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3rd year > RRAPID > Flashcards

RRAPID Flashcards

1
Q

What are the characteristics of acute severe asthma?

A

HR >110, RR >25, PEFR (33-55%), cant speak in full sentences

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2
Q

What are the characteristics of life threatening asthma?

A

PEFR <33%, O2 sats <92%, PaO2 down

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3
Q

What are the characteristics of near fatal asthma?

A

Cyanosed, PaCO2 > 6 , silent resp effort

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4
Q

Drug treatment of acute asthma?

A

ABCDE Asessment then OH SHIT

O2 15L non rebreathe
Salbutamol nebs 5mg (every 20 mins)
Ipatropium bromide nebs 500mcg (every 4-6 hours)
Hydrocortisone (200mg) IV or 40mg pred PO
Mg Sulfate IV 2g IV

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5
Q

What investigations do you want to do for acute asthma?

A

ABG
PEFR
CXR
FBC and U+E, cultures if sepsis

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6
Q

What are symptoms/signs of acute COPD exacerbation?

A 
Cough up
exercise tolerance down
tachpnoeic
thick green mucopurulent sputum
Wheeze 
cyanosis
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7
Q

What is one of the first things you do to any resp patient?

A

Sit them up (yes loads of other answers too)

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8
Q

What Ix you wanna do for COPD exacerbation?

A 
ABG
Sputum mc and s
Blood cultures - sepsis
FBC, u+E
ECG - cor pulmonale
CXR?
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9
Q

What is the drug treatment for COBP exacerbation?

A 
O2 15L non re breathe
Salbuatamol nebs 5mg every 20 mins
Ipatropium bromide neps 500mcmg
Hydrocortisone 200mg IV or PRed 40mg PO
Abx - trust guidelines
I would consider ventilating too
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10
Q

What are the signs and symptoms of a tension pneumothorax?

A

Dyspnoea (pleuritic chest pain)
SOB

Hyperesonance
Decrease ae
Decreased vocal resonance
Trachea deviated away
hypotension  (some debate about cant be tension without hypotension hmmm blah blah)
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11
Q

What Ix you wanna do if pneummothorax?

A

ABG
FBC u+E
Glucose apparently!!!

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12
Q

What is the treatment for a tension pneumothorax?

A

Probs give them some O2 firsts (15L non re breathe) Insert large bore needle into second intercostal space midclavicular line. Leave and insert test tube.

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13
Q

What are signs and symptoms of PE?

A

SOB
Sudden pleuritic chest pain
Haemoptysis
syncope collapse

JVP up
Tachy all round
May get T1 resp failure
RV heaves

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14
Q

What is your immediate treatment for a PE?

A

ABCDE assessment

LMWH and consider thrombolysis

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15
Q

What are the ix in PE?

A 
Take bloods and glucose
Give fluids
ABG
Monitor cardiac output
No CT angiogram til stable
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16
Q

What are the signs and symptoms of an ACS?

A

Central crushing chest pain can radiate down arm and to jaw
sweating
Palpitations
nausea
vomiting
sweaty
Diabetics and old people can get none of this

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17
Q

Do you give oxygen in ACS?

A

Only if sats below 94% but if in doubt give

trying to avoid free radicals in reperfusion

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18
Q

What are you doing for the C aspect in ACS?

A

Two wide bore cannulas
Take blood: FBC, UE, glucose, Ca, Mg, troponin
Blood cultures?

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19
Q

Other investigations for ACS?

A

ECG

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20
Q

What is the immediate treatment for ACS?

A 
Reassure
O2 if less that 94%
Morphine 5mg (and an anti emetic)
Aspirin 300mg
Nitrates (2 spray GTN)
Clopidogrel 300mg/ Ticagrelor 180mg
Enoxaparin/ECG
PCI - all about ambulance to balloon time
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21
Q

What are the definition of AKI? (there are 3)

A
  1. > 36umol/L 48h
  2. 1.5x normal creatinine 1 week
  3. Urine output = <0.5ml/kg/hour 6 hours
22
Q

What are the signs and symptoms of AKI?

A 
hypovolaemia
dehydration - skin turgor
oliguria
maybe signs vasculitis
maybe signs of renal bruits
23
Q

What are you gonna do in C element for AKI? (its a fair chunk of stuff)

A 
Standard two cannulas
Bloods:
FBC U and E
Bicarbonate
LFTs
Ca
Phosphate
Creatinine ( can i compare this to earlier creatinine?)
THINK ABOUT SEPSIS (maybe get a BP here)
if thinking sepsis get going on BUFFALO

Fluids 500ml NaCl ( NOT HAARTMANS, they might have high potassium christtt)

24
Q

They have just told you that because of the AKI the person has hyperkalaemia what you going to do?

A

Calcium gluconate 30mls IV over 15 mins
Insulin and glucose mix
(50ml 50% glucose, 10 units insulin) 5-10 mins and monitor glucose
^^ thats your standard

E book mentions more…
Salbutamol nebs 5mg 20 mins
Calcium resonate - 15mg oral every 6-8hr (give with lactulose as constipation)

25
Q

How high must the Potassium level be to be high? hmm

A

over 5.5

26
Q

When do you treat hyperkalaemia?

A

over 6 with ecg changes

over 6.5 irrelevant of anything else

27
Q

How do you spot hyperkalaemia on an ECG?

A

small p waves
tall tented t waves
wide QRS

28
Q

What is anaphylaxis?

A

A life threatening allergic reaction - T1 hypersensitivity reaction. IgE mediated

29
Q

What are the main features of anaphylaxis?

A 
Angioedema
Laryngeal oedema
Broncho constriction 
Rash/uticaria 
hypotension and shock
nausea/vomit/diarrhoea
30
Q

What you definitely going to be thinking about doing in A in anaphylaxis?

A

Sercure the airway - adjunct?

Any difficulty anaesthetist

31
Q

Drug treatment of anaphylaxis?

A

Adrenaline 0.5mg IM every 5 mins and reasess
Chorphenamine 10mg IV
Hydrocortisone 200mg IV
Haartmaans 500ml STAT (15 mins)

32
Q

What is an easy way to help circulation in anaphylaxis?

A

lift legs up

33
Q

What is a broad complex tachycardia?

A

QRS > 0.12s
BPM >100
there IS a pulse

34
Q

What is the go to treatment for a broad complex tachycardia?

A

Amiodarone 300mg IV over 1h

Then 900mg IV over 24h

35
Q

What is a treatment for bradycardia?

A

Hr below 50bpm

Atropine

36
Q

Averse features of broad complex tachycardia?

A

Shock, hypotension, syncope MI, HF

37
Q

How are you going to find out if there is a broad complex tachycardia?

A

ECG

38
Q

What to do when you enter a RRAPD station?

A 
Hi whatup im a 3rd year med student
Is the patient conscious? (if not BLS) (they will be conscious)
30s history. history from nurse
Can I see a NEWS chart?
I am gonna do ABCDE assessment
39
Q

What are you going to recognise and look for for A?

A

Patent airway - if talking all good
Partial obstruction - eg stridor, grunting, snoring, gurgling
Full obstruction - cyanosis, silence
If worried about airway get anaesthetis asap

40
Q

How do you respond to A?

A

Head tilt chin lift
jaw thrust if spinal
Adjunct/anaesthetist (measure incisor to angle mandible)
Get some o2 going

41
Q

What do you recognise in B?

A 
General inspection
RR
o2 sats
Tracheal deviation
percussion
Auscultation
PEFR
42
Q

How you gonna respond to B?

A

15L o2 non rebreathe
Sit the patient up
ABG
Portable CXR

43
Q

What do you recognise in C?

A 
Feel peripheries
CRT
Pulse
BP
JVP
Skin turgor clavicle
Hydration mouth
Urine output- do they have a catheter
44
Q

What do you do in C?

A

2 wide bore cannulas anterior cubital fossa
Bloods - FBC, u+e, CRP, ESR (plus whatever is relevant)
If bleeding crossmatch 6 units
I think do a blood glucose now
Give any fluids (500ml NaCl STAT (15 mins))
VBG- can look at haemoglobin and lactate (more than 2 =high lactate)

45
Q

What to do for disability?

A 
1. AVPU
Alert
Voice
Pain
Unresponsiveness
(Treat/identify cause for lack consciousness)
2. Check pupils
3. Cap glucose if haven't already
4. Wiggle toes and squeeze hands
46
Q

What to do for exposure?

A
  1. I’M ENSURING PATIENT DIGNITY
  2. BARTS
    Bruises
    Abdo
    Rashes ( i would look @ back)
    Thrombus (squeeze calf for tenderness)
    Scars
  3. Drug chart review and prescribe abx
47
Q

What is SBARR?

A 
Situation
Background
Assessment
Recommendation
Review
48
Q

What is BUFALO for Sepsis?

A 
Blood cultures
Urine output (.05ml/kg/hour)
Fluids (500ml Haartmans)
Abx - trust guidelines
Lactate (>2)
O2
49
Q

Signs of Sepsis?

A

Temp >38.3
HR >90
RR > 20
WCC >12 or <4

50
Q

What is septic shock?

A

Sepsis and hypotension (BP <90)

51
Q

What are the 10 questions for and AMTS?

A 
what is your date of birth
What is your age
What is the time
What year is it
Who am I and who is this
Where are we
Can you remember this address 30 West street
Can you buy count back 20 to 1
What year did World War I start
Who is the current reigning Monarch

What was the address I told you turn number

3rd year (10 decks)

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