EP 121: Code Blue: Dos & Don’ts

EP 121: Code Blue: Dos & Don’ts

Nurses and Code Blues

Code blues are one of the scariest situations to be in as a nurse. Every nurse should know the basics of code blue because they can happen at any time. Many times a nurse is the first one to witness a patient going into cardiac or respiratory arrest. There is a lot to know about how to run a good code blue.

Prevention

The best way to deal with a code blue is to prevent a code blue. As a nurse you need to try and round on your patients at appropriate times, even the more stable ones can turn on you. It is understandable that in certain situations hourly rounding is impossible but rounding should never be neglected on purpose. Labs are important and should be one of the first things to look into during your shift and throughout.

What to do during a code blue

It is very important to stay calm and professional during a code blue. The nurse in charge of the situation should delegate tasks accordingly. This includes making sure that when there are nurses available, they are doing what they can for their assigned patient while not forgetting about the other patients on the floor space as well.

During a code blue, nurses should first assess the situation. They need to check for signs of life, and then start CPR if needed. There are times when you can visually see that the patient is not breathing even by the way they look. If you enter the room and are not sure of what is going on with your patient always assess. Call their name, touch or shake them, and feel for a pulse. If there are no signs of life call a code!

According to ACLS guidelines, the adult cardiac arrest algorithm is:

For Shockable Rhythms

  1. Start CPR (100 compressions/min), attach to monitor and defibrillation pads, and give Oxygen.
  2. Check the rhythm: is it shockable? Ventricular Fibrillation and Pulseless Ventricular Tachycardia are shockable.
  3. Shock 120 – 360J
  4. Continue CPR for 2 min and establish IV access.
  5. Rhythm and pulse check, shockable? VF/pVT
  6. Shock 120 – 360J
  7. CPR: 2 min, Epinepherine every 3-5 min
  8. Rhythm and pulse check, shockable? VF/pVT
  9. Shock 120 – 360J
  10. CPR: 2 min, Amiodarone, lidocaine, treat reversible causes.
  11. Back to step 5

For Nonshockable Rhythms

  1. Start CPR (100 compressions/min), attach to monitor and defibrillation pads, and give Oxygen.
  2. Check the rhythm: is it shockable? Asystole and Pulseless Electrical Activity are not shockable.
  3. CPR every 2 min and IV access
  4. Epinephrine ASAP every 3-5 min
  5. Treat Reversible cause
  6. Back to step 3 until ROSC or termination

What are the nurses’ roles during a code blue?

There are a few nursing roles to play in a code blue situation and each has its own responsibility. The first thing to understand is that it is not your fault.

Lead Nurse

The first nurse role is the “lead” aka the nurse who is in charge of running the code. This nurse is responsible for dictating and delegating certain tasks. This should be the primary nurse or a charge nurse because the primary nurse is the one that knows the patient the best and the charge usually has a higher knowledge base and skill set. The primary nurse or a charge nurse are the best people to assess the situation because they have been managing the patient’s care and are our best hope in figuring out what happened. 

The lead can then change when a physician comes or another nurse takes over.

The dos and don’ts of a lead

  • Don’t take on other tasks or leave the room.
  • If you are the lead, you are running the show so know the cardiac arrest algorithm.
  • Speak loudly so everyone knows what is going on, make sure people know you are the one running the code.
  • If you are the primary hand this role over to the physical and critically think of what could have happened (harder than you think).

IV access and medication

This role can be filled by one or two nurses because getting IV access and maintaining IV access can be a tough job. It is better to have 2 nurses on this job until good IV access is maintained then one nurse can step away and take on another task. You will be administering medications per the cardiac arrest protocol but also some paralytics and sedatives like etomidate, propofol, versed, fentanyl, etc…

Dos and Don’ts

  • Don’t stop after the first attempt, keep trying.
  • If you are struggling ask for help and keep trying
  • Try not to forget the labs
  • If pushing med keep the vials so you don’t forget what you gave.
  • Push the correct medication.
  • Let people know what you’re pushing and when.

Recorder

the recorder’s role is exactly what its title is, you record. Many nurses don’t like this role because it usually requires you to chart after the code. As the recorder, you write down everything that is going on into time slots. A code blue sheet looks like a spreadsheet. It is your job to also manage time so everyone knows when it is time for a shock, pulse check, and medication.

Dos and Don’ts

  • Don’t think you will remember something, always write it down.
  • Maintain this role, don’t do other tasks
  • Keep your eyes on the clock.
  • Know the Cardiac arrest algorithm.
  • Speak loudly.

Compression master

This is usually when the boys come in. Every guy likes doing compressions but just like other things, not every guy is good at them. Always remember 100 – 120 compressions a minute is a way to go. This is also not a one-man job. There should be a person or two ready to hop on the chest. Compression gets tiring so try and switch every 2 min.

Dos and Don’ts

  • Don’t be a hero, ask for help, and switch!
  • Give good compressions, 2 inches, and push down hard and fast.
  • If no one is in line, delegate to someone that isn’t doing anything.

Runners

This role can be plated by a few people. Your job is to chase down and meds or equipment. You can also be the one putting in orders for labs, making phone calls to radiology, or getting ahold of anesthesia or a physician.

Dos and Don’ts

  • If there are a lot of you, then it is better to stay away
  • Try and recognize when the situation is under control and you might not be needed. Sometimes the more bodies the harder it is to run a code.
  • Check on the other patients.
  • Let people know what you are getting or where you’re going.
  • The better you get at this the more efficient you will be inputting in orders or grabbing meds.

Speaking with family

This is a very important role and will usually be the responsibility of the primary nurse. It is always hard letting the family know that their loved one is in cardiac arrest or has passed away. This is a skill that gets better with practice.

Dos and Don’ts

  • If you are not sure how to approach a family ask someone.
  • Be honest and don’t speak on things you aren’t sure of.
  • Ask the family to come in.
  • You can always defer some concepts to the physician and say the Doctor will better explain the situation once you arrive.
  • Don’t give false hope.

As the primary nurse, try to figure out the underlying causes of cardiac arrest. Look at lab values and prior issues. It’s easier said than done but try to stay calm. If this is not your patient make sure you have a role not just standing by and interfering. If it is your patient make sure to stay in or near the room because you will have to maintain the report. Remember to speak to the family and explain what has happened. Always try your best, brush up on your knowledge, and remember that it was not your fault.

https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/algorithms/algorithmacls_ca_200612.pdf?la=en

EP 120: 5 Habits That Will Change Your Life

EP 120: 5 Habits That Will Change Your Life

5 Habits to incorporate into your life

If you’ve been feeling like you’re stagnating in life or just can’t seem to figure out what to change, we have a list of 5 habits for you to start incorporating into your life outside of work and inside. We always try to better ourselves or change in some way, you usually start with a self-reflection and then some research. Unfortunately, many people fail to realize that the best habits are fostered when introduced by someone else with life experience. 

5 important habits

  1. Create a Schedule
    1. What is something you enjoy doing in the morning or what is something you currently do that you enjoy? Maybe you like to meditate, work out, read, or enjoy a healthy breakfast. Whatever it is that makes you feel supercharged, kickstart your day with that habit. 
    2. Establishing a meaningful morning ritual helps you start your day on a positive, proactive note. Having a structured start to your day instead of rushing to make up for the lost time also helps eliminate stress, mental fatigue and enhances your productivity.
    3. If you don’t know where to start, a good idea is to plan out your morning the prior night. You don’t have to plan out your whole day just think about 1 or 2 things you’ll do after you wake up.
  2. Do not stay up too late
    1. What we’ve noticed throughout the years as being the number 1 reason people stay up late is control. People’s lives get busy and some people almost lose control. So just like some drug users seek drugs because their life is in shambles and drugs are the only control they have, you seek to have control oversleep. This type of control is bad because you are tired, your body is saying sleep. You control when you go to bed and you will not let your body tell you who is boss. This is negative control because you lose sleep by staying up too late and this turns into a vicious cycle. 
    2. You can’t comprehend the effect and importance of going to sleep on time or early. You have more functioning day hours and you’ll feel great and more accomplished. Studies show that ⅓ people don’t get enough sleep. Don’t be one of them. https://www.sleephealth.org/sleep-health/the-state-of-sleephealth-in-america/ 
  3. Learn to single-task
    1. There are many people out there that say you need to multitask. What they don’t tell you is that only about  2.5% of people can actually multitask efficiently. https://health.clevelandclinic.org/science-clear-multitasking-doesnt-work/#:~:text=%E2%80%9CWhen%20we%20think%20we’re,are%20able%20to%20multitask%20effectively
    2. It’s a simple concept that you think is inefficient simply because math always told you 2 are greater than one. That is not the case in life. Most people are a lot more efficient doing 1 thing at a time. This is especially true at work. Most jobs require you to handle one thing at a time, many people try to do more than one, and then their productivity dwindles and you cant figure out why things are not getting done.
    3. This goes along well with prioritizing. What is due first, what is something you want to do first, and what is most important are good things to ask yourself before starting that first task. 
  4. Listen and be kind
    1. This sounds cheesy but it really works. Some people are struggling in life and just a simple conversation lights up their spirits. We all need outlets and the greatest outlet is speech. It is really that simple. Not only will you make someone’s day you will also learn something. This is also important at work, especially in the medical field. Just by actively listening you can figure out what is going through your patient’s head. You’ll be better at treating not only their medical issue but you’ll also be helping them on a mental and emotional level.
    2. What goes around comes around. What energy you give to this world you receive back. Too many people surround themselves with hate and anger and you can feel it. There is too much negativity in this world so start doing kind things for others. It would blow your mind how much good advice and free things you can get just by being nice. People are at different points in life and in situations, we might not be able to comprehend. Share the love and you’ll get love back. 
  5. Always try to learn
    1. By this, we mean to try and experience everything. Conquer your fears inside of work and out. Treat every experience as a learning opportunity. Try and do new things.
    2. Being uncomfortable is the area for growth. Learning is hard and it’s usually uncomfortable because you are dealing with something unfamiliar. 
EP 119: Should You Move Out After Nursing School

EP 119: Should You Move Out After Nursing School

Moving Out After Nursing School

How soon did you move out after nursing school? 

There is no ideal time frame. Some nurses do it a few weeks after landing their first job, some wait a few years and build up their finances, while others have already been living on their own. Moving out is a big part of your life, so make sure to think it through. Why do you want to move out? Is it because everyone is doing it, you want more space, you want more freedom, etc… You may think; what are the benefits of moving out after nursing school.

Things to consider before moving out

Finally getting to move out of your parents’ home is one of the greatest and most accomplishing things you will do in your lifetime. It puts you in a point of optimal growth, you’re going to experience life on a different level. These are some steps to take before you move out.

  1. Figure out your financial situation
    1. If you want to move out you first have to make sure you have enough money. There’s a thing called rent or mortgage for everyone still living at their parents’ home. You’re going to be paying for the place you are living in and it is going to be your most costly expense. The average cost of rent in the US is a little over $1,000 a month, depending on the location you will most likely be paying more. For example, a 2 BR condo in LA will run you around $3,000 – $5,000, in Chicago $1,800 – $3,000.
    2. You also need to incorporate groceries, utilities, Netflix, phone bills, and personal expenses. It all adds up and it’s usually a lot more expensive than you initially thought. 
    3. Consider your loans. What are your monthly loan payments? You might be better off living at home for a few months or years longer to get them paid off quicker. 
  2. Where do you want to live
    1. Location, location, location, one of the biggest real estate owners is McDonald. You need to think about where you want to live, city, suburb, local, or out of state. Is there a particular spot you always go to or really like? Do you want some views, or maybe live close to your parents.  
  3. Why do you want to move out
    1. Moving out is a lot of work and increases your responsibility. Are you moving out for the right reasons or are you mindlessly doing it because everyone else is? 

Benefits of moving out

  • More freedom: You will not have a room anymore, the whole place will be your temple. You can do whatever whenever walking naked from your bedroom to the kitchen kind of freedom.
  • More responsibility: You will now be a fully functioning adult with complete control of your life and future. You are going to learn all the things associated with living at your own place; decorating, cleaning, fixing, maintaining, etc… It is a new sense of being. 

 

EP 118: Managing Your Finances as a Nurse

EP 118: Managing Your Finances as a Nurse

Managing Your Finances as a Nurse

Managing your finances is something schools and universities still neglect. Coming out of college some people don’t know how to open a bank account. A career in nursing can be lucrative when it is done right. The highest nursing salaries also allow you to pick and choose where you will work around the US.

We also did a great episode about how to pay off debt and save money with the DebtFreeNurse

Understand how much you get paid

The 2 biggest things in understanding your pay are; there is a difference in the amount you get paid by your employer and how much you take home. That is called net and gross income.

  • Gross income = Income before taxes
  • Net income = Income after tax (the amount you actually get)

It’s always good to know how much money you make on a yearly basis as well as know your average paycheck total. 

  • If you make $2,800 biweekly then your monthly income is double, $5,600/month
  • That’s $67,200 a year

Your income means that just by yourself you already make above the median household income of the US, according to the median income in 2019. Median household income was $68,703 in 2019, an increase of 6.8 percent from the 2018 median of $64,324.

It is also important to take into account how much you pay for insurance. Most people get health insurance, dental, and vision through their employer. It gets taken out directly from your paycheck. 

Understand your bills

We are entering a more and more subscription-based society. It is a lot harder to keep track of monthly occurring expenses vs a one-time payment basis. What makes it tricky is they offer something low cost with improved tiers which don’t seem like a lot at the time but multiply it for the year and it might add up to $1,000. 

Some staple bills to always keep in mind are; cell phone, internet, home bills (gas, electric, water, rent), Netflix, apple subscriptions, and car insurance. 

Take into consideration your costs of groceries.

Create a budget and stick to it

Knowing your income and expenses is the key to understanding your financial situation. Once you have those understood it is time to create a budget. When making a budget to add up all the money you make from work and add up all your recurring monthly/weekly expenses.

This gives you an idea of how much you make and basic necessary spending. This also gives you an amount left over. You need to budget the money you have leftover when you subtract your expenses from your income. 

The money you have leftover is technical your “spending money”, but that also accounts for money you want to save. This is the money you have to do things outside of food, shelter, water, etc.. Your budget should consist of 2 major things; money to save and money to spend.

It is important to realize what percentage of your money goes where. The best way to make a budget is to break it down into months. X% is devoted to categories like bills, food, restaurants, ets.. Let’s take $4,000/month of income for example

  • 40%: $1,600 in monthly bills (water, loans, mortgage, rent, comedy, internet, cellphone, etc..)
  • 15%: $600 on groceries
  • 25%: $1,000 saving
  • 10%: $400 extra
  • 10%: $400 eating out/leasure

Starting with just breaking down to the major categories gives you an idea of how much money it actually costs to live and how much you really make. Once you have the fundamentals of the budget you can then add other categories like goals, or you can rearrange where your money goes. Once you have a budget you can safely save and spend. It’s about understanding your money not how much money, at least in the beginning. 

Saving and Paying off debt

The biggest and most inconvenient things about being an adult are saving for the now, saving for the future, and paying off debt. The best way to battle debt is to not get in it in the first place. 

The number one rule with paying off debt is to pay the high interest off the quickest because that’s the one that is charging you the most for borrowing. Another good step would be to pay your credit off in full if you have the chance to instead of just adhering to the monthly payments. It is also good to use your leftover income to get used on the loans, trying to make a higher than your regular/minimal monthly payments because you’ll pay it off quicker.  

When it comes to credit cards you should use them like a debit card. Only spend money you have, not money you will have. The majority of the time it is more beneficial to use your credit card so you can earn points and build your credit. Most debit cards don/t offer any perks. 

It is good to save outside of your 401k, most employers over a 401k plan which makes it very simple. You should still have a savings account as your savings for the short term. In your savings, you should also have an emergency fund with at least 3 months worth of living expenses.

Understand your credit score

Your credit score is a three-digit number that can have a big impact on your finances. Lenders are willing to offer borrowers with high credit scores better loan terms and lower interest rates.

As you apply for large loans such as a mortgage, a small interest rate reduction can save you thousands of dollars. Credit scores generally range from 300 to 850

What Factors Impact Your Credit Score?

  • Pay your bills on time, every time.
  • Pay off your debts as quickly as you can.
  • Keep your credit card balance well below the limit.
  • Applying for multiple credit cards
EP: 57 Walmart’s Insulin & Magic Mushrooms Regrow Brain Tissue

EP: 57 Walmart’s Insulin & Magic Mushrooms Regrow Brain Tissue

Walmart created an insulin brand to undercut the market.  

The American Diabetes Association (ADA) released in 2018 estimating the total costs of diagnosed diabetes have risen to $327 billion in 2017 from $245 billion in 2012 when the cost was last examined. This represents a 26% increase over a Five-year period.

So, Walmart just launched a more affordable analog insulin branded ReliOn. The Brand is designed to overcome common impediments, like the affordability of and access to diabetes care, especially for those without health insurance. There are three different kinds of ReliOn Novolin insulins available. There is regular, or short-acting, intermediate (N), and a mixed 70/30 available in the ReliOn line of insulins.

ReliOn/NovoLIN N is an intermediate-acting insulin that starts to work within 2 to 4 hours after injection, peaks in 4 to 12 hours, and keeps working for 12 to 18 hours.

The analog insulin vials and will save customers between 58% to 75% off the cash price of branded insulin products, or up to $101 per vial or $251 per package of “FlexPens,” the retailer said. The medication will be available in Walmart pharmacies and Sam’s Club pharmacies in July. 

More than 34 million people in the country (11%) suffer from diabetes, with an additional 1.5 million diagnosed within the United States every year, according to the American Diabetes Association. 

According to data from the Health Care Cost Institute, people with Type 1 diabetes in the U.S. had to dish out $5,700 per year in 2016, up from $2,600 in 2012.

“The price point, we hope, will improve and hopefully revolutionize the accessibility and affordability of insulin,” said Walmart’s Executive Vice President Cheryl Pegus of the company’s health and wellness department, according to the report.

Seems purely philanthropic but this is the largest grocer and employer in the U.S and now, just like Amazon, will take a cut in the healthcare brand market. 

Walmart so far has opened 20 clinics adjacent to its stores with budget-level medical care, including $25 dental cleanings, and $30 annual checkups. They even bought a telehealth company called MeMD in May to offer virtual care and has exerted pressure on the entire pharmaceuticals industry before sending its prescription program to market, which provides monthly supplies of ubiquitous generic drugs for wildly low prices of $4.

https://www.diabetes.org/resources/statistics/cost-diabetes

https://healthcostinstitute.org/

https://corporate.walmart.com/newsroom/2021/05/06/walmart-health-to-acquire-telehealth-provider-memd

https://www.walmart.com/cp/4-prescriptions/1078664

https://abcnews.go.com/Business/prices-insulin-skyrocket-walmart-launches-affordable-brand/story?id=78577787

Psychedelic Mushrooms Can Regrow Brain Tissue Lost in Depression

According to a new study in the journal of Neuron, psilocybin, which shows up naturally in some mushrooms, has shown signs of increasing durable connections between neurons in mouse brains. 

In this study, they used two-photon microscopy to image longitudinally the apical dendritic spines of layer 5 pyramidal neurons in the mouse medial frontal cortex.

What are pyramidal neurons?

Pyramidal neurons are the most populous members of the excitatory family in the brain areas they inhabit. They comprise about two-thirds of all neurons in the mammalian cerebral cortex, which places them center-stage for many important cognitive processes.

What do pyramidal neurons do? 

Like many other types of neuron, their main job is to transform synaptic inputs into a patterned output of action potentials. What makes them special is their numerical dominance, as well as the fact that they are ‘projection neurons’ — they often send their axons for long distances, sometimes out of the brain altogether. For example, pyramidal neurons in layer 5 of the motor cortex send their axons down the spinal cord to drive muscles. Pyramidal neurons might thus be thought of as the ‘movers and shakers of the brain.

Study highlights

  • Psilocybin improves stress-related behavioral deficit in mice
  • Psilocybin increased spine density and spine size in frontal cortical pyramidal cells
  • Psilocybin-evoked structural remodeling is persistent for at least 1 month
  • The dendritic rewiring is accompanied by elevated excitatory neurotransmission

The researchers observed rising numbers and girth of dendritic spines on the first day following exposure to psilocybin. The girth increase happens to create small protrusions on nerve cells capable of enhancing the way information transmits from one neuron to the next. 

These changes persisted for at least a month, and the mice previously placed in stressful situations exhibited improved behavior, with increased neurotransmitter activity, following the administration of psilocybin.

How Depression Affects the Brain

No one knows for sure what causes depression, but researchers have determined that it is definitely a disorder that has biological underpinnings and that the chemistry of the brain plays a big role. 

  • Cortisol and memory
      • The hippocampus releases the hormone cortisol when you’re stressed, which includes episodes of depression. When your brain gets flooded with cortisol for long periods of time, it can slow or stop the growth of new neurons in the hippocampus. This results in the hippocampus actually shrinking in size, which in turn leads to memory problems.
  • Cortisol and the amygdala 
      • The influx of cortisol triggered by depression also causes the amygdala to enlarge. This is a part of the brain associated with emotional responses. When it becomes larger and more active, it causes sleep disturbances, changes in activity levels, and changes in other hormones.
  • Brain inflammation 
    • Inflammation shuts down energy production in the neurons, so brain endurance drops, making it harder to read, work, or concentrate for any length of time. This also leads to depression. In the long run, chronic neuroinflammation results in neuron death and brain degenerative disorders.

https://interestingengineering.com/psychedelic-mushrooms-regrow-brain-tissue-depression

https://www.cell.com/neuron/fulltext/S0896-6273(21)00423-2?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0896627321004232%3Fshowall%3Dtrue

https://www.cell.com/current-biology/pdf/S0960-9822(11)01198-5.pdf

https://www.bridgestorecovery.com/blog/how-major-depression-affects-the-brain-and-body-why-residential-treatment-can-help/