#nurseswithtattoos #nurseswholift

BCEN #instacrew #mywhy


A long time ago, I was thrust into the preceptor role when we didn’t even have a preceptor “class”. Someone just said, “you like to teach, why don’t you take one of the new nurses and train her?” Of course, I agreed. That nurse that I taught has now been a certified flight RN #cfrn for over 15 years. 18 years ago, I decided to get my CEN #cen and that was my 1st certification exam. Today, I have taught numerous clinical rotations, paramedic interns, nursing students, residents, emergency nurses, trauma nurses and I am grateful that my certifications help to pave the way by showing my continued dedication to being a lifelong learner and nursing excellence. •

Follow BCEN certifications or anyone in the BCEN #instacrew (all members tagged in my pic) for more info about what being a certified RN means or how to prepare, sit for a certification exam 😃💯 #bcen #cen #tcrn #cpen #cfrn #ctrn #bcenmywhy #nurseeducator #traumamama #runswithscissors #showmeyourshears #emergencytraumamama



• @the_resuscitationist .

AUTOMATIVE CPR MACHINES: to include “lucas” “autopulse” etc.


BOTTOM LINE: these do NOT increase rates of survival and out of hospital discharge neurointact. .

POLARIZING statement I know… but this isn’t just an emotional based opinion. Multiple studies over the years (I can send them to you or a quick search) shows no increased survival when compared to manual (hands on chest) CPR. There’s added concern for the delay in compressions during placement.



HOWEVER: there is added benefit for small pre-hospital crews that the use of these machine does keep crews more safe and “free’s up hands” to prevent task saturation. In the ER setting, I typically wont take the time to place one. They also cover the chest and make any needed chest procedures difficult (pericardiocentesis, chest tubes, central lines, needle decompressions etc)



NOTE: cost roughly $15k per unit. If you’re system does not have these, do not think your CPR is inferior.


MY MAIN POINT: quality CPR principles include early chest compressions and limited interruptions. Peds has a few subtleties, but keys below -Intubate while compressions take place. – hard and fast (100-120 bmp) -ribs will likely crack. This is normal.

-place patient on hard surface

– don’t hyperventilate. Even bystander compressions only without rescue breaths is acceptable – keep compressions after shocks given

– coronary perfusion pressure (CPP) is greatly impacted from above principles.





#cpr #heartattack #acls #bls #ems #paramedic #anesthesia #medicine #emergency #er #emergencymedicine #arrest #compressions #chest #pulse #medicine #medical #research #science #rn #medic #paramedic #nurse #crna #doctor #doc #discuss #hospital #education #teach #learn #help

The Emergency Department Neuro Exam – Three YouTube Videos

The Emergency Department Neuro Exam – Three YouTube Videos

— Read on www.tomwademd.net/the-emergency-department-neuro-exam-three-youtube-videos/

Strangulation of Adult & Pediatric Patients

As a trauma nurse that is cross-trained with a master of forensic science degree, I spend a lot of time thinking about recognition & assessment of strangulation patients. •

Strangulation and Domestic Violence

Strangulation has been identified as one of the most lethal forms of domestic violence. It is one of the best predictors for subsequent homicide. Prior strangulation increases the odds of strangulation homicide by more than seven times. For perpetrators, strangulation is the ultimate form of power and control. However, because there are often no visible injuries, patients, physicians, and law enforcement often minimize the possible health consequences of reported strangulation.


The vasculature of the neck is relatively unprotected and vulnerable to injury and vascular occlusion. The application of 4.4 pounds of pressure to the jugular veins causes venous outflow obstruction from the brain and thus stagnant hypoxia. Eleven pounds of pressure to the carotid arteries can cause loss of consciousness in approximately 10 seconds. Compression of the trachea requires significantly more force: 33 pounds of pressure for occlusion and 35 pounds to fracture tracheal cartilage.

Strangulation can be fatal in as little as four to five minutes. Mechanisms in addition to hypoxia due to vascular occlusion have been proposed. Pressure on the carotid body may cause bradycardia and subsequent cardiac arrest. Delayed mortality may be caused by carotid artery dissection, aspiration, postobstructive pulmonary edema, acute respiratory distress syndrome, or tracheal injury.

📓: ACEP Now, Heather V. Rozzi, MD, FACEP; and Ralph Riviello, MD, MS/April 2019


Answer: Bradycardia & hypotension are the hallmark signs of neurogenic shock. This type of shock falls under the distributive umbrella.

Renin Angiotensin Aldosterone System (RAAS) review

RAAS Review 
It’s critical to understand RAAS for critically ill/traumatically injured shock patients. The RAAS regulates blood pressure and fluid balance in the body. When blood volume or sodium levels in the body are low, or potassium is high, cells in the kidney release the enzyme, renin. Renin converts angiotensinogen, which is produced in the liver, to the hormone angiotensin I. An enzyme known as ACE or angiotensin-converting enzyme found in the lungs metabolizes angiotensin I into angiotensin II. Angiotensin II causes blood vessels to constrict and blood pressure to increase. Angiotensin II stimulates the release of the hormone aldosterone in the adrenal glands, which causes the renal tubules to retain sodium and water and excrete potassium. Together, angiotensin II and aldosterone work to raise blood volume, BP and sodium levels in the blood to restore the balance of sodium, potassium, and fluids in an attempt to normalize the BP in an otherwise “shocky” patient.

Hypovolemic shock occurs due to loss of in total volume of blood, available for circulation. Whether the bleeding is caused by blunt or penetrating trauma, the loss of blood stimulated baroreceptors in the carotid bodies and aortic arch to speed up the HR. HR X SV=CO.

When pts are trying to compensate hypovolemic shock, RAAS (Renin angiotensin aldosterone system) is activated.
The activated RAAS system releases angiotensin II. Angiotensin II causes vasoconstriction of arteries and veins, thereby increasing blood pressure. It also promotes adrenal cortex to secrete aldosterone. Aldosterone in turn stimulates sodium and water retention as well as excretion of potassium from kidneys. The resulting high sodium ions in the serum causes secretion of ADH (antidiuretic hormone). ADH intensifies water reabsorption, resulting in increased blood volume, BP (blood pressure) and CO (cardiac output). This is why we frequently see our hypovolemic trauma patients present with tachycardia and hypotension, depending on which stage of shock they present with. 
#themoreyouknow #nclex #nclexprep #nclexstudying#nclexreview #nursingschool #nursingstudent#nursingstudentlife 

Trauma Triad Of Death

💉🚑🚑💉💉🚑🚑💉💉🚑🚑🚑🚑 The lethal trauma triad of death is one of the things that increases trauma patients morbidity & mortality. By majority, the answer would be hypovolemic shock. Hypovolemia is defined as a state in which there is a decrease in plasma volume within the body. Hypovolemia, if severe enough, produces shock. Shock is defined as inadequate tissue perfusion combined with the inadequate removal of cellular wastes, ultimately producing a defect in oxidative metabolism and therefore a subsequent dysfunction in the way that the body transports, delivers, and utilized oxygen. Hypovolemic shock in trauma patients often stems from acute hemorrhage. •

Hypovolemic shock secondary to hemorrhage produces a lethal triad


1.) acidosis

2.) hypothermia

3.) coagulopathy

Hypovolemic shock produces several defects in physiology. The decreased intravascular fluid volume decreases venous return to the heart, which ultimately reduces preload and stroke volume (SV). The body initially compensates for the decreased SV by increasing the heart rate in order to maintain cardiac output (CO). Eventually CO decreases and subsequently results in decreased end-organ perfusion.

As the body becomes deprived of oxygen, aerobic metabolism shifts to anaerobic metabolism. This shift causes the build up of lactic acid, which ultimately produces metabolic acidosis. The hemorrhage in hypovolemic shock results in extreme activation of prothrombin, which causes an excess of thrombin formation. The excess thrombin causes the conversion of fibrinogen to fibrin. Fibrin activation produces wide-spread clot formation. This process depletes coagulation factors. Overtime, secondary fibrinolysis and coagulopathy results in further bleeding. As the hemorrhage progresses, hypothermia results from excess shunting of blood away from extremities producing a “shocky” looking patient who is clamped down.

The patient usually has delayed cap refill and w/kids an early sign is a gap between central and peripheral pulses. Giving volume such as whole blood or 1:1:1 of PRBC’s/platelets/FFP is what the patient needs in order to achieve homeostasis, maintain normal perfusion and to hopefully achieve a MAP of 65.

Pediatric Hyperthermia

Have you ever taken care of a pediatric patient who was left in a hot car during the summer and suffered from hyperthermia? •

Have you even thought about what kinds of clinical complications you may see w/this type of case? If so, tune in now to my new podcast episode….👂🏼

👶🏼🚁🚑🏩 #newpodcastalert #newpodcastepisode #pals #enpc #ena #emergencynurse #pediatrichyperthermia #rhabdomyolysis #hypoglycemia #electrolyteimbalance #emergencytraumamama