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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.
What You’ll Learn
- Code STEMI
- Code Stroke
- 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.
Code STEMI
- 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!
If you’re looking for more on cardiac, check out the FreshRN® Cardiac Nurse Crash Course.
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)
- 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
Code Sepsis
- 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
- Antibiotics!
- Definition of Core Measures – Joint Commission
- The Nurse’s Famous Last Words: “But the Doctor Said it Was Okay” – FreshRN Blog
- 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
Hello Kati,
This is Rodca Negrut from Michigan, an international nurse who has got an RN license in the USA in May 2020. I worked with no license in a private outpatient clinic for oncology hematology doctors for 5 years and in private duty home care palliative, hospice care in MI. In my home country, I worked in the ER and Med Surge for 6 years. In 2020 September I was accepted in Med Surge unite, Troy Beaumont Hospital. I started orientation for a couple of weeks in they pooled me in Acute care COVID 19 with no hospital training and experience in the USA. They implemented disaster protocol and I didn’t have any choice. After 13 weeks the manager told me I am dismissed with no specific explanations. I worked very hard with Covid pat, sometimes with no N/A and I felt I used. I applied for a job again in the Cardio and Oncology and Progress care units and I was accepted. The problem is they offer only 3-4 weeks of orientations and for me is not safe. I don’t know what to do, what to choose, I love to work but I am scared of previous experience. I would like to take your online review courses. I really need your advice. Do your online courses are approved by the Michigan Board of Nurses?
Thank you very much for your nice job to help nurses, for a fresh RN site.
Best regard and happy new year.
Our CE’s are provided in conjunction with Skills on Point, LLC and is approved as a provider of continuing nursing education by the Ohio Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation (ANCC). (OBN-001-91). Most state boards of nursing recognize anything approved by the ANCC as acceptable and since awarding CE’s in 2018 have not had a BON state it was not acceptable. If you’re not sure but want to check on your specific state requirements, as all 50 state BON’s have different ones, head to your state board of nursing’s website and look for “Continuing Education Requirements” or “License Renewal Requirements”.