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4th Year - Management > rRAPID > Flashcards

rRAPID Flashcards

1
Q

Acute Asthma - Investigations

A

ABG

O2 sats

PEFR

CXR - exclude pneumothorax

Bloods - FBC, UEs, Glucose

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2
Q

Acute Asthma - Response

A

15L O2, sit patient up

  • Sabutamol 5mg Nebuliser
  • Ipratropium 500mcg Nebuliser
  • Hydrocortisone 200mg IV
  • Magnesium Sulphate 2g IV

CALL FOR HELP!

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3
Q

COPD - ABG Result

A
  • pH <7.35
  • low O2
  • CO2 >6.0
  • raised bicarb

= Chronic respiratory acidosis

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4
Q

COPD - Investigations

A
  • ABG
  • O2 Sats (aim 88-92)
  • CXR
  • ECG (may show cor pulmonale)
  • Bloods (FBC, UEs, Glucose)
  • Blood cultures
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5
Q

COPD - Response

A

O2 to maintain sats at 88-92%

  • Salbutamol 5mg Neb (with air if necessary)
  • Ipratropium 500mcg
  • Hydrocortisone 200mg IV
  • Broad spectrum abx if sepsis suspected
    e. g. Co-amoxiclav and clarithromycin

CALL FOR HELP!

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6
Q

Tension Pneumothorax - Recognition

A
  • SOB
  • Hypotension
  • Distended neck veins
  • Trachea deviated AWAY from affected side
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7
Q

Tension Pneumothorax - Response

A

15 L O2

  • Needle decompression
    2nd intercostal space, mid-clavicular line
  • Chest drain insertion

CALL FOR HELP!
- Expose patient, may required log roll

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8
Q

Chest Drain - Triangle of Safety Borders

A
  • Anterior to mid axillary line
  • Posterior to pectoral groove
  • Above 5th intercostal space (avoid VAN under rib)
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9
Q

Massive PE - Investigations

A
  • ABG
  • Bloods (FBC, UEs, Glucose)
  • ECG (sinus tachycardia, S1QT3 wave)
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10
Q

Massive PE - Response

A
  • Fluid resus
    500ml 0.9% saline
  • Treatment dose LMWH
  • Unfractionated heparin if eGFR <30

CALL FOR HELP!
- Diagnostic CTPA when stable

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11
Q

Massive PE - Follow Up

A

3 months NOAC therapy (rivaroxaban)

If unprovoked, must investigated for cancer

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12
Q

ACS - STEMI

A

ECG

  • ST elevation
  • New LBBB

Troponin
- Raised

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13
Q

ACS - NSTEMI

A

ECG

  • ST depression
  • T wave inversion

Troponin
- Raised

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14
Q

ACS - Unstable Angina

A

ECG

  • ST depression
  • T wave inversion

Troponin
- No Change

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15
Q

Troponin Measurement

A

Rises 4-8 hours

Peaks at 24 hours

Cardiac specific

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16
Q

ACS - Response

A

15 O2 to maintain sats 94-98%

Serial ECGs

IV Access
- Bloods (FBC, UEs, Ca2+, Mg, Glucose, TROPONIN)

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17
Q

STEMI - Mx

A
  • Diamorphine 2.5-10mg IV
  • Aspirin 300mg
  • Clopidogrel 300mg
  • GTN 2 puffs every 5 minutes until no pain
  • Metocloperamide 10mg

PCI in 12 hours

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18
Q

NSTEMI - Mx

A
  • Diamorphine 2.5-10mg IV
  • Aspirin 300mg
  • Clopidogrel 300mg
  • GTN 2 puffs every 5 minutes until no pain
  • Metocloperamide 10mg

Thromboylysis with LMWH after discussion with cardiology

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19
Q

AKI - Rx

A
  • Fluid status
  • Optimise BP
    IV access and fluids
  • STOP nephrotoxic drugs
  • Monitor
    Fluid balance
  • Bloods
    UEs, bicarbonate, eGFR
20
Q

Referral for Renal Replacement Therapy

A

Intractible

  • Hyperkalaemia
  • Pulmonary oedema
  • pH <7.15

Uraemic pericarditis
Encephalopathy

21
Q

Hyperkalaemia - Investigations

A

ABG - for quick K+ level

IV Access

  • FBC
  • UEs
  • Glucose
  • LFTs

ECG

22
Q

Hyperkalaemia - ECG Findings

A

Tall, tented T-waves

Broad QRS

Ventricular Fibrillation

23
Q

Hyperkalaemia - When to treat?

A

K+ > 6 with ECG changes

K+ >6.5 regardless of ECG

24
Q

Hyperkalaemia - Rx

A

Calcium gluconate

  • Cardio protective
  • 30ml 10% over 20mins

Salbutamol 5mg Nebuliser

Insulin/Glucose

  • 10U actrapid
  • 50ml 50% dextrose

Calcium Resonium
- 15mg orally (with lactulose)

25
Q

Anaphylaxis - Airway

A

Secure

  • Head tilt, chin lift
  • Jaw thrust
  • Adjunct
  • LMA if LOC (CALL ANAESTHETIST)
26
Q

Anapylaxis - Response

A
  • 15 L O2
  • REMOVE ALLERGEN
  • Raise legs
  • IV Access (500ml 0.9% Saline)
  • Bloods (FBC, UEs, LFTs, Ca2+, Glucose)
27
Q

Anaphlaxis - Mx

A
  • Adrenaline 0.5mg 1:1000 IM
  • Chloramphenamine 10mg IV
  • Hydrocortisone 200mg IV
28
Q

Adverse Features

A
  • Shock (systolic less than 90)
  • MI
  • Syncope
  • Heart failure
29
Q

Broad Complex Tachycardia - Investigations

A
  • 15L O2

IV Access
- FBC, UEs, Ca2+, Mg, Glucose, LFTs

12 LEAD ECG

30
Q

Broad Complex Tachycardia - Adverse Features

A

Synchronised DC shock

31
Q

Broad Complex Tachycardia - No Adverse Features

A
  • Amiodarone 300mg IV over 1 hour

- Amiodarone 900mg IV over 24 hours

32
Q

Narrow Complex Tachycardia - Adverse Features

A

Synchronised DC Shock

33
Q

Narrow Complex Tachycardia - REGULAR (No Adverse)

A

Treat as SVT

Vagal manouvres

  • Blow out syringe
  • Carotid massage 15 secs

Adenosine

34
Q

Narrow Complex Tachycardia - IRREGULAR (No Adverse)

A

Treat as AF

  • Beta blocker for rate control
  • Chemical Cardioversion with Amiodarone
35
Q

Bradyarrhythmia - Adverse Features

A

Atropine 500mcg
- Repeat 3-5 minutes, max 3g

Consider transcutaneous pacing

36
Q

Bradyarrhythmia - No Adverse Features

A

Assess risk of asystole
- If risk = treat as with adverse features

If no risk - observe

37
Q

Risk Factors for Asystole (4)

A
  • Recent aystole
  • Mobitz type II heart block
  • Complete heart block
  • Ventricular pause >3 seconds
38
Q

Heart Failure - CXR

A

Alveolar bats wing oedema

Kerley B lines

Cardiomegaly

Distended vessels

39
Q

Pulmonary Oedema - Investigations

A

IV Access
- Bloods (FBC, UEs, Glucose, Ca2+, Mg, LFTs)

ECG

CXR

40
Q

Pulmonary Oedema - Investigations

A

O - 15 L O2

M - Diamorphine 2.5mg IV

F - Furusomide 40-80mg IV

G - GTN spray/50mg in 50ml saline over 2 hours

41
Q

SIRS - Criteria

A

Temp <36 or >38

Heart rate >90

RR >20 or PaCO2 <4.3

WCC <4 or >12

42
Q

Sepsis

A

SIRS with source of infection

43
Q

Septic Shock

A

Sepsis + organ dysfunction

44
Q

Severe Sepsis

A

Low BP despite adequate fluid resus

45
Q

Sepsis - Investigations

A

ABG - lactate and PaO2

IV Access

  • Bloods (FBC, UEs, LFTs, CRP)
  • Blood cultures
46
Q

BUFALO

A

Within 1 hour

Blood cultures
Urine output
Fluids (500ml 0.9% saline)
Abx (broad spectrum)
Lactate >2
O2 (15L NRBM)
47
Q

Status Epilepticus - Mx

A
  • Rectal diazapam/buccal midazolam
  • Lorazepam 1-2mg IV
  • Phenytoin IV - 20mg/kg
  • CALL FOR HELP!!

RSI with thiopentone (cerbro-protective)

4th Year - Management (11 decks)

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