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What Can I Do To Save A Life? (with Sarah Lorenzini, RN)
Episode 6322nd August 2023 • Your Doctor Friends • Dr. Jeremy Alland and Dr. Julie Bruene
00:00:00 00:49:25

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Medical emergencies are common and the vast majority happen outside of hospitals. On the street. In the airport. In line at Starbucks. In the movie theater.

That means that the true “first responder” is often someone without any medical training at all. Many people don't feel prepared for these situations. Certainly, it's unfair to blame the everyday layperson for not being immediately ready to give someone CPR, however it's well-established that delaying lifesaving care often leads to worse outcomes. So what do we do? 

We thought we should call up one of our friends (who is an absolute EXPERT in saving lives) and bring them on to teach you all the ways YOU can save a life. 

We will cover the obvious (like cardiac arrest and choking), but also some lesser-discussed emergencies such as stroke.

How do you recognize these emergencies? What should you do first? What should you not do? When to call the ambulance? And that's just the surface! 

Today, Your Doctor Friends present the every person’s guide to What Should I Do In a Medical Emergency?

Welcome to our esteemed guest, THE RAPID RESPONSE RN herself, Sarah Lorenzini, RN!

  • She is an expert in emergency medical care as a Rapid Response nurse.
  • Even better, she is an expert in teaching others on how to recognize and respond to emergencies.
  • You may know her as TheRapidResponseRN on social media and the host of the Rapid Response RN podcast where she teaches other nurses the ins and outs of rapid response/critical care.

FOLLOW SARAH on social media (@therapidresponsern) and listen to The Rapid Response RN podcast!

Key topics in this episode include:

How do we recognize someone having a cardiac emergency?

What's the first thing we should do when we suspect someone is in cardiac arrest?

When should we call 911?

What is "hands-free CPR"? Is it effective?

How do we use an AED? Where/how can we find them?

What are the consequences if bystanders don’t help before EMS arrives?

What are the signs of choking?

How can we immediately help a choking victim? Is the Heimlich still recommended?

What are the signs of stroke?

How do we know if it is a stroke or something else?

What should we do if we are concerned that someone is having a stroke?

I’ve been told if I help and it doesn’t go well, I can be sued. Is that true? How do I know if I should help or not?

What are "Good Samaritan Laws"? Do they apply to everyone who is rendering first aid?

What if I feel like I can drive the person faster to the hospital, rather than waiting for an ambulance?

Check out Sarah's own Rapid Response and Rescue courses online to learn more about how to save lives!

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But most of these people are not prepared for these situations. It's hard to blame somebody who works in tech for not being ready to give someone CPR when they Go into cardiac arrest in the middle of a movie that you're at, but it has been very well established at this point that the associated delays in care often lead to worse outcomes.

People do poorly when they have an emergency and nobody helps them right away. So what do we do about that? We thought that we should do what we do best and find one of our friends who's an expert in saving lives and bring them on to teach you all the ways you can save a life. What do you think about that?

Julie? I


[00:01:05] Jeremy Alland: Yeah. I mean, as, as a physician, the thing you fear the most is that airplane seat when somebody is like, is there a doctor on board?

And you're like, I'm in the middle of a movie. Is that okay?


[00:01:19] Jeremy Alland: Oh, wow. I'm the complete opposite. So that's funny. I, I, I'm like children though too. It's a little different. I just don't want to have to. Yeah. Okay. Um, so We're going to cover obvious things like cardiac arrest.

I think a lot of people when they think of an emergency, they think of somebody's heart stopping and passing out, but we're also going to cover choking. I think that's another one that at least gets shown on TV shows and movies all the time and then maybe some less discussed emergencies like stroke, which certainly has had some more buzz around it, but.

Often goes unrecognized and could be treated a lot better. So we're going to go over things like how do you recognize them? Should you do first? What should you not do when to call the ambulance? And honestly, that's just the surface. We're going to really dive deep because we have an awesome expert today who honestly is so good at this, that she has her own podcast where she goes through all of these fun situations.

So today on your doctor friends, we're going to present the every person's guide to what should I do in a medical emergency? Ready? Let's get it.

Welcome to your doctor Friends, the show that teaches you to sniff out the garbage and answers all the questions that you wish you could call or text your doctor friend. My name's Julie Bruny. And I'm Jeremy Allen. And we are two physicians who work at a nationally ranked practice and take care of some of the world's greatest athletes.

We know that you have questions and we want to help. We wanna be your doctor friends.


Please welcome our friend. Sarah Lorenzini. Sarah, thanks for joining us.


[00:03:16] Jeremy Alland: Yes. We had been talking about doing this, uh, having you on for like a while and it, you know, life just gets in the way and we both have shows and day jobs, but we finally are going to make it happen.

And this is a, this is an awesome episode. I'm really excited. I think Julie and I are going to learn stuff. Julie, did you cover, did you cover codes when you were in residency? Did you guys have to go to like emergencies?


[00:03:47] Jeremy Alland: you did.

Yeah, I was in an unopposed hospital where we're the only that means we were the only residents in the hospital. So anytime there was an emergency, we ran the codes. And so I ran by running code. What I mean is we're the ones that are Trying to save said person. And one of the things that I said is I, the PTSD from that of the click on intercom had took me years to get over.

Like whenever an intercom would go off, even like an airport where it would like click and somebody's going to tell you your gate has changed. Like I would get a sudden little drop in my heart because like I would have to, usually that meant I was going through an emergency. Um, so code blue seven tower


[00:04:22] Julie Bruene: But


[00:04:24] Julie Bruene: I'm trying to, I'm trying to give Jeremy cold


So as they say, when there is a burning building, most people run away, but first responders run in when shit is hitting the fan in the hospital. Sarah, you are running to be the first one there and you're like proud and excited and happy about it. So tell us your story. Why do you like to be in the fire?


So I'm not your typical like adrenaline junkie that goes. Skydiving in my free time. Not at all. Like I'm a mom of five kids and I crochet for fun and drive a minivan, but I really love being there for people on the worst day of their life. And so I spent years working as an ER nurse and then cardiac ICU.

And then I found out about this position of rapid response nursing. And I was like, literally all day long, running to people who are having the worst day of their life. That is the. The dream job for me. And so I don't know what it is about me that makes me enjoy this role, but I do think that, uh, God wired me in a way that I can handle high stress situations and not freak out and keep a level head.

I've learned some tips and techniques to kind of stay calm. Um, when everything around you is crashing. So it really is a perfect job for the way that I'm wired and for what I love to do. That's how I ended up doing this.


I was shitting my pants and it was the nurses that were working with me to be like, okay, you should do this next, you know, and it makes me think of, um, I, I, I, I assume, you know, like, like all badass nurses know each other. I'm not sure if that's true, but I sure hope it is. But like it makes me think of what you just said and opening up your, your, your origin story makes me think of Jen Hamilton, the, who's amazing nurse.

And her, uh, thing online that she says that just makes me almost cry every time is that when she is with a patient, who's really having a really difficult time and is really scared and is really freaked out and she does labor and delivery. Um, she always, you know, says to them and it's been kind of like a viral thing that she talks about is, um, I know you're scared, but I'm not.

And like, that just like gives me chills every time. And I just think of, I think of you too, Sarah. Oh,


[00:07:18] Jeremy Alland: So in addition to your day job as that badass rapid response Nurse that Julie was referencing. You've dedicated a lot of your time to educating others on responding to emergencies. You have the podcast, you have a course that you teach people, you do it on a daily basis at your day job.

Medical emergencies are kind of your thing and medical emergencies for every person level one is what we've asked you to come on and teach everybody. So where should we start?


Oh my gosh, do I have to do mouth to mouth to this stranger? So I'd love to dive into that. If you feel like that's a good way to get


[00:08:03] Sarah Lorenzini: thing. So first thing is go assess them. Hello, sir.

Are you okay? Are you okay? Like, tap them on the shoulder, on the chest, see if they respond to you. And then if they don't, there's checking a pulse. I would say, you could also start yelling, Can someone please call 9 1 1? Yeah. They say it's best to actually look someone in the eyes and point at them directly and say, You with the blue shirt.

Call 9 1 1. Do you just say, can someone call 9 1 1? Everyone assumes someone else is doing it. And then it maybe never gets done. So point at someone and then checking for a pulse just involves feeling someone's neck and feeling if there's a pulse and if you don't feel anything in just a couple seconds, it's time to start compressions.

Worst case scenario, they don't need compressions and you do two of them and they come off. They're like, stop, stop. Great. That's great. That's a great response. But if they need compressions, you don't want to spend forever looking for a pulse because that whole time the heart is not actually squeezing.

So the whole goal of doing CPR to someone who is. Pulseless is to actually generate a pulse to actually squeeze the heart for them from the outside. Now, a CPR course, that's like a four hour course. I cannot teach you CPR in the audio format of a podcast minutes, but I would highly recommend if you have not taken a CPR course to go take one.

They're like 30 bucks, and then you can know what to do to save someone that might, you know, maybe your loved one that, you know, uh, collapses in front of you. So CPR, um, in the hospital setting, we are compressing on the chest and also providing breaths. We have a device, like a mask that fits around the face that can deliver breaths to the patient.

And outside of the hospital, they used to teach, um, compressions and then mouth to mouth resuscitation. But the American Heart Association said, you know what? A lot of people are not into that. Um, and so people are not getting CPR because no one wants to do mouth to mouth. So years ago they actually switched it to outside of the hospital.

Hands only CPR is excellent. That's an excellent way to get someone to save someone's life. Obviously providing breath is a little bit better, but the benefit is minuscule. When you think about the risk of someone not doing it at all, if they're afraid of doing the breast part. So hands only CPR is literally just crouching over the patient, locking your elbows out, putting all your body weight in that person's chest.

Um, you can interlace your fingers to put them right in the center between the nipples and just press. Hard and fast. Um, I've been a nurse for 20 years and I still sing in my head, uh, uh, staying alive, staying alive. Uh, uh, because that's the perfect pace to achieve a hundred to 120 compressions per minute.

So if you're kind of moving to the beat of that song. You are nailing it with regards to how fast you give CPR.


[00:10:52] Julie Bruene: Z song. Like, cause I feel like we're going to be not cool anymore with these.

They're like, I don't know what


Oh my God. Let's see it alive. Everyone knows that song. Um, that's, that's what I've been singing for all these years. So who's the CPR too? They found out. Okay, good. Yes. A lot of good ones. So just dance. It'll


[00:11:29] Sarah Lorenzini: Just dance. Spin that record, babe. Yep. Yeah, it really gets you in the mood for some CPR dancing, but doing CPR is, is so, so important.

And statistically for every minute that bystander CPR is not provided, that decreases someone's chance of survival by 10%. So if we're all sitting around staring at this person who has no pulse for 10 minutes, their chance of survival is next to nothing.

But for patients that have had bystander CPR, even subpar CPR, their chance of survival is so much greater. And you know, working in the ER, we'd get report from EMS and they would say, this patient's been down for X amount of minutes, but they had bystander CPR from the beginning. And all of us are like, okay, good.

We might actually get them back. But if they say. This patient's been down at the mall for 10 minutes with no bystander CPR. All of us in our heads are thinking this is not gonna, gonna go very well, but I have seen people who have made a full recovery after having 30 minutes, 40 minutes of CPR and somehow they still come back because even though technically they are dead, we are.

Circulating the blood for them through doing high quality CPR. So CPR is important. Uh, the other piece is knowing how to use an AED. Um, man, there's are so popular now. Like I feel like when I started my career, it was this rare thing. Like, Oh, look at that. The grocery store has an AED, but now everywhere has AEDs.

Um, there's even apps that will tell you where the AEDs are located in your community with like little photos of where they're located on the wall. So, I mean, the gym, the grocery store, the library, like any. Government building everywhere has AEDs. They're super easy to use, um, for a lot of people. The reason why they collapse is for the, from an arrhythmia.

And if we can get the AED on them, we can actually shock them out of that rhythm and, and get them back. So, um, early defibrillation is good for patient outcomes as well. But again, And 80 is scary unless you've used them before. But if you take a CPR class, you will get to practice with the ad and feel more comfortable with it because they really did kind of make it foolproof.

You put the pads on and you hit analyze, and then it tells you to press the shock button or not. So pretty good.


I mean, it's just common vernacular, which is great. But in addition, if you open up the new ones, they're, the instructions are written for like a, uh, Five year old like my it's stickers that literally tell you on what part of the body in a picture to put on the tube on the patient or whoever and you push the button and it literally reads it for you and says either shock advised or shock not advised.

And, and it. It couldn't be easier and so I just think everything you've set up to this point is so empowering for everybody listening who does not have medical training but could save a life because you just said doing even subpar CPR getting your hands on them and pushing is going to give them a better chance and then putting an AED on which on the surface may sound scary but is not can really save their life.

So I just so empowering for people who are not medically trained to get into the fire. If somebody fell down or excuse me, you know, has cardiac arrest or passes out collapses to be there. And you can, you can be a huge part of, of saving somebody's life. One,


And I think, I don't know, I don't know if you guys have thought of this too, but like. Do you have to take, should you be taking someone's shirt off? And if so, like, do you have to take their bra off? If they're a woman? Like, I don't know. I've never had to put... These are great questions. Right? And I think some people might think of like, ooh, decorum, but it's like, if you don't do this, this person might die.


Sure. You can still have a bra on and you can get the 80 pads on them appropriately. Yeah. Um, the real challenge is a hairy man. Cause sometimes. Or hairy woman, I guess, but a hairy person, hairy folks can make it difficult to get pad contact. So most AEDs come with two sets of pads. So you can put the first one on, wax the hairs off and then put the second set of pads on.

But that's a whole other discussion. Well, and like, how


[00:16:13] Sarah Lorenzini: wax them and start again with the next set of pads. But those, those pads are very sticky. Like, I don't know what those are made out of, but they could be doing some.

Some really high end wax jobs. They're really, really sticky material. She


[00:16:29] Sarah Lorenzini: Many, many times. Well,


Like, what if they are hairy? Like, is that, what if they're sitting in water? Like that, you know, like there's logistics stuff that this, the things that. I don't know that I, you don't think about and then you're already panicking. You're like, is this bad? Like, so I think it's good to walk through these scenarios.


[00:16:54] Jeremy Alland: Hold them out of water. Before you shock them. That's awesome. Um, one of the, uh, uh, other things that I really wanted to, um, return back to that you already said, and I think you said it well, but I just want to emphasize it again is I think that, that the. I think it was the American Heart Association, right?

Saying that we didn't have to do breaths was a huge boon to us saving lives because I, I, I don't want to do mouth to mouth on somebody I've never met before. And if that's the reason I'm not going over and saving a life, that is devastating, right? And so I have found that that has been one of the biggest improvements in our ability to have people Stepping in and providing bystander care, but also a little bit under communicated.

I still think there's a lot of people who think that they need to do breasts when they do CPR. Would you agree with me?


I mean, the movies make it seem like it's a bigger deal than it is, but really it's just putting your hands on the chest and pressing hard and fast, putting pads on the and pressing. analyze and it does everything else for you. So they really have worked very hard to make this life saving stuff accessible to people outside of the hospital.




[00:18:44] Julie Bruene: I usually tell them, like, most of the time, yes. And then everybody recoils and shudders with that, but yeah, the one I get is, is it tiring? And the other one is, do you end up cracking people's ribs? And the answer is, uh, yes and yes, uh, but then you just still keep going anyway. And then that's, what's helpful about, I don't know.

I usually tell people that the times that I've done CPR, it's exhausting and I couldn't do it for longer than a minute or two before I need someone to, to sub in and help me out. Did you guys feel the same way? Or I don't know, maybe you have better cardio than I.


Yeah. And then you sub in. But there is something about like that dump of adrenaline in your own system. Whenever there's an emergency, your body goes into that fight, flight, or freeze mode. And hopefully, uh, your body chooses fight and you have the energy to get through a good, long run of CPR in the hospital.

We rotate every two minutes, the compressor, but I would say outside of the hospital, just as soon as you're tired, say, I need someone to relieve me. Can someone come behind me and relieve me? Cause we know if you're tired, you give less quality compression. So swapping out, it's really important.


[00:20:07] Jeremy Alland: I noted a couple of special circumstances.

The first let's go back to my, my nightmare, which is the airplane. So like, if somebody has. You know, collapses on an airplane. I assume that there's not a whole lot you're changing, but they have EDS on airplanes, I would assume. And you're kind of doing the same thing that you would usually do. Yeah.


But yeah, in that time is going to be the, the people on the flight that are responsible for saving this person's life and continuing to circulate bud for them by providing compressions on their chest.


[00:20:45] Jeremy Alland: AUD? Oh my god,


There's gotta be. Come on, it's funny, they're known for being cheap. It's gotta be funny


[00:20:57] Julie Bruene: Yeah, they're clamoring to give us


Um, the other special circumstance I wrote down natural transition was, um, you sports, um, we take care of athletes. You sports are, um, you know, generally speaking. Younger people are not as prone to having cardiac arrest as older people, but it does happen and it certainly gets a lot of attention, especially since it's shocking and awful to see somebody young go down.

So my question to you is, um, do you do anything differently when it's a child? Um, meaning do you handle the CPR differently? Do you handle the AED differently? Any of thing


Um, same thing with kids and adults, you know, babies, you hold your hands a little bit differently and the ratio is a little bit different, but I wouldn't even worry about memorizing that. Just know that kids need CPR as much as adults do. Um, and same process called 911. Someone get on the field, do compressions until.

The experts can arrive.


Pub at that time. Um, and luckily there was a police officer whose kid who was on the team and had his police car there and had an ad. I mean, like all of those things combined, right? So like, not only was there a police officer there, but had an ad, which they did not all have them 25 years ago and was able to put it on and save this kid's life.

Um, and so just again, this stuff being around and having more awareness is helpful, but a very powerful story for, for me personally. Um, yeah. What else do we miss about cardiac arrest CPR? Anything you want to hit before we move on to our next emergency?


[00:23:16] Julie Bruene: more songs. Do you want more songs?


Uh, choking is, I think, one of the scariest things that anybody ever sees in the face of the planet if they've ever been around true choking. Um, it's much more scary in my personal opinion than a cardiac arrest. Um, cardiac arrest is somebody collapses and at that point they're more or less dead and you're trying to bring them back.

Choking that person's very much alive and it's, it's terrifying. I don't know if you feel the same about the terrifyingness of that, Sarah, do you feel the same as me? I'm ready for both


[00:24:09] Jeremy Alland: Yeah. So, um, we've all seen the shows or movies. Someone's choking. Another person goes behind them, thrusts. We all know the word Heimlich and a food piece goes flying across lands and somebody else's dish and the person's fine.

Um, how accurate is this depiction? Are we being misled? As


Um, I think what we underestimate is when someone's choking, it's not very long until they collapse. And so your option of like standing behind them as they are standing to do the Heimlich, you have very little time to do that. You're probably going to be doing. Compressions to someone lying on the ground, because someone who's not getting any oxygen, they're going to pass out on you.

So I would say be prepared for them to kind of collapse over in front of you. Um, I had an experience last year where a rapid response was called. The patient was still awake when they called the rapid. By the time I got there, she's wide awake, looking at me. And I go over to put my hands around her to do the Heimlich's.

I could tell she was choking. And as I approached her, she just collapsed into my arms, like unresponsive. Now I'm 120 pounds, five, three, but something just came over me like super human strength because of that dump of epinephrine, and I just picked her up and threw her in the bed. Now she's blue jump on her chest and start doing compressions.

And as I'm doing CPR, the force of. Because the compression itself actually pushed the chicken nugget out of her mouth. So, um, compressions is, I would say, even more effective than the Heimlich. But for someone who's still awake, you can come behind them and circle your arms around them, excuse me, um, and kind of press Up and into their chest with a big hard thrust.

Like you want to do it hard to recreate, like generate a little bit of force to push the dislodged thing out of their airway. But yeah, I think, um, the fact that the Heimlich works every time in the movies is not very realistic. A lot of times when someone's truly choking, they end up passing out and they're doing compression.

So just being prepared for that.


I have a very similar experience to you, Sarah, actually, in the hospital when somebody was choking, um, the patient was actually discharged, which was the worst. They were supposed to be leaving and then they choked on a piece of food that they were eating as they were leaving. And by the time I got there, you know, I went around to do the same thing as you.

I was going to go do a Heimlich and two seconds later, there's... Diarrhea down her leg and she's passed out on the floor because she, and then you had to do CPR. And then again, yeah, CPR dislodged the, whatever the food item was. I don't remember what it was and she was fine, but it's just, that is the adrenaline that comes from, from that.

Again, I find that adrenaline more than cardiac arrest personally. Um, I think in for people listening who are going to see this many times, it's going to be, what are the signs of choking and when do I need to step in? So maybe talking a little bit about


They're probably not truly choking because if something's really lodged in your airway, you can't actually make any sounds, which is even scarier because they can't get helps. They're probably like waving their hands to get your attention. And there's the classic hand encircling motion of someone covering over their neck to show like, there's something stuck in my neck.

Um, in my experience, they have. The, uh, the look of fear in their eyes, because they know this is really bad. So if someone is silent and trying to get your attention and has fear in their eyes, possibly like holding their neck, that person is choking. And the first thing you want to do is do the highlight on them as soon as possible.

And in the back of your mind, be prepared for, if this doesn't dislodge it, they're going to pass out. So making sure that I am ready for that and be prepared to do compressions. Would


I'd probably


[00:28:29] Jeremy Alland: What about if somebody was maybe more towards that first person you were talking about that says like, I'm choking, I'm choking. I, what would you encourage? Yes. Thank you. Cough, cough,


Yeah. Um, I mean, the cough reflex is the body's response to try to get that thing dislodged. So just remind them you have the ability to get it out. Try to cough really hard. Um, but I've There's a lot of debate about the whole back blows thing, if we should be snacking on the back or not. So I don't want to speak to that because the literature says both, they say do the Heimlich and they say do back blows.

So, um, I would, I would say I probably would just do the Heimlich because it's been proven to work. There's some studies that show the back blows might make it fall down a little bit deeper into the lungs. So, um, I don't want to make any recommendations either way. The American heart association teaches abdominal thrust is what they call it.


[00:29:34] Julie Bruene: say, Sarah. Yes.


Somebody is not getting help from a bystander because it's gonna turn into cardiac arrest, right? You're not getting enough oxygen. Um, maybe one last question in the choking area. Like, at what point are you calling 911? Like, if you're going to give the Heimlich, should you have somebody call that? Like, if you can tell somebody call 911 at the same time, or you, when, when are you telling people to get somebody?



Right. I, I think, and they would agree to please call us. You can always cancel if it's fine, but most likely you're going to need them. Same, same in the hospital. I tell nurses, if you're not sure if it's an emergency, just call us. I would rather discover it's not an emergency than you wait till the patient's blue and then call.

And it's really hard to turn things around. So always feel empowered to call 9 1 1. That's what they're there for. Um, I don't think there'll be upset if you call and they don't need them. Yeah. And then there's


I mean, maybe that person still needs some medical attention afterwards. Maybe they should be monitored for a while or, you know, making sure they're. What are your, what are your thoughts on that? Do you, I mean, I feel like that's the trope of like, well, even if you've gotten it out, should they be going to the hospital anyway, or at least


It depends on how long they were without oxygen, right? If it's a very brief step, they're probably going to be okay. They might need to be hospitalized just for their own peace of mind to check it out and make sure they're okay. But if someone has had no oxygen for a while, there's a lot of physiological damage that has gone on that needs to be monitored and checked and, um, followed up on.

So I would definitely have them evaluated. Yeah.


[00:31:40] Julie Bruene: From choke to stroke now. So yeah.


[00:31:49] Julie Bruene: Let's do it.


Let's dive in. Let's Give me the primer. Stroke is one of those things that we have limited time. And so it's so important to recognize the signs and symptoms of stroke and call 9 Period. There is no other option. Call 911. If there are signs of stroke, because if there's two types of stroke, there's either a clot in the brain or there's bleeding happening in the brain, both of them, the clock is ticking, right?

If there's bleeding into the brain, the person's going to go very quickly from awake and alert to unresponsive to not breathing. And if there is a clot in the brain, then we have a narrow window with which to give medications to break up that clot. So the longer we wait with stroke like symptoms, some patients arrived at the hospital too late to even give the intervention because it's been too long.

Yeah. And so let's talk about stroke like symptoms because they're, they're really vague and weird. And sometimes they're easy to write off. Um, I like to teach B fast, B E F A C, because you have to go, you have to go fast, B fast. So B is for balance. So if you're having a hard time balancing, kind of like lifting, lifting to one side or the other.

E is for eyes. So visual problems, your vision is blurry, or you can't see off one side, a change in your vision, your eyes. F is for face. So one side of your face is drooping. Um, I will have patients smile, say smile real big, and you'll see one smile, one side go up and the other one just doesn't move at all.

Or I'll say lift your eyebrows like you're scared. One eyebrow goes up and the other one doesn't move. So that's F for face or facial drooping. A is for arm. So I have the patient raise both arms up and if one falls down or starts to kind of starts to fall a little bit. So one arm is weaker than the other.

S is for speech. So if the speech starts to get like slurred or the person's having a hard time finding their words or pronouncing their words. So speech changes. And the last one, T. Is time is time to call nine one one. So be fast is balance eyes, facial drooping, um, arm weakness, uh, slurred speech, and then time to call an ambulance because the faster we go, the faster we get an intervention for someone having a stroke.

The better their outcome is going to be like, we lose billions of neurons every minute that we wait before intervention happens. And so the difference could be being discharged home in a couple of days or having to go to rehab for a couple of months because of so much brain damage that has happened.

So the symptoms of strokes. really depend on where the stroke is happening in the brain, right? There are lots of different lobes of the brain that all control different parts of the body. So whether the speech is affected or the vision is affected or the personality is affected all depends on where the stroke is happening, but.

The great news is there's treatment for both of them, if we can go quickly and what breaks my heart is I've had so many patients come in and say, yeah, my arm started kind of tingling and felt heavy. And so I went and took a nap because I was like, maybe I should just sleep it off or my eyes, my vision was getting weird.

So like I need to take an, I hear this all the time. So I went and took a nap. I'm like. But when you took a nap, now you're outside of the window for the intervention. And I can't actually give you the medication that would have saved your brain. And so the message to everyone out there, especially those that have family members who are older or have high blood pressure or diabetes, which is high risk factors for stroke.

It's important to know the symptoms of stroke. And when you recognize those symptoms, Don't wait. Don't blow it off. Please do not go take a nap, call 911 and get to your closest hospital that has the treatment for stroke because the outcomes are really good if we can get to it quickly. But whenever we wait too long, the outcomes are not as good.

Um, even the lifesaving intervention that we have. So we have a four and a half hour window to give it. Patients that wait until closer to the four and a half hour, they actually have a worsened outcomes than ones that get it like right away. I think my favorite stroke story is I cared for a woman. She was like 30 ish years old, um, new mom of twins.

And she was a school teacher. And she had just gone back to school. Like she had finished her maternity leave and just gone back. And so she, women who are postpartum are at high risk for clots. And then she also had restarted birth control, which increases your risk for clot. And she had been somewhat immobile on her, not immobile, but less mobile on her maternity leave.

And now she's back in the classroom and moving around. So if there was a clot that had formed, it has a chance to, you know, travel North. Anyway, so she's teaching on her first day. And she starts having slurred speech and her students, her second grade students recognized her as a change in how she was talking and they intercom to the front office and said.

Mrs. Johnson. I'm just, I'm making this up. Mrs. Johnson's talking weird. And the front office was able to recognize this is stroke like symptoms and they called an ambulance. So she got to us within 20 minutes of her stroke like symptoms starting. By the time she arrived, she was totally paralyzed on one side of her body.

Couldn't speak at all, but she was still in there. So like she was following commands, but couldn't actually speak to us. It's heartbreaking. Anyways. We booked it to cat scan, determine it was a clot determined. She was a good candidate for the medication that breaks of the clot within 15 minutes of giving the medication, her symptoms started resolving and now she's able to feel her hands again and starting to speak again.

Like it was, it was a miraculous recovery to watch it happen. But if, if those students had not recognized the change that this had gone on for a while, more and more damage would have happened. Right. I mean, she could have ended up. In a nursing home with a feeding tube, unable to move one side of her body and speak at all, but instead, because there's a quick intervention.

She was discharged home and got to take care of her kids again. Like she, she had, she made a full recovery with no deficits at all. So in the hospital, we say time is brain because the faster we go, the more brain that we can save. So the message to anyone, whether you're someone who could have a stroke or be around someone who is having stroke like symptoms is don't mess around, don't write them off, call an ambulance.

Don't try to drive the person there yourself because the ambulance can do more assessments and manage the patient more than you can in the backseat of your car.


And people listening to this episode who don't have medical training need to feel empowered to help. And sometimes it's just picking up the phone and calling help. But when you do it, you actually save lives. And it's just, I, that story's, I've always said that the two most. impactful things I've ever seen in medicine were giving Narcan to a patient and seeing what happens after they come out of like being, uh, you know, overdosed on opioids and seeing TPA, which is the medication you're talking about, given to somebody with a stroke early on and seeing them go from having their stroke symptoms to not having their stroke symptoms in front of your eyes.

And it's crazy. It's a miracle. It's a


I am an ER nurse for life. This is the best thing ever that she gets to go home to her family because of. Because of our hustle, she is, she's going to survive. So yes, I'm, I'm with you there, Jeremy. It's really awesome to see a recovery before your eyes.


And so, um, I just, That was a really good, powerful story to finish with. I feel like that was just, that summarized almost everything we've talked about to this point under stroke, which was great.


[00:40:18] Jeremy Alland: yeah, I don't, I don't know if there's much more to say about stroke, anything you can think of Julie or Sarah that we didn't, I feel like Sarah did a great job.

She clearly is passionate about it and has taught somebody before how to look for a stroke.

Um, one of the things that I wrote towards the end here, which I really would love to hit on a little bit is I, I think one of the things that does hold people back from helping in emergencies is the concept that if I help and it doesn't go well, I am at risk of being sued or.

having negative consequences. Can you speak to whether that's true or if that should affect whether people are


And every state has a version of it that protects those people from, from being sued. So if, if you're trying to help, you're not going to be sued. Um, and again, the, the helping that you do, Okay. You really can't get it wrong. Like maybe you go a little slow on the compressions or maybe you don't press quite hard enough for the Heimlich, but that's not going to harm.

Right. You, you gave your best shot to, to save someone. Um, and I feel like that that's, that's worth the risk. I, I would, I would gladly. Um, how I say this, I would gladly risk not doing it. Perfect. Knowing that I might do it just good enough to save their life. And so I think that's the approach we have to take when we see emergencies.

I mean, I'm the person that pulls over when I see car accidents and, you know, Caesar's when I can do I've several times found myself in situations where someone's having a seizure in public or like some sort of emergency. Um, and so many times when I get there, there's a ton of people just standing around and looking.

And no one's doing anything. Um, but they all have the ability to do something right. And I, and I understand that one to do it wrong, but like, What are, what are you afraid it's going to be wrong? Like you're, you're trying to help someone who's in need. So I don't, I don't think you can really even like get it wrong.


I just kind of feel like if I just threw this person in the car, I could get them to the hospital faster than waiting for the ambulance. What is your thought there?


Can you help me get him out? And I run out there and the person's dead. Yeah, because they try to drive them there themselves. And so yes, maybe you could get there faster, but in the, in your drive there, you don't have an AED, you don't have medications, you're unable to deliver CPR while you're driving. So even if it takes them an extra five minutes to get to you, then for you to get to the hospital, at least in route, there's someone that has the equipment and the training.

To care for your loved one the best. Um, so calling them on one for a true emergency is always worth it. Always better than just throwing someone in the back of your pickup truck and haul into the hospital because you can't actually do anything for them while you're driving.


I feel that I have learned a lot. Um, I hope that people listening to our podcast have learned a lot. I, at the end of this, if even one person takes home something where they can help somebody, we've made a huge difference for people, but I want you to spend a little time talking about what you do on your, on your podcast, your course, your social media, because I think that the stuff that you're putting out is incredibly powerful and I want people to be able to find it.


And so having that knowledge, it really is life saving. Um, and then as far as my own stuff, um, I have, uh, all my social media handles are the rapid response RN, and I have a podcast called. Rapid response are in every episode. I share a real life story of a patient that I cared for, obviously keeping the patient's information private and changing it.

But I talk about like, what happened? What's your diagnosis? What did we do? How to respond? What's the pathophysiology and the pharmacology and the nurse's role? Um, A lot of people listen that actually aren't medical professionals. I just love like the storytelling part of it. Um, my step mom who's awesome.

Uh, she's like, Sarah, I love your podcast. I always listen to the story. And then I'm totally lost when you go into the path of physiology, but I love the stories. So if you like medical stories, these are real ones, actually of patients that I got to care for. Um, and then I also have an online course that's really geared towards nurses.

It's an introduction to how to respond to any emergency. So how, what's the framework that I use to assess people to determine how sick they truly are? What are the first things that I do? Uh, there's a lot of how I manage myself in an emergency. How do I not freak out and hyperventilate and freeze? How do I like have the right mindset, um, whenever I'm approaching emergencies?

Um, and then there's a little bit of pathophysiology about how, why emergencies happen and what our priorities are, but it's just a quick one hour course. And it's been really rewarding to hear from nurses. You say like, I took that course and then I had a patient crash and I knew exactly what to do. Um, and for that, I'm like, okay, it's totally worth it.

I love getting to do and do this work. So yes, I love taking care of sick people in real life and I love teaching medical professionals how to do it. So they feel empowered and confident for the next time it happens to them. That's really,


I think if, um, this helped you, um, I want you to do two things. The first is I want you to share it with one person because if we can have this spreading around one person at a time, there's going to be more people saving lives and recognizing things like choking and cardiac arrest and stroke. In addition, I want you to go over to Sarah's, um, social media or podcast.

I want you to listen to an episode or see some of her posts. follower. I learned something from her every single week. It's fantastic.


The ESPYs just happened not too, it was a week or two ago. And, um, a tearful Demar Hamlin present the SB award, the Pat Tillman service award to the Buffalo Bills training staff, some of whom treated him when he suffered a cardiac arrest on the field. And I think that's just the most beautiful thing. So I know that you're, I listened to the episode, um, of rapid response I ran when Jeremy was on and it was excellent and I enjoyed it.

So I would highly recommend. And that was. I just love that there's a beautiful end to that story, too. I agree. Um, alright, I had a couple, I'll see what the best ones are. Well, this one is just dumb and funny, so you can cut it out if you want, and then I'll go to the real one,


[00:48:21] Julie Bruene: Um, and it just was talking about, if you start compressions on someone, and that person tells you to stop, you should probably do that, which is the first one. You, you should do that. Um, and then really it's, even if it's just calling 911, you can help in an emergency and don't worry about picking the wrong CPR song, listen to your doctor friends.

the amazing music is credited to Skill Cell with Bay Licensure The podcast is meant for educational and entertainment purposes only The contents of this podcast should not be taken as medical advice to treat any medical condition in either yourself or others Please consult a medical professional for any medical issues that you may be having The contents of this podcast are the opinions of the host only and do not reflect the opinions of their employers or affiliations This entire disclaimer also applies to any guess or contributors to the podcast Under no circumstances shall Dr Julie Bruene or Dr.

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