveform - address this first. Start with a nasal cannula, if that doesn't give your pt relief. Apply NRM, while you set up BIPAP. Find out if they have COPD or emphysema or a chronic smoker - oxygen saturation requirements are less for this population. High flow nasal cannula may be an option. Keep hob elevated to min. 30 degrees. 45-90 better. Watch the position that your patient is sitting. If they are leaning forward or sitting up straight - Put the hob at 90 degeees and ask them, is it easier for you to breathe sitting up. Obese patients may prefer to have legs over the side of the stretcher due to abdominal girth. Get an EKG stat. After you get the

AAAs are Always Scary!

Welcome to the very first episode of the Resus Nurse Podcast! Spoiler alert: The goal is elevate emergency nursing, so we are practicing at the highest level in order to achieve the BEST outcome for our patients—no matter what the situation presents. Nursing care in the ED matters! The “real care” starts in our EDs, not after a patient goes upstairs to their admission bed. If one of your family members needs resuscitation care, what standards would you want to be applied to your loved ones? Nursing is absolutely vital within the multi-discplinary care, we implement the care. We’re at the bedside recognizing that a patient is decompensating and immediate intervention is needed, not the docs. Our patients are coming into our EDs sicker than ever. Hopefully this podcast will help you be calm and collected during these stressful situations and save some lives! Cite this post as: Yun Cee Dirsa. 001 Your Standards Are Too High!. Resus Nurse Podcast and Blog. Published on May 25, 2017. Date accessed October 12, 20