Who You’ll Hear
Kati Kleber, MSN RN– Nurse educator, former cardiac med-surg/stepdown and neurocritical care nurse, author, and speaker.
Melissa Stafford, BSN RN CCRN SCRN – highly experienced and currently practicing nationally certified neurocritical care nurse.
Elizabeth Mills, BSN RN CCRN – highly experienced neurocritical care nurse, current Stroke Navigator for a Primary Stroke Center.
Code STEMI, Code Stroke, and Code Sepsis – Tips for Med Surg Nurses
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 reflective of 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.
- STEMI = ST-elevated Myocardial Infarction
- American Heart Association – Recommendation for Criteria for STEMI Systems of Care
- Symptoms – a non-exhaustive list
- Chest pain
- 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!
- 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)
- 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:
- Neuro Nurse Tips for Newbies, Part 1: When to Worry, Disease Processes
- Neuro Nurse Tips for Newbies, Part 2: Disease Processes
- Neuro Nurse Tips for Newbies, Part 3: Meds, Monitoring, Diagnostics, and Surgeries
Neuro-specific blog posts:
- Nursing Considerations for 3 Neuro ICU Meds
- How to Assess an Unconscious Neuro Patient Like a Neuro ICU Nurse
- Why is My Stroke Patient NPO?
- Nursing Blood Pressure Management in Stroke Patients
- Nursing Priorities for Ischemic Stroke Patients
- Journal of the American Medicine Association (JAMA) – Management of Sepsis and Septic Shock, updated February 2017
- Overwhelming immune system response to a pathogen; unable to turn down the immune system and organs are not appropriately perfused and therefore you have end-organ damage
- Recognition, timing, essential
- Easily overlooked
- Communicate concerns to MD, bring another set of eyes in if you’re not sure
- Important points
- Altered LOC, RR >22/min, SBP < 100 mmHg, fever
- Labs – lactate, cultures, procalcitonin
- Definition of Core Measures – Joint Commission
- Sepsis Alliance – TONS of great information here!
- What Nurses Need to Know About Sepsis – FreshRN Podcast interview with two doctorate-prepared nurses who are highly experienced in sepsis
More Resources for New Med Surg Nurses
- Major Differences Between ER Nurses and Floor Nurses
- What Do Med-Surg Nurses Do?
- Nursing Time Management Tips
- Code Blue! Surviving Your First Code Blue or RRT
- Nursing Report Basics For Med-Surg Nurses – a free mini course that includes my fav med-surg report sheet and my top abbreviations I would use when taking report!
Are you a new Med-Surg nurse?
Med-Surg Mindset from FreshRN is the ultimate resource for nurses new to this complex and dynamic acute care nursing specialty. Whether you are fresh out of nursing school or an experienced nurse starting out in med-surg for the first time, the learning curve is steep. With input from three experienced bedside nurses, this comprehensive course is all you need to learn all of the unspoken and must-know information to become a safe, confident, and successful medical-surgical nurse.