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Your first year as a registered nurse is challenging. This podcast is hosted by Kati Kleber, BSN RN CCRN and Elizabeth Mills, BSN RN CCRN and features experienced nurses from, who discuss the basics of that first year. From nursing orientation, code blues, tricks of the trade, and personal experiences, to time management, delegation, patient deaths, and more.

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Download the Season 2, Episode 009 show notes or view them below

Code STEMI, Code Stroke, and Code Sepsis

Code STEMI, Code Stroke, and Code Sepsis – Show Notes

In this episode, Elizabeth (former code-team nurse) takes the lead in discussing what’s important for new nurses to know about STEMI, stroke, and sepsis. We discuss nursing care and the big three – Code STEMI, Code Stroke, and Code Sepsis.  Please note, this episode was recorded in January 2017, and the latest evidence at that time. The best practices surrounding treatment of these evolve continually and we encourage you to ensure you’re referring to the latest evidence and facility policy while providing patient care.


  • ST-elevated Myocardial Infarction
  • American Heart Association – Recommendation for Criteria for STEMI Systems of Care
  • Symptoms – a non-exhaustive list
    • Chest pain
    • SOB
    • Diaphoresis
    • Atypical symptoms (back or epigastric pain)
  • STAT 12-lead will confirm and is required
  • Time to diagnosis to intervention is critical
  • Notify MD immediately for them or cardiology to review ECG; notify cath team/rapid response
  • Need a working IV, preferably 2 and get them on a monitor and full vitals
  • MONA is mentioned (morphine – oxygen – nitroglycerin – aspirin) but is not a hard and fast rule
  • May give a beta blocker and/or heparin
  • Goal to get to cath lab as fast as possible to stent/restore myocardial blood flow
  • Time is of the essence!

Code Stroke

  • Ischemic and hemorrhagic
  • American Stroke Association Guidelines and Statements
  • Time is brain, people!
  • Various scales to measure signs/symptoms    at different points of contact
    • NIHSS, FAST, Cincinnati Stroke Scale
  • Symptoms – a non-exhaustive list
    • Arm drift
    • Slurred speech
    • Facial droop
  • Blood sugar and vitals first – hypoglycemia can mimic stroke
  • Get nursing help! Rapid response, charge nurse, notify MD
  • Last known normal time is critical if you’re getting a history from the family/loved ones
  • Patient will need a CT – transport them yourself, do not wait for transport
  • Patient should be on a monitor with frequent vital
  • Neurologist/MD should be evaluating if the patient is a candidate for tPA and/or intervention (like a thrombectomy)
    • This is a really great resource from the American Stroke Association and American Heart Association, containing stroke treatment standard of care, tPA criteria, and information on mechanical thrombectomies
  • Very important to know blood pressure! May need to decrease it to qualify for tPA
  • If you’re not sure – get another set of experienced eyes on the patient, STAT!

More neuro resources

FreshRN Podcast episodes specifically related to neuro:

NRSNG Podcast Episodes specifically related to neuro:

Neuro-specific blog posts:

Code Sepsis

Need more in-depth neuro info? Check out the Neuro Nurse Crash Course brought to you by FreshRN® where we discuss essential topics like essential neuroanatomy and disease processes, primary and secondary injury, neuro nursing report, meds, time management, mastering the neuro assessment, and more!

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