Claim OwnershipSTAT Stitch Deep Dive Podcast Beyond The Bedside
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*** ATLS UPDATE***
***An Exciting Update. ATLS material will be available real soon! ATLS is for physicians, but if you're a trauma junkie like me you want to know the stuff because you simply love trauma as long as it is not you on the bed in The Bay***
Welcome to STAT Stitch Deep Dive: Beyond the Bedside, the podcast where nursing knowledge, clinical storytelling, and the realities of nursing school collide. Whether you’re a current nursing student, preparing for boards, or a new nurse navigating your first year at the bedside, this show is designed to give you the mix of insight, clarity, and encouragement you need to succeed in both the classroom and the hospital.
Hosted by a trauma nurse and nursing student who’s living the journey alongside you, each episode combines Audio Overviews—broken down into conversational, easy-to-digest lessons—with real-world reflections and practical nursing tips. The goal? To simplify complex concepts and help connect theory to clinical practice.
What You’ll Hear on the Podcast:
Deep Dives into Nursing Content: From pathophysiology to pharmacology, each overview is presented in a way that feels like you’re sitting down with a mentor who explains not just the “what,” but the “why.” These episodes break down intimidating topics into clear, conversational lessons that stick.
Nursing Management Focus:
Every content-heavy episode goes beyond theory to explore how you’ll actually manage a patient at the bedside. If it’s pathophysiology, we’ll dive into the nursing management of those manifestations. If it’s pharmacology, we’ll cover nursing considerations, indications, and patient safety.
Chronicles from Nursing School:
Think of this as a mini audio diary—stories from the trenches of nursing education. From late-night study sessions and clinical rotations to exam wins (and fails), these episodes highlight the challenges, growth, and resilience that every student nurse will relate to.
Practical Nursing Tips:
Every episode closes with a tip you can immediately apply—whether it’s a study hack, a clinical shortcut, or a mindset strategy to stay resilient during stressful shifts.
Why This Podcast?
Because nursing school is hard—and the transition to practice can feel overwhelming. STAT Stitch Deep Dive bridges the gap between theory and bedside, helping you connect what you’re learning in your textbooks to the realities of patient care. You’ll get evidence-based content delivered in a friendly, conversational style that feels more like a study group than a lecture.
Who Should Listen?
Nursing students (ADN, BSN, accelerated, or bridge programs)
Pre-nursing students preparing for the rigors ahead
New graduates in their first year of practice
Nurses preparing for the NCLEX or refreshing their knowledge
Anyone passionate about nursing education, patient safety, and the art of caring beyond the bedside.
This podcast is for anyone searching for nursing school tips, NCLEX prep, clinical practice advice, study hacks for nurses, nursing student motivation, bedside nursing skills, pathophysiology explained, pharmacology made simple, nursing management strategies, and the realities of life as a nurse.
At its core, STAT Stitch Deep Dive: Beyond the Bedside is about stitching together knowledge, experience, and humanity. It’s not just about surviving nursing school—it’s about thriving as a future nurse who can think critically, act compassionately, and manage confidently at the bedside.
So if you’re ready to go beyond memorization, beyond the stress, and beyond the bedside—hit play, subscribe, and join the conversation.
Because in nursing, every detail matters. And here, we stitch them together.
59 Episodes
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🫁 Thoracic Trauma High-Yield (NCLEX/ED)I) 🌪️ Tension Pneumothorax (TPTX)Key idea: Clinical dx—treat now, don’t wait for imaging. Patho: One-way valve → air traps in pleura → lung collapse + mediastinal shift → ↓venous return → obstructive shock; often from PPV with visceral injury. Meds: O₂ (often high-flow). Analgesia after stabilization. Team: MD does immediate needle/finger decompress → chest tube. RN preps gear, monitors vitals, reassesses; eFAST must not delay care. Cues (prio): 🟥 Hypotension/shock; 🟥 unilateral absent breath sounds; 🟧 severe tachypnea/air hunger; 🟧 tracheal deviation (late); 🟨 JVD; 🟨 cyanosis (late). RN actions: High-flow O₂; set up needle decompress (5th ICS, anterior to MAL) → mandatory tube. Reassess for recurrence. Quick: TPTX = air trapping + shock. Priority = decompression → tube. Avoid too-medial field placement.II) 🩸 Massive Hemothorax (MHX)Def: >1500 mL (or ≥⅓ blood volume) rapidly in chest. Patho: Blood in pleura → hypovolemic shock + lung compression → hypoxia. Tx fluids/blood: Large-bore IV/IO; crystalloids judiciously; start uncrossmatched/type-specific blood; consider autotransfusion. Team: MD inserts 28–32 Fr chest tube; considers thoracotomy. RN runs rapid infuser, assists tube, logs initial/ongoing output. Cues: 🟥 Shock; 🟥 initial tube output >1500 mL; 🟧 ↓/absent breath sounds; 🟧 dullness to percussion; 🟨 flat neck veins (often). RN actions: Two large IVs, rapid blood; assist tube (5th ICS, anterior to MAL); track loss—>200 mL/hr ×2–4 h = call for OR. Quick: Simultaneous volume + decompression; thresholds drive thoracotomy.III) ❤️ Cardiac Tamponade (CT)Patho: Blood in pericardium → restricted filling → ↓CO (obstructive shock). Definitive: Surgery (thoracotomy/sternotomy). Pericardiocentesis = bridge. FAST for dx. Cues: 🟥 Hypotension/poor response to fluids; 🟥 PEA arrest; 🟧 muffled heart sounds; 🟧 JVD (may be absent if hypovolemic); 🟨 Kussmaul’s sign. RN actions: Rapid IV fluids (temporize), continuous ECG, facilitate FAST, prep for OR. Quick: Think CT with PEA + shock in chest trauma.IV) 🕳️ Open Pneumothorax (OPX) / “Sucking Chest Wound”Patho: Large chest wall defect (~≥⅔ tracheal diameter) shunts air via wound → failed ventilation → hypoxia/hypercarbia. Team/Tx: Three-sided occlusive dressing (flutter valve) → chest tube remote from wound → surgical closure. Cues: 🟥 Hypoxia/hypercarbia; 🟧 audible sucking; 🟧 tachypnea/dyspnea; 🟨 ↓breath sounds. RN actions: Seal with sterile occlusive taped on 3 sides; watch for tension; place tube ASAP; secure airway if needed. Quick: Four-sided seal can create TPTX—avoid.V) 🔑 Associated Injuries & Nursing PearlsAirway obstruction: Look/listen/feel for stridor, voice change, neck crepitus. Suction blood/vomit; prep definitive airway; reduce posterior clavicle dislocation if obstructing. Flail chest + Pulmonary contusion: Contusion = common lethal chest injury. Give humidified O₂, ventilatory support PRN; judicious fluids; aggressive analgesia (IV/regional). Rib fractures: Pain → splinting → atelectasis/PNA. Treat pain (systemic or regional). Never tape/belt. Ribs 1–2 = high-force (check great vessels). Ribs 10–12 → suspect hepato-splenic injury. Older adults = higher mortality.
🚑 Trauma Shock & Thorax EmergenciesI) 🩸 Hemorrhagic (Hypovolemic) ShockPatho: Acute blood loss ↓preload → ↓SV/CO; early tachycardia + vasoconstriction; prolonged hypoperfusion → lactic acidosis; lethal triad = 🧊 hypothermia + 🩸 coagulopathy + acidosis. Fluids/Blood:Warm crystalloids (1 L adult, 20 mL/kg peds) → avoid excess; consider permissive hypotension.MTP: pRBCs/Plasma/Plts (warm). O neg for childbearing-age females; AB plasma if unknown type.TXA: within 3 hrs (bolus then 8-hr infuse).Calcium: guide by ionized Ca²⁺. No vasopressors first-line. Team: MD leads definitive bleed control (OR/angio); RN gets 2 large-bore IVs/IO, gives warmed fluids/blood, binder/pressure, tracks response; Lab preps products. Priority cues: Marked tachy + hypotension + narrow PP + ↓LOC (Class IV); cool, pale skin; ↓UO. Elderly may lack tachy on β-blockers—SBP 100 can be shock. RN priorities: Categorize response (rapid/transient/non-), direct pressure/binder, target UO ≥0.5 mL/kg/hr, warm patient & fluids to 39 °C, trend lactate/base deficit. High-yield: Don’t rely on SBP alone—watch pulse pressure; stop bleeding + balanced resus; vasopressors 🚫 initial.II) 🌪️ Tension Pneumothorax (Obstructive Shock)Patho: One-way valve air → ↑pleural pressure → lung collapse + mediastinal shift → ↓venous return. Management: Immediate decompression (needle/finger) → chest tube. Don’t wait for X-ray. Cues: Hypotension/CO drop, severe dyspnea/air hunger, absent unilateral breath sounds, hyperresonance, tracheal shift (late), JVD. RN: Set up decompression ASAP, then assist sterile tube; monitor hemodynamic rebound. Pearl: Think triad—hypotension + unilateral absent sounds + hyperresonance.III) ❤️ Cardiac Tamponade (Obstructive Shock)Patho: Blood in pericardium → impaired filling → ↓CO. Often penetrating trauma. Management: Definitive surgery; pericardiocentesis = temporizing. FAST to detect fluid. Cues: Beck’s triad = hypotension, muffled heart sounds, JVD; tachy; poor response to fluids. RN: Prep for OR, support FAST, note non-response to resus; educate that surgery removes pericardial blood.IV) 🧠 Neurogenic Shock (Distributive)Patho: Cervical/upper thoracic SCI → loss of sympathetic tone → vasodilation & hypotension; may coexist with bleeding. Isolated head injury doesn’t cause shock unless brainstem involved. Distinct cues: Hypotension without tachycardia, warm/dry skin (no vasoconstriction), normal/wide PP. Management: Treat as hypovolemic first; if unresponsive to fluids, pursue neurogenic cause with advanced monitoring. Maintain full C-spine precautions. High-yield: Key differential = low BP + no tachy + warm skin.
🛑 Acute Airway & Ventilation Review1) 🫁 Acute Airway Obstruction & CompromisePatho: Fastest killer in trauma. Obstruction may be complete/partial/progressive. Common: tongue occluding hypopharynx with ↓LOC; also vomit, blood/secretions, teeth/FBs. ↓LOC → high aspiration risk → often needs definitive airway. RSI Meds:Etomidate 0.3 mg/kg → sedation w/ minimal BP/ICP effect; watch adrenal suppression & hypovolemia.Succinylcholine 1–2 mg/kg → rapid, brief paralysis; avoid in crush/burns/electrical/CKD/neuromuscular dz (↑K⁺). If fail intubation → BVM until recovery. Team Roles: 👨⚕️ Leader/Airway → assess & choose route/timing; plan for difficult airway. 👩⚕️ RN → suction ready, draw RSI meds, SpO₂/ETCO₂ monitoring, manual C-spine restriction. 🫁 RT → ventilator setup, capnography confirmation. 🧠 Consultants (neurosurg) for head-injured timing. Key Signs (🚨): No response/abnormal speech, stridor/gurgle/snore, absent breath sounds, agitation (hypoxia), tachypnea, cyanosis (late). RN Actions: Stimulate for verbal response; jaw-thrust/chin-lift; suction + log-roll lateral if vomit (maintain C-spine); pre-oxygenate 100% before/after attempts; OPA/NPA as bridge; high-flow O₂ ≥10 L/min; continuous SpO₂ + ETCO₂. Quick Hits:Priority #1 = airway & ventilation.Intubate if GCS ≤8, seizures, cannot maintain patency/oxygenation.Maintain C-spine throughout.Drug-assisted intubation needs rescue plan (surgical airway).Confirm ETT: bilateral breath sounds + exhaled CO₂ ✅.2) 🗣️ Traumatic Airway Injuries (Laryngeal/Neck/Maxillofacial)Patho: Neck hematoma displaces airway; larynx/trachea disruption → bleeding into tree; facial fx + swelling/teeth/secretions obstruct; bilateral mandibular fx = loss of support (esp. supine). Med pearls: Avoid nasal tubes if cribriform/basilar skull fx suspected. Team: 🔪 Surgeon → hemorrhage control & emergent airway (cric > trach in ED). 🖼️ Imaging (CT) after airway secure. 👩⚕️ RN/Airway → anticipate rapid loss; gentle ETT under direct vision if laryngeal injury. Red Flags (🚨): Laryngeal triad = hoarseness + subQ emphysema + palpable fracture; expanding neck hematoma/stridor; basilar skull signs (raccoon eyes, Battle’s, CSF leak) → no nasotracheal; refusing supine (mandible issues). RN Actions: Watch for swelling/SC air; be ready for surgical airway; avoid nasal routes with facial/skull fx. Quick Hits: Cric preferred; LEMON for difficulty; OTI is first-line when feasible.3) 🌬️ Ventilatory CompromisePatho: Ventilation failure from chest mechanics (rib fx/flail), CNS depression, or SCI.SCI: Above/below C3 → diaphragmatic-only breathing; rapid shallow ≠ effective → atelectasis → failure.Chest trauma: Pain → splinting → shallow breaths → hypoxemia. Sedation/Analgesia: Helps tolerance of assisted ventilation, but excess can abolish tone → airway loss ⚠️. Team: 👩⚕️ RN/Airway → assess symmetry, listen for ↓/absent sounds; beware PPV converting simple → tension pneumo or causing barotrauma. 🫁 RT → PPV, ETCO₂ monitoring. 👨⚕️ MD → ABGs; treat pain/CNS causes. Key Signs (🚨): Seesaw/abdominal breathing (SCI), asymmetrical rise (pneumo/flail), ↓/absent sounds, accessory muscle use. RN Actions: Check symmetric rise & bilateral air entry; 2-person BVM if needed; if poor sounds → alert for pneumo; continuous ETCO₂ for ventilation; protect head-injured from hypercarbia.
🫁 Airway Compromise & Obstruction (A)Pathophysiology: Life-threatening blockage → prevents gas exchange. Causes: foreign bodies, fractures, blood/secretions, trauma, ↓LOC (GCS ≤8). Failure to speak/respond = urgent airway issue. 💊 TXA: ↓bleeding, ↑survival if given ≤3 hrs post-injury. Continue infusion 8 hrs after bolus. Team Roles: 👨⚕️ Leader → directs & coordinates 👩⚕️ Airway manager → secures airway 👩🔬 Nurses → prep/test equip, stabilize c-spine 🩺 Surgeon → perform surgical airway if needed Key Signs: Can’t speak, GCS ≤8, visible obstruction, facial/laryngeal trauma. Nursing Focus:Assess speech → suction blood/secretions 💨Maintain c-spine alignment 🔒Monitor GCS & prep for intubation if ↓LOCReassess airway frequently 🔁 ⚡ Quick Tips:Airway first, spine protectedGCS ≤ 8 = intubateTest gear; frequent reevaluationSurgical airway if intubation fails🌬️ Breathing & Ventilation Failure (B)Patho: Airway patency ≠ ventilation. Check gas exchange. Threats: tension pneumo, hemothorax. 💊 O₂: All trauma pts need it; use mask-reservoir if not intubated. Team: Clinician = chest exam 🔍 | RT/Nurse = monitor O₂ & CO₂ | Surgeon = chest decompression. Signs: Dyspnea, pain, ↓SpO₂, distended neck veins, tracheal shift. Nursing:Monitor SpO₂, ABG, ETCO₂ 📊Give O₂ immediatelyAvoid PPV until decompressed if pneumo suspected 🚫 ⚡ Summary:Tension pneumo = clinical dx—treat fast!Pulse ox + capnography = vitalWatch for simple pneumo → tension after PPV💉 Hemorrhagic/Hypovolemic Shock (C)Patho: Blood loss = main preventable death. Hypotension → assume hemorrhage until ruled out. 💊 Fluids/Blood/TXA:Warm crystalloids (≤1.5 L) 🌡️MTP for transfusion; never microwave blood 🩸TXA within 3 hrs ↓mortality Team: Leader = find/control bleed | Nurse = IV access, warm fluids | Surgeon = definitive control. Signs: Rapid, thready pulse 💓, ashen skin, altered LOC, pelvic pain/ecchymosis. Nursing:2 large-bore IVs/IO for fluidsMonitor pulses, urine (≥0.5 mL/kg/hr) 💧Apply pelvic binder for suspected fracture ⚡ Summary:Warm all fluidsAvoid over-resuscitationTXA + balanced transfusion = best outcome🧠 Disability (D) & 🌡️ Exposure (E)Patho: LOC changes = possible brain injury; prevent hypoxia/hypoperfusion. Hypothermia = lethal. 💊 Small IV opiates/anxiolytics (avoid IM). Team: Neuro consult early 🧠 | Nurse = monitor temp & record events | All = PPE 🧤 Signs: ↓GCS, unequal pupils, cold skin. Nursing:Reassess ABCDEs if neuro declineWarm pt + fluids (39°C) 🔥Pain relief = careful titration ⚡ Summary:Complete primary survey before secondaryMaintain spine restrictionUrinary output = perfusion checkAvoid nasal tubes if facial fx✅ Overall Priorities: 1️⃣ Airway w/ spine protection 2️⃣ Breathing (O₂ & chest) 3️⃣ Circulation (bleeding control + warm fluids) 4️⃣ Disability (neuro status) 5️⃣ Exposure (prevent hypothermia)
This episode lets you guys know I found an ATLS manual to upload. I am super excited
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.
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