RRAPID Flashcards
What do you see look and listen for in airway?
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
What is your response to airway?
Head tilt chin lift Jaw jerk reflex Get rid of the obstructive material Suction Naso/Oropharyngeal tube if not Oxygen if needed
How much oxygen would you give in a acute setting?
15L in a non re breathable mask
In breathing what are you looking, listening and feeling for?
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
What should be your response to abnormal breathing?
Give oxygen 15L non rebreathable mask Sit the patient up Maybe do further investigation: Bloods CXR Chest drain Nebuliser
What are you assessing in circulation?
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
What is the management in circulation?
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
What are you assessing in Disability?
Pupil light reflex
Gross neuro exam –> wiggle your toes
Capillary glucose blood level= 4-6 mmol/L (normal)
AVPU
What does AVPU stand for?
Alert
Voice–> respond to voice stimulation
Pain–> respond to pain
Unresponsive
How do you manage disability section?
Give glucose/glucagon if they are hypoglycemic
Treat seizures or to withdrawel
What drug do you give to treat seizures?
Phenytoin and BZD
What drug do you give to treat BZD overdose?
Flumazenil
What drug do you give to treat opiate overdose?
Naloxone
What are you assessing in exposure?
Head to toe examiantion
Prevent cold and preserve dignity
Senior medical advice
What system do you use to transfer patient information to a higher doctor?
SBAR
What does SBAR stand for?
Situation
Background
Assessment
Recommendation
What is respiratory acidosis and what causes it?
pH<7.35, elevated CO2
DUE TO: resp depression, neurological damage, drugs,
chest injury, acute airway obstruction
What is respiratory alkalosis and what causes it?
pH>7.45, low CO2, hoperventilation
DUE TO: PE, neurological problems, anxiety
What is metabolic acidosis and what causes it?
7.35, reduced HCO3 level (bicarb mops up excess H+)
DUE TO: ketoacidosis, lactic acidosis, poisonings, AKI, CKD
What is metabolic alkalosis and what causes it?
pH >7.45, high bicarbonate
DUE TO: hypovolaemia, hyperaldosteronism
What is moderate asthma attack?
PEFR 50-75%
What is acute severe asthma attack?
PEFR 30-50%
RR= 25
HR= 110
Cannot speak full sentances
What is life threatening asthma attack?
PEFR <33% Silent chest + poor respiratory effort PaO2 <8 O2 sats <92% on air Arrhythmia & unconscious
What is hypovolaemic shock?
Patient looses 20% or more of blood or fluid supply
Reduced cardiac output
What is the bodies response to hypovolaemic shock?
Increase HR and increase vascular resistance
What hormone is released to increase vascular resistance in hypovolaemic shock?
Catecholamine
What can cause hypovolaemic shock?
Dehydration, fluid loss and haemorrhages
What are two examples of distributive/vasodilatory shock?
Sepsis and anaphylactic
What is the process of vasodilation in a anaphylactic shock
IgE mediated causes mast cell degranulation which leads to histamine release and then vasodilation
What is initial response to sepsis and anaphylactic?
Increase cardiac output and increase HR then functional loss
What happens in cardiogenic shock and what are the causes?
Cardiac pump failure
MI, Arrhythmia and HF
What is the bodies response to cardiogenic shock?
Systemic vascular resistance increases to compensate
What is obstructive shock and what are the causes?
Obstruction to cardiac output
PE. C.tamponade and t. pneumothorax
If a patient has continued wheeze on auscultation what medication should you give?
Nebulized salbutomal with 02 changed to 6 or 8L
What is oral Vancomycin given?
Given for C.diff causing diarrhoea
What can happen to your glucose levels in person who is alcohol dependent?
hypoglycemia
How does your body adapt and compensate for respiratory alkalosis or acidosis?
By increasing or decreasing ventilation rate
How does your body adapt and compensate for metabolic acidosis or alkalsosis?
Increase or decrease the rate of excretion of HCo3 or H+ via the kidneys
How does Tension pneumothorax cause reduced cardiac output?
Increase pressure in thorax area, causing reduced venous return.
Subsequently reduced preload and therefore reduced cardiac output
What causes neurogenic shock?
Spinal transection or brain spinal injury
loss of sympathetic flow below the level of injury
What does SIRS stand for?
Systemic inflammatory response syndrome
What are the criteria for a patient to have SIRS?
Temp either <36 or >38
HR: >90bpm
RR>20 breaths/min and PaC02 <4.3
WCC <4 or >12
When is SIRS classed as sepsis?
When it is caused by a infection
What is severe sepsis?
Sepsis + ( organ failure and reduced blood flow):
Hypotension
Hypoperfusion
Organ dysfunction
What is septic shock?
Sepsis plus hypotension despite adequate fluid resuscitation
What is the treatment for sepsis?
BUFALO Bloods Urinalysis + U&E Fluids Abx Lactate Oxygen
What should be the normal fluid output ?
0.5ml/kg/hour
What does SBAR stand for?
Situation
Background
Assessment
Response
What in SBAR used?
To transfer information to a higher clinician
What are the common symptoms of subarachanoid haemorrhage
Worse headache ever Photophobia Neck stiffness Focal neurology Vomiting
What is the cause of SAH?
Often berry aneurysm rupture
Where do berry aneurysm usually occur?
Circle of Willis
What are the symptoms of meningitis?
Photophobia N&V fever Headache rash Seizures and coma
What is the acronym for the treatment for severe asthma?
O SHIT ME
What is the treatment for severe asthma?
Oxygen
Salbutamol ( nebulizer)
Hydrocortison (steriod either oral or IV)
Ipratropium
Theophyline
Magnesium
Extra help
Who administers magnesium for severe asthma?
Consultant
What is Ipratropium?
It is a bronchodilator for the medium and large vessels
At what stage do you give the O SHIT ME treatment for severe asthma?
B–> breathing stage
Why do you do a ABG in severe asthma?
They should be hyperventilating
If hypoxic or hypercapnic then serious
Do you give all of the treatment at one for severe asthma?
No you first give Oxygen Salbutamol Hydrocortison Ipratropium
Together then reassess
How offten do you give Ipratropium?
4-6 hours Iv
What dose of salbutamol for acute asthma is given?
5mg nebulized change the oxygen 6-8L
What is the dose of hydrortison or alternatively predinisolne for acute asthma?
Prednisolone 40mg orally daily
Hydrocortison 100mg Iv 6 hourly
What is the key clinical feature of tension pneumothorax?
Is hypotension due to reduced venous return
What are the symptoms and signs of tension pneumothorax?
Unilateral reduced chest expansion Pleuritic chest pain Tachyponea hypotension Deviated trachea Unilateral decreased breath sounds Unilateral hyper resonance
What is the treatment for tension pneumothorax?
Needle decompression–> large bore neddle (14-16G) in the 2nd intercostal space mid clavicular line
Chest drain 5th intercostal space mid axillary line
Do you do need decompression superior or inferior to the ribs and why?
Superior as neurovascular bundle is inferior to the ribs
What is the treatment for pulmonary oedema?
Oxygen FMGS: Furosemide (80mg IV) Morphine GNT Salbutamol if wheeze present consider CPAP
How do you treat emergency AKI?
Treat sepsis if present
Stop nephrotoxic drugs (NSAIDS, Gentamicin)
Optimise BP
Prevent harm by treating complications such as hyperkalamia, acidosis, pulmonary oedema
When is immediate treatment of hyperkalemia given?
> 6mmol/L with ECG chagnes
or
6.5mmol/L with or without ECG chages
What is the treatment for hyperkalaemia?
CIGS Calcium Insulin 50% with 50% dextrose Glucose Salbutamol
Why do you give calcium in a patient who is hyperkalaemia?
To protect the heart ( cardio protection)
What are the risk of hyperkalaemia?
Cardiac arrhythmia
Sudden death
What is the action of insulin, salbutamol and glucose in treatment of hyperkalaemia?
Prompts K back into the cells
What is the treatment for a - Anaphylatic patient?
Oxygen Fluid Adrenaline 1:1000 5mg Iv ( repeat in 5 min if needed) Salbutamol if wheeze present Lie flat Raise legs Hydrocortisone Chlorphenamine
What actions should be taken if someone has acute COPD
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
What actions should be taken for a patient with PE?
Patient sit up Oxygen Cardiac monitor ABG IV fluids Given LMWH Thrombolysis if needed: streptokinase or t-pa
What is status epilepticus?
Epileptic fit that last greater than 30 minutes or two fits with out regain of consciousness
What are the treatments for Status epilepticus?
BZDP ( lorazepam) if continues then phentyoin
What do you give for ventricular tachycardia?
IV amiodarone 300mg/hr
900mg over 24 hours
What are you looking for on a ECG for ventricular tachycardia?
Pulse
Signs of MI, shock or HF
What is bradycardia and what is the treatment?
BPM <50
Atropine 500mg 3-5 minutes
what emergency condition does cranial nerve 3 palsy be a indication of?
berry aneurysm rupture leading to SAH and then damage the parasympathetic section of 3rd cranial nerve
What are the 5 main upper airway noises?
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
What are the 4 main lower airway noises?
Wheeze= narrowing of airway= asthma/copd
Bronchial breathing= lung consolidation
Crackles= pus and fluid
Absent= lung collapse, pleural effusion and pneumothorax
