RRAPID Flashcards
What are the characteristics of acute severe asthma?
HR >110, RR >25, PEFR (33-55%), cant speak in full sentences
What are the characteristics of life threatening asthma?
PEFR <33%, O2 sats <92%, PaO2 down
What are the characteristics of near fatal asthma?
Cyanosed, PaCO2 > 6 , silent resp effort
Drug treatment of acute asthma?
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
What investigations do you want to do for acute asthma?
ABG
PEFR
CXR
FBC and U+E, cultures if sepsis
What are symptoms/signs of acute COPD exacerbation?
Cough up exercise tolerance down tachpnoeic thick green mucopurulent sputum Wheeze cyanosis
What is one of the first things you do to any resp patient?
Sit them up (yes loads of other answers too)
What Ix you wanna do for COPD exacerbation?
ABG Sputum mc and s Blood cultures - sepsis FBC, u+E ECG - cor pulmonale CXR?
What is the drug treatment for COBP exacerbation?
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
What are the signs and symptoms of a tension pneumothorax?
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)
What Ix you wanna do if pneummothorax?
ABG
FBC u+E
Glucose apparently!!!
What is the treatment for a tension pneumothorax?
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.
What are signs and symptoms of PE?
SOB
Sudden pleuritic chest pain
Haemoptysis
syncope collapse
JVP up
Tachy all round
May get T1 resp failure
RV heaves
What is your immediate treatment for a PE?
ABCDE assessment
LMWH and consider thrombolysis
What are the ix in PE?
Take bloods and glucose Give fluids ABG Monitor cardiac output No CT angiogram til stable
What are the signs and symptoms of an ACS?
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
Do you give oxygen in ACS?
Only if sats below 94% but if in doubt give
trying to avoid free radicals in reperfusion
What are you doing for the C aspect in ACS?
Two wide bore cannulas
Take blood: FBC, UE, glucose, Ca, Mg, troponin
Blood cultures?
Other investigations for ACS?
ECG
What is the immediate treatment for ACS?
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
What are the definition of AKI? (there are 3)
- > 36umol/L 48h
- 1.5x normal creatinine 1 week
- Urine output = <0.5ml/kg/hour 6 hours
What are the signs and symptoms of AKI?
hypovolaemia dehydration - skin turgor oliguria maybe signs vasculitis maybe signs of renal bruits
What are you gonna do in C element for AKI? (its a fair chunk of stuff)
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)
They have just told you that because of the AKI the person has hyperkalaemia what you going to do?
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)
How high must the Potassium level be to be high? hmm
over 5.5
When do you treat hyperkalaemia?
over 6 with ecg changes
over 6.5 irrelevant of anything else
How do you spot hyperkalaemia on an ECG?
small p waves
tall tented t waves
wide QRS
What is anaphylaxis?
A life threatening allergic reaction - T1 hypersensitivity reaction. IgE mediated
What are the main features of anaphylaxis?
Angioedema Laryngeal oedema Broncho constriction Rash/uticaria hypotension and shock nausea/vomit/diarrhoea
What you definitely going to be thinking about doing in A in anaphylaxis?
Sercure the airway - adjunct?
Any difficulty anaesthetist
Drug treatment of anaphylaxis?
Adrenaline 0.5mg IM every 5 mins and reasess
Chorphenamine 10mg IV
Hydrocortisone 200mg IV
Haartmaans 500ml STAT (15 mins)
What is an easy way to help circulation in anaphylaxis?
lift legs up
What is a broad complex tachycardia?
QRS > 0.12s
BPM >100
there IS a pulse
What is the go to treatment for a broad complex tachycardia?
Amiodarone 300mg IV over 1h
Then 900mg IV over 24h
What is a treatment for bradycardia?
Hr below 50bpm
Atropine
Averse features of broad complex tachycardia?
Shock, hypotension, syncope MI, HF
How are you going to find out if there is a broad complex tachycardia?
ECG
What to do when you enter a RRAPD station?
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
What are you going to recognise and look for for 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
How do you respond to A?
Head tilt chin lift
jaw thrust if spinal
Adjunct/anaesthetist (measure incisor to angle mandible)
Get some o2 going
What do you recognise in B?
General inspection RR o2 sats Tracheal deviation percussion Auscultation PEFR
How you gonna respond to B?
15L o2 non rebreathe
Sit the patient up
ABG
Portable CXR
What do you recognise in C?
Feel peripheries CRT Pulse BP JVP Skin turgor clavicle Hydration mouth Urine output- do they have a catheter
What do you do in C?
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)
What to do for disability?
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
What to do for exposure?
- I’M ENSURING PATIENT DIGNITY
- BARTS
Bruises
Abdo
Rashes ( i would look @ back)
Thrombus (squeeze calf for tenderness)
Scars - Drug chart review and prescribe abx
What is SBARR?
Situation Background Assessment Recommendation Review
What is BUFALO for Sepsis?
Blood cultures Urine output (.05ml/kg/hour) Fluids (500ml Haartmans) Abx - trust guidelines Lactate (>2) O2
Signs of Sepsis?
Temp >38.3
HR >90
RR > 20
WCC >12 or <4
What is septic shock?
Sepsis and hypotension (BP <90)
What are the 10 questions for and AMTS?
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
