RRAPID

Question 1

Airway (Recognition)?

Answer 1

Is the patient talking (patent)

Look, listen, feel,

Question 2

Signs of airway obstruction? (4)

Answer 2

Paradoxical chest and abdominal movements
Grunting, gurgling
Foreign body visible
Cyanosis/hypoxia is a late sign

Question 3

Response if airway compromised? (7)

Answer 3

CALL FOR HELP
Head tilt, chin lift
Jaw thrust 
Oropharyngeal/Nasopharyngeal airway
Suction secretion: Yankauer
Oxygen
Call anaesthetist for definitive airway management.

Question 4

Breathing (Recognition)? (5)

Answer 4

Look, listen, feel
Signs of respiratory distress: sweating, central cyanosis , and use of accessory muscles of respiration (chest expansion)
RR
Oxygen sats
Respiratory exam: air entry, added sounds, percussion, trachea central

Question 5

Response to breathing difficulties?

Answer 5

Sit patient up
Give Oxygen 15L/min via reservoir bag (targets: 94-98% , if patient at risk of hypercapnia respiratory failure: 88-92%)
ABG
Chest X-ray
PEFR
Sputum culture
If not breathing: ventilate with a bag and mask

Question 6

Circulation (Recognition)?

Answer 6

Look, feel peripheries (hands & feet)
Pulse
Capillary refill
BP
JVP
Urine output
Peripheral oedema
Cardio exam: heart sounds + check lung bases of pulmonary oedema

Question 7

Signs of poor end organ perfusion?

Answer 7

Agitation
Reduced consciousness
Urine output <0.5 mls/kg/hr (30 - 80 ml/hr)

Question 8

Circulation (Response)?

Answer 8

Treat underlying problem
Take PMH, PDH, Allergies
2 large bore cannula (14/16G)
Bloods (routine haematological, biochemical, coagulation, group & save, culture)
Fluid challenge: 500ml Hartmanns/normal saline over 15 mins (250 mls: frail/heart problems)
ECG
Catheter

Question 9

Disability (Recognise) ?

Answer 9

AVPU
GCS
PEARL
Blood glucose
Focussed neurological examination 
Evidence of seizure activity
Check patients drug chart for reversible causes, e.g. drug overdose

Question 10

Disability (Response)?

Answer 10

Protect airway
ET if GCS <8 (call for anaesthetic help)
Recovery position if airway not protected 
Give glucose if hypoglycaemic <4 mmol/L
BZD for seizure activity

Question 11

Exposure (Recognition)?

Answer 11

BARTT:
Bleeding
Abdomen
Rashes
Temperature 
DVT

NEWS review
Investigation results

Question 12

Exposure (Response)?

Answer 12

SBARR
Senior medical advice
Mx plan
Documentation 
Organise transfer to HDU or ICU if needed