STAT Stitch Deep Dive Podcast Beyond The Bedside

STAT Stitch Deep Dive Podcast Beyond The Bedside

por Regular Guy
CursosCiencias de la Vida
Temporada 20

PALS | Management of Respiratory Failure/ Distress

1️⃣ MANAGEMENT OF RESPIRATORY DISTRESS (Compensation Phase) Goal → Support oxygenation & ventilation BEFORE fatigue sets in. A. Airway Opening Maneuvers Positioning is everythingInfants: sniffing position Older kids: tripod or chin lift / jaw thrust Avoid hyperextension in infants (soft trachea collapses) B. Oxygen Administration 🫧 Start low → escalate: Blow-by (infants, mild) Nasal cannula Simple mask / NRB Humidified O₂ for croup Target SpO₂ ≥ 94% unless chronic lung disease. C. Treat the Underlying Problem Upper airway (stridor):Racemic epi neb Dexamethasone Avoid upsetting the child ❗ Lower airway (wheezing):Albuterol ± ipratropium Magnesium sulfate (severe) Steroids Parenchymal (pneumonia):Antibiotics High-flow nasal cannula if hypoxemic Fluid overload: diuretics Foreign body: encourage cough; prepare for removal D. Monitoring Continuous pulse ox Reassess work of breathing q5–10 min Cap refill, mental status, perfusion Prepare airway equipment early E. Red Flags That Require Escalation Increased fatigue Declining retractions (NOT improvement) Rising CO₂ signs: headache, confusion, lethargy SpO₂ not improving with O₂ 2️⃣ MANAGEMENT OF RESPIRATORY FAILURE (Decompensation Phase) Goal → Ventilate & oxygenate NOW. Fatigue → arrest in minutes. A. Call for Help / Activate PALS Team 🚨 Failure means the child cannot compensate. You need backup. B. Immediate Bag-Mask Ventilation (The #1 lifesaving step) Correct size mask → seal with “EC clamp” Rate: 12–20/min (1 breath q3–5 sec) Use PEEP valve if available Watch chest rise and SpO₂ Avoid over-ventilation (↓ venous return → ↓ BP) C. Consider Airway Adjuncts OPA if no gag NPA if gag intact Suction PRN D. Prepare for Intubation Indications: Fatigue Worsening hypoxemia Hypercarbia Apnea / bradypnea Diminished or silent chest Setup: Appropriate ETT size Stylet Suction BVM with PEEP Confirm with waveform capnography E. Ventilation Strategy Post-Intubation Use lowest pressures needed Avoid breath stacking Adjust rate for CO₂ goals Reassess every few minutes F. Treat the Cause (Critical) Anaphylaxis → IM epi, fluids Asthma → continuous albuterol, steroids, mag, possible ketamine Croup → racemic epi, steroids Bronchiolitis → suction, high-flow
T20 · E5
1 dic 2025
39:09

PALS | Recognition of Pedi Arrhythmias

1️⃣ Bradyarrhythmias (Slow Rhythms) Definition: HR <60 bpm with poor perfusion = treat immediately. 🌡️ Causes Hypoxia (MOST COMMON), heart block, vagal stimulation, hypothermia, drugs. 🫀 Sinus Bradycardia Recognition: P waves present, regular rhythm, slow rate. Peds Tip: Normal in athletes/sleeping; NOT normal with poor perfusion. 🟪 AV Blocks 1° AV Block: PR prolonged (>0.20s adult-equivalent), but every P → QRS. Usually benign; watch for progression. 2° Type I (Wenckebach): PR progressively lengthens → dropped QRS. “Longer, longer, longer, drop ▶️ Wenckebach.” Usually transient, often vagal. 2° Type II: Normal PR intervals with random dropped QRS. Bad. Can progress to complete block. 3° Complete Heart Block: Atria + ventricles beat independently. Regular P waves, regular QRS—but no relationship. Often bradycardic, poor perfusion. 2️⃣ Tachyarrhythmias (Fast Rhythms) Definition: Above age-appropriate range (often >180 infants, >160 children). ⚡ Supraventricular Tachycardia (SVT) Rate: 180–300 bpm P waves: Absent or hidden QRS: Narrow Onset: Abrupt Key Tip: Infant may just appear irritable, poor feeding, or pale. ⚡ Atrial Flutter Sawtooth F-waves Rate often 250–350 Rare in kids (post-op congenital heart disease) ⚡ Ventricular Tachycardia (VT) With Pulse: Wide QRS, regular rhythm Rate usually 120–250 May have poor perfusion Pulseless VT: Treat like VF (defibrillate) 💥 Ventricular Fibrillation (VF) Chaotic, no identifiable waves No pulse → CPR + defibrillate immediately 😵 Asystole (Flatline) No electrical activity Confirm in 2 leads CPR + epinephrine only (NO shock) 🌪️ PEA (Pulseless Electrical Activity) Organized electrical rhythm without a pulse Causes = H’s & T’s (hypoxia, hypovolemia, hypothermia, H+ acidosis, hypo/hyperK, tension pneumo, tamponade, toxins, thrombosis) 3️⃣ How to Rapidly Recognize Rhythms (PALS Algorithm) Step 1: Pulse Check Present? → Rhythm with pulse Absent? → Treat as cardiac arrest rhythm Step 2: Narrow vs. Wide QRS Narrow (<0.08s): SVT, sinus tach, atrial flutter/fib Wide (>0.08–0.12s): VT, aberrancy Step 3: Regular vs. Irregular Regular: SVT, VT, sinus tach Irregular: Atrial fibrillation/flutter with variable block, polymorphic VT Step 4: P Waves Present? Yes → sinus or atrial rhythm No → SVT or VT
T20 · E6
1 dic 2025
36:51
Temporada 21

ACLS, PALS, ABLS, ASLS, ENLS Certifications

Explícito
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.com or leave a comment or review on apple podcast or whatever platform you're listening from.
T21
22 oct 2025
7:27
Temporada 22

ACLS VS | Intro to The Comparison

Explícito
this is the intro to a new segment comparing two drugs or disease processes to bring you more clarity.
T22
22 sept 2026
9:01

VS ACLS | Lidocaine v Amiodarone

IA
80/20 Comparative Summary: Amiodarone vs. Lidocaine 1. Class & Mechanism of Action Amiodarone (Cordarone): Class III antiarrhythmic with Class I, II, III, and IV actions[1][2]. Primarily blocks potassium channels in phases 2 and 3, delaying repolarization and prolonging effective refractory period[1]. Weakly blocks sodium channels (phase 0 upstroke), depresses SA/AV automaticity, blocks calcium channels, noncompetitively inhibits alpha/beta receptors, and causes vasodilation[2][3]. Lidocaine: Class IB antiarrhythmic and amide local anesthetic[4]. Selectively inhibits fast sodium channel influx in phase 0, shortening action potential duration and refractory period in His-Purkinje tissue while suppressing automaticity/reentry preferentially in ischemic myocardium[6]. Blocks nerve sodium channels for local anesthesia[7]. 2. Indications & ACLS Role Amiodarone: Indicated for life-threatening recurrent ventricular fibrillation (VF), hemodynamically unstable ventricular tachycardia (VT), and atrial fibrillation[8]. Used in ACLS CPR for VF/pVT unresponsive to defibrillation[11][12]. Lidocaine: Indicated IV for acute life-threatening VF/VT (post-MI/cardiac surgery) and ACLS CPR[5][13]. Used topically/regionally for local anesthesia[4][14]. In pediatric ACLS, associated with higher return of spontaneous circulation (ROSC) rates than amiodarone[15][16]. 3. Pharmacokinetics & Administration Amiodarone: Oral, IV, or IO route[17]. Lipophilic (Vd ~70 L/kg), delayed steady state (1–5 months), and long terminal half-life (mean 53 days)[19][20]. Hepatically metabolized via CYP3A4/2C8 to active metabolite DEA[21]. Dilute in D5W only, use volumetric pumps and in-line filters, and avoid PVC containers/tubing for long infusions due to drug adsorption and DEHP leaching[22]. Lidocaine: Administered IV, IO, IM, topically, or transdermally[4]. Rapid IV onset (immediate) with short duration (10–20 min)[27]. Hepatically metabolized via CYP1A2/3A4 to MEGX and GX; >98% excreted renally[28][29]. Given as IV bolus load followed by continuous infusion[13][30]. 4. Adverse Effects & Safety Warnings Amiodarone: Boxed warnings for pulmonary toxicity (up to 17%), fatal hepatotoxicity, and proarrhythmia (QT prolongation, Torsades de Pointes)[31]. Contains ~37% iodine, causing thyroid dysfunction[36]. Causes hypotension, phlebitis (>3 mg/mL), corneal deposits, and photosensitivity[32]. Contraindicated in 2nd/3rd degree AV block, SSS, and severe bradycardia[33]. Lidocaine: Toxicity causes CNS effects (seizures, confusion, dysarthria) and cardiovascular collapse (bradycardia, hypotension, arrest)[40]. Boxed warning prohibits viscous lidocaine for infant teething pain[44]. Requires 50% infusion rate reduction after 24 hours or in heart failure/hepatic impairment[30].
T22 · E1
22 sept 2026
24:14
Temporada 25

ATLS Announcement

This episode lets you guys know I found an ATLS manual to upload. I am super excited
T25
28 oct 2025
7:17
Temporada 30

ATLS | Initial Assessment

🫁 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 ↓LOC Reassess airway frequently 🔁 ⚡ Quick Tips: Airway first, spine protected GCS ≤ 8 = intubate Test gear; frequent reevaluation Surgical 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 immediately Avoid PPV until decompressed if pneumo suspected 🚫 ⚡ Summary: Tension pneumo = clinical dx—treat fast! Pulse ox + capnography = vital Watch 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 fluids Monitor pulses, urine (≥0.5 mL/kg/hr) 💧 Apply pelvic binder for suspected fracture ⚡ Summary: Warm all fluids Avoid over-resuscitation TXA + 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 decline Warm pt + fluids (39°C) 🔥 Pain relief = careful titration ⚡ Summary: Complete primary survey before secondary Maintain spine restriction Urinary output = perfusion check Avoid 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)
T30 · E1
30 oct 2025
48:19

ATLS | Airway

🛑 Acute Airway & Ventilation Review 1) 🫁 Acute Airway Obstruction & Compromise Patho: 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 Compromise Patho: 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.
T30 · E2
30 oct 2025
20:20

ATLS | Shock

🚑 Trauma Shock & Thorax Emergencies I) 🩸 Hemorrhagic (Hypovolemic) Shock Patho: 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.
T30 · E3
30 oct 2025
39:54

ATLS | Thoracic Trauma

🫁 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 Pearls Airway 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.
T30 · E4
30 oct 2025
45:46
33 de 35