rapid response

Acute cardiac tamponade

Acute cardiac tamponade

Martin Pace, a 65-year-old man, is admitted with an inferior wall ST-segment elevation myocardial infarction and receives a permanent pacemaker for sick sinus syndrome. When he returns to…

Acute cardiogenic pulmonary edema

RONALD BARRETT* is admitted to the medical telemetry unit after arriving in the ED after 2 days of nocturnal dyspnea and mild chest pressure. Mr. Barrett, who’s 68…
Acute hypopituitarism, healthcare, registered nurse, nursing, nursing journal

Acute hypopituitarism

Your recognition of troubling signs and symptoms results in prompt diagnosis and treatment. Takeaways: Hypopituitarism is the deficient secretion of one or more pituitary hormones. The most common…

Acute mesenteric ischemia

With a mortality rate exceeding 50%, acute mesenteric ischemia requires prompt nursing identification and vascular intervention. Most patients experience acute onset of abdominal pain out of proportion to…

Adult intussusception

Quick action ensures prompt diagnosis and treatment. Takeaways: Metformin-associated induced lactic acidosis (MALA) is a life-threatening condition that requires prompt, aggressive management. Early recognition of signs and symptoms…
Amniotic fluid embolus

Amniotic fluid embolus

Immediate treatment to optimize hemodynamic function, cardiac output, respiratory support, combined with aggressive management of volume and coagulopathy, enhances maternal outcome.
Anaphylasxis_schoolnurse

Anaphylaxis in the school setting

School mealtimes are important for socialization and nutrition, but food allergies can be life-threatening. Quick assessment and action by school nurses are essential to help students in distress.…
Atrial fibrillation

Atrial fibrillation

Patient history, new symptoms, and assessment findings prompt a call for the rapid response team Takeaways: Atrial fibrillation results from rapid electrical activity that arises from different ectopic…
Atypical myocardial infarction

Atypical myocardial infarction

While Jane*, a 47-year-old woman with no significant medical history, visits her neighbor, Helen, in the hospital, Helen notes that Jane appears pale. Jane says that she hasn’t…

Atypical presentation of myocardial infarction

Cardiovascular disease remains the leading cause of death in women, but it’s often under-recognized because of atypical symptoms.  Women may experience vague symptoms that are inconsistent with what’s…

Barely breathing

After cleft palate repair, 16-month-old Nicholas* is admitted to the general care unit in a children’s hospital for postoperative monitoring. Because of the nature of the procedure, Nicholas has a…
bradykinin induced angioedema

Bradykinin-induced angioedema

Quick treatment results in a good outcome. Takeaways: Angiotensin-converting enzyme inhibitors can increase the release of bradykinin, which can increase tissue permeability with dilatation of the vessels and…
Cerebral Vasospasm

Cerebral vasospasm

Prompt recognition of subtle signs saves patient’s life. Key Points: Patients who experience an aneurysmal subarachnoid hemorrhage (aSAH) require frequent neurologic assessments to monitor for vasospasm. Vasospasm occurs…
esophageal

Esophageal varices

Darrel has been drinking 1 pint of whiskey each day for 35 years. He worked in construction until he was terminated for absenteeism. His family reports that he’s…
FES

Fat embolism syndrome

Early identification prevents negative outcomes.    Takeaways: Fat embolism syndrome is a rare complication that can occur after traumatic orthopedic injuries. Early identification of neurologic, respiratory, and dermatologic symptoms…

Hemothorax

Treatment for respiratory distress follows the ABC acronym (airway, breathing, circulation). Responders must first ensure adequate ventilation and oxygenation and then perform FAST, a point-of-care investigative tool for…

Herpes zoster ophthalmicus

Caroline Carey*, a 62-year-old woman recently diagnosed with non-small cell lung cancer, arrives at the emergency department (ED) with fatigue, facial pain, and a rash on the left…

Hypoglycemia and the Rule of 15

The parents of Susie Johnson*, a healthy 8-year-old child, bring her to the emergency department because she’s been experiencing abdominal pain, nausea, and vomiting. Susie recently was diagnosed…
myxedema-coma

Myxedema coma

Myxedema coma is the most severe, potentially life-threatening form of hypothyroidism and a medical emergency. It frequently results from untreated or undertreated hypothyroidism. Hallmarks of myxedema coma include…

Neuroleptic malignant syndrome

Neuroleptic malignant syndrome, a life-threatening neurologic emergency, frequently occurs with dopamine antagonists (antipsychotics and antiemetics).
pediatric hypoglycemia

Pediatric hypoglycemia

While watching a children’s softball game on a sunny 88° F day, you see one of the players, Mia Smith*, suddenly collapse. Mia’s mother runs to her child’s…

Pediatric malignant hyperthermia

Daniel Sanchez*, an 8-year-old boy, arrives in the pediatric recovery unit after an appendectomy. You note that his electronic health record (EHR) indicates Daniel weighs 57 lbs (25.8…

Pleural effusion

Early identification results in prompt diagnosis. Takeaways: Parapneumonic effusions can increase in size despite antimicrobial therapy. Nurses should be attuned to changes in pulmonary assessment parameters and prepared…

Postoperative atelectasis

Early recognition and prompt action achieve a positive outcome. Atelectasis occurs in 90% of patients who receive general anesthesia. Partial or complete collapse of the lungs’ small airways…

Postpartum hemorrhage

Freya Jenkins*, a 22-year-old woman, delivers 32 week gestation triplets via cesarean birth. In the operating room, she experienced quantitative blood loss of 1,050 mL. Ms. Jenkins had…
Pyelonephritis

Pyelonephritis

Early identification results in a positive outcome.     Candance Walker* is a 28-year-old woman who arrives in a wheelchair in the emergency department accompanied by her husband. She’s crying…
rapid response team psychiatric hospital

Rapid response team in a psychiatric hospital

A twist on the RRT positions nurses as leaders in responding to non-life-threatening situations. Takeaways Medical emergencies occur in many medical settings, including psychiatric hospitals. Psychiatric nurses are…

Rapid Response: Supraventricular tachycardia

Supraventricular tachycardia is a broad term describing a fast regular rhythm originating above the atrioventricular (AV) node. A narrow complex and regular rhythm would suggest AV nodal reentrant…
Rapid Response

Recognizing autonomic dysreflexia

Your quick action ensures a good outcome.     Takeaways: Autonomic dysreflexia results from a noxious stimulus, such as a distended bladder or bowel. Signs and symptoms include sweating, hypertension,…
Sickle Cell Crisis

Sickle cell crisis in the ED

Following the pain pathway leads to a good outcome.     Takeaways: Quick action and critical thinking leads to optimal pain control for sickle cell patients in crisis. Pain management…
bowel-obstruction

Small bowel obstruction

Abdominal pain, bloating and distension, vomiting, and obstipation are warning signs of small bowel obstruction. Small bowel obstructions are treatable if recognized early. Some bowel obstructions are life-threatening…
stroke alert ant

Stroke alert

Quick identification of stroke in a postpartum patient yields positive result. Anna Connor, a 30-year-old woman, is admitted to the medical-surgical unit with a diagnosis of pneu­­monia. Her…

Subarachnoid hemorrhage

Karen Thompson*, a 55-year-old woman, ar­rives in the ED via ambulance. She reports the worst headache of her life and sensitivity to light. She has no significant medical…
TURP

Transurethral resection of the prostate

Quick response to postsurgical complication.     Takeaways: Benign prostatic hypertrophy, if left untreated, may lead to chronic urinary retention. Medical therapy failure may warrant urologic outflow studies and…

Vancomycin flushing syndrome

Shantae Demano*, a 62-year-old woman with a history of recent total left knee surgery, is admitted to the ICU with sepsis and an infection of the knee, which…

Wernicke’s encephalopathy

Amber White*, a 35-year-old woman who’s 21 weeks pregnant, arrives in the ED with an altered level of consciousness, blurred vision, weakness, and ataxia. The nurse notes slurred…

When all signs point to tension pneumothorax

Key takeaways Initial presentation of tension pneumothorax in patients with unassisted breathing is slower and more subtle than in patients who are mechanically ventilated. Early detection of tension…

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