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year 3 OSCE > RRAPID > Flashcards

RRAPID Flashcards

1
Q

What do you see look and listen for in airway?

A 
Look for chest expansion
If they can talk 
If they cannot talk, are they chocking, gurgling, coughing etc.
Foreign body material in their mouth
oxygen mask misting up 
If they are loosing consciousness
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2
Q

What is your response to airway?

A 
Head tilt chin lift
Jaw jerk reflex
Get rid of the obstructive material
Suction
Naso/Oropharyngeal tube if not
Oxygen if needed
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3
Q

How much oxygen would you give in a acute setting?

A

15L in a non re breathable mask

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4
Q

In breathing what are you looking, listening and feeling for?

A

Any signs of obstruction and therefore what type
If they are using their accessory muscles
Look at there Oxygen sats
Auscultate and palpate the chest
Also feel for trachea deviation
Respiratory rate of the patient –> 12-20
Pulse
PEFR
ABG

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5
Q

What should be your response to abnormal breathing?

A 
Give oxygen 15L non rebreathable mask 
Sit the patient up
Maybe do further investigation: Bloods 
CXR
Chest drain
Nebuliser
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6
Q

What are you assessing in circulation?

A 
Pulse
BP
Temp
Could do Blood glucose level
Cap refill
Blood--> so need bore cannulas ( FBC, U&E, LFT)
Urine output
ECG
Auscultate the heart 
Oedema in the ankles and sacral
Raised JVP
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7
Q

What is the management in circulation?

A 
Iv Access two large bore cannulas 
Give fluids --> 500ml of Hartmans solution over 15 minutes 
Give ABX if querry infection 
Catheter to measure urine output 
Bloods and ECG
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8
Q

What are you assessing in Disability?

A

Pupil light reflex
Gross neuro exam –> wiggle your toes
Capillary glucose blood level= 4-6 mmol/L (normal)
AVPU

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9
Q

What does AVPU stand for?

A

Alert
Voice–> respond to voice stimulation
Pain–> respond to pain
Unresponsive

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10
Q

How do you manage disability section?

A

Give glucose/glucagon if they are hypoglycemic

Treat seizures or to withdrawel

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11
Q

What drug do you give to treat seizures?

A

Phenytoin and BZD

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12
Q

What drug do you give to treat BZD overdose?

A

Flumazenil

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13
Q

What drug do you give to treat opiate overdose?

A

Naloxone

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14
Q

What are you assessing in exposure?

A

Head to toe examiantion
Prevent cold and preserve dignity
Senior medical advice

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15
Q

What system do you use to transfer patient information to a higher doctor?

A

SBAR

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16
Q

What does SBAR stand for?

A

Situation
Background
Assessment
Recommendation

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17
Q

What is respiratory acidosis and what causes it?

A

pH<7.35, elevated CO2
DUE TO: resp depression, neurological damage, drugs,
chest injury, acute airway obstruction

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18
Q

What is respiratory alkalosis and what causes it?

A

pH>7.45, low CO2, hoperventilation

DUE TO: PE, neurological problems, anxiety

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19
Q

What is metabolic acidosis and what causes it?

A

7.35, reduced HCO3 level (bicarb mops up excess H+)

DUE TO: ketoacidosis, lactic acidosis, poisonings, AKI, CKD

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20
Q

What is metabolic alkalosis and what causes it?

A

pH >7.45, high bicarbonate

DUE TO: hypovolaemia, hyperaldosteronism

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21
Q

What is moderate asthma attack?

A

PEFR 50-75%

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22
Q

What is acute severe asthma attack?

A

PEFR 30-50%
RR= 25
HR= 110
Cannot speak full sentances

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23
Q

What is life threatening asthma attack?

A 
PEFR <33%
Silent chest + poor respiratory effort
PaO2 <8
O2 sats <92% on air
Arrhythmia &amp; unconscious
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24
Q

What is hypovolaemic shock?

A

Patient looses 20% or more of blood or fluid supply

Reduced cardiac output

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25
Q

What is the bodies response to hypovolaemic shock?

A

Increase HR and increase vascular resistance

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26
Q

What hormone is released to increase vascular resistance in hypovolaemic shock?

A

Catecholamine

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27
Q

What can cause hypovolaemic shock?

A

Dehydration, fluid loss and haemorrhages

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28
Q

What are two examples of distributive/vasodilatory shock?

A

Sepsis and anaphylactic

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29
Q

What is the process of vasodilation in a anaphylactic shock

A

IgE mediated causes mast cell degranulation which leads to histamine release and then vasodilation

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30
Q

What is initial response to sepsis and anaphylactic?

A

Increase cardiac output and increase HR then functional loss

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31
Q

What happens in cardiogenic shock and what are the causes?

A

Cardiac pump failure

MI, Arrhythmia and HF

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32
Q

What is the bodies response to cardiogenic shock?

A

Systemic vascular resistance increases to compensate

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33
Q

What is obstructive shock and what are the causes?

A

Obstruction to cardiac output

PE. C.tamponade and t. pneumothorax

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34
Q

If a patient has continued wheeze on auscultation what medication should you give?

A

Nebulized salbutomal with 02 changed to 6 or 8L

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35
Q

What is oral Vancomycin given?

A

Given for C.diff causing diarrhoea

36
Q

What can happen to your glucose levels in person who is alcohol dependent?

A

hypoglycemia

37
Q

How does your body adapt and compensate for respiratory alkalosis or acidosis?

A

By increasing or decreasing ventilation rate

38
Q

How does your body adapt and compensate for metabolic acidosis or alkalsosis?

A

Increase or decrease the rate of excretion of HCo3 or H+ via the kidneys

39
Q

How does Tension pneumothorax cause reduced cardiac output?

A

Increase pressure in thorax area, causing reduced venous return.
Subsequently reduced preload and therefore reduced cardiac output

40
Q

What causes neurogenic shock?

A

Spinal transection or brain spinal injury

loss of sympathetic flow below the level of injury

41
Q

What does SIRS stand for?

A

Systemic inflammatory response syndrome

42
Q

What are the criteria for a patient to have SIRS?

A

Temp either <36 or >38
HR: >90bpm
RR>20 breaths/min and PaC02 <4.3
WCC <4 or >12

43
Q

When is SIRS classed as sepsis?

A

When it is caused by a infection

44
Q

What is severe sepsis?

A

Sepsis + ( organ failure and reduced blood flow):
Hypotension
Hypoperfusion
Organ dysfunction

45
Q

What is septic shock?

A

Sepsis plus hypotension despite adequate fluid resuscitation

46
Q

What is the treatment for sepsis?

A 
BUFALO
Bloods
Urinalysis + U&amp;E
Fluids
Abx
Lactate
Oxygen
47
Q

What should be the normal fluid output ?

A

0.5ml/kg/hour

48
Q

What does SBAR stand for?

A

Situation
Background
Assessment
Response

49
Q

What in SBAR used?

A

To transfer information to a higher clinician

50
Q

What are the common symptoms of subarachanoid haemorrhage

A 
Worse headache ever
Photophobia
Neck stiffness
Focal neurology 
Vomiting
51
Q

What is the cause of SAH?

A

Often berry aneurysm rupture

52
Q

Where do berry aneurysm usually occur?

A

Circle of Willis

53
Q

What are the symptoms of meningitis?

A 
Photophobia
N&amp;V
fever
Headache
rash 
Seizures and coma
54
Q

What is the acronym for the treatment for severe asthma?

A

O SHIT ME

55
Q

What is the treatment for severe asthma?

A

Oxygen

Salbutamol ( nebulizer)
Hydrocortison (steriod either oral or IV)
Ipratropium
Theophyline

Magnesium
Extra help

56
Q

Who administers magnesium for severe asthma?

A

Consultant

57
Q

What is Ipratropium?

A

It is a bronchodilator for the medium and large vessels

58
Q

At what stage do you give the O SHIT ME treatment for severe asthma?

A

B–> breathing stage

59
Q

Why do you do a ABG in severe asthma?

A

They should be hyperventilating

If hypoxic or hypercapnic then serious

60
Q

Do you give all of the treatment at one for severe asthma?

A 
No you first give
Oxygen
Salbutamol
Hydrocortison
Ipratropium

Together then reassess

61
Q

How offten do you give Ipratropium?

A

4-6 hours Iv

62
Q

What dose of salbutamol for acute asthma is given?

A

5mg nebulized change the oxygen 6-8L

63
Q

What is the dose of hydrortison or alternatively predinisolne for acute asthma?

A

Prednisolone 40mg orally daily

Hydrocortison 100mg Iv 6 hourly

64
Q

What is the key clinical feature of tension pneumothorax?

A

Is hypotension due to reduced venous return

65
Q

What are the symptoms and signs of tension pneumothorax?

A 
Unilateral reduced chest expansion
Pleuritic chest pain
Tachyponea
hypotension
Deviated trachea
Unilateral decreased breath sounds
Unilateral hyper resonance
66
Q

What is the treatment for tension pneumothorax?

A

Needle decompression–> large bore neddle (14-16G) in the 2nd intercostal space mid clavicular line
Chest drain 5th intercostal space mid axillary line

67
Q

Do you do need decompression superior or inferior to the ribs and why?

A

Superior as neurovascular bundle is inferior to the ribs

68
Q

What is the treatment for pulmonary oedema?

A 
Oxygen
FMGS:
Furosemide (80mg IV)
Morphine
GNT
Salbutamol if wheeze present
consider CPAP
69
Q

How do you treat emergency AKI?

A

Treat sepsis if present
Stop nephrotoxic drugs (NSAIDS, Gentamicin)
Optimise BP
Prevent harm by treating complications such as hyperkalamia, acidosis, pulmonary oedema

70
Q

When is immediate treatment of hyperkalemia given?

A

> 6mmol/L with ECG chagnes
or
6.5mmol/L with or without ECG chages

71
Q

What is the treatment for hyperkalaemia?

A 
CIGS
Calcium
Insulin 50% with 50% dextrose
Glucose
Salbutamol
72
Q

Why do you give calcium in a patient who is hyperkalaemia?

A

To protect the heart ( cardio protection)

73
Q

What are the risk of hyperkalaemia?

A

Cardiac arrhythmia

Sudden death

74
Q

What is the action of insulin, salbutamol and glucose in treatment of hyperkalaemia?

A

Prompts K back into the cells

75
Q

What is the treatment for a - Anaphylatic patient?

A 
Oxygen
Fluid 
Adrenaline 1:1000 5mg Iv ( repeat in 5 min if needed)
Salbutamol if wheeze present
Lie flat
Raise legs
Hydrocortisone
Chlorphenamine
76
Q

What actions should be taken if someone has acute COPD

A 
Ask them to sit up
Oxygen 
ABG
ECG
Chest x ray 
Salbutamol
Ipotropium bromide
prednisolone/hydrocortisone 
Abx if infection is present
Ventilation if type 2 respiratory failure
77
Q

What actions should be taken for a patient with PE?

A 
Patient sit up
Oxygen
Cardiac monitor 
ABG
IV fluids
Given LMWH
Thrombolysis if needed: streptokinase or t-pa
78
Q

What is status epilepticus?

A

Epileptic fit that last greater than 30 minutes or two fits with out regain of consciousness

79
Q

What are the treatments for Status epilepticus?

A

BZDP ( lorazepam) if continues then phentyoin

80
Q

What do you give for ventricular tachycardia?

A

IV amiodarone 300mg/hr

900mg over 24 hours

81
Q

What are you looking for on a ECG for ventricular tachycardia?

A

Pulse

Signs of MI, shock or HF

82
Q

What is bradycardia and what is the treatment?

A

BPM <50

Atropine 500mg 3-5 minutes

83
Q

what emergency condition does cranial nerve 3 palsy be a indication of?

A

berry aneurysm rupture leading to SAH and then damage the parasympathetic section of 3rd cranial nerve

84
Q

What are the 5 main upper airway noises?

A 
Stridor= high pitch on inspiration that indicate obstruction
Gurgling= secretion in upper airway
Chocking= mechanical obstruction
Hoarseness= due to irritation or damage to the vocal cords
snoring= partially occluded pharynx
85
Q

What are the 4 main lower airway noises?

A

Wheeze= narrowing of airway= asthma/copd
Bronchial breathing= lung consolidation
Crackles= pus and fluid
Absent= lung collapse, pleural effusion and pneumothorax

year 3 OSCE (14 decks)

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