rRAPID Flashcards
Acute Asthma - Investigations
ABG
O2 sats
PEFR
CXR - exclude pneumothorax
Bloods - FBC, UEs, Glucose
Acute Asthma - Response
15L O2, sit patient up
- Sabutamol 5mg Nebuliser
- Ipratropium 500mcg Nebuliser
- Hydrocortisone 200mg IV
- Magnesium Sulphate 2g IV
CALL FOR HELP!
COPD - ABG Result
- pH <7.35
- low O2
- CO2 >6.0
- raised bicarb
= Chronic respiratory acidosis
COPD - Investigations
- ABG
- O2 Sats (aim 88-92)
- CXR
- ECG (may show cor pulmonale)
- Bloods (FBC, UEs, Glucose)
- Blood cultures
COPD - Response
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!
Tension Pneumothorax - Recognition
- SOB
- Hypotension
- Distended neck veins
- Trachea deviated AWAY from affected side
Tension Pneumothorax - Response
15 L O2
- Needle decompression
2nd intercostal space, mid-clavicular line - Chest drain insertion
CALL FOR HELP!
- Expose patient, may required log roll
Chest Drain - Triangle of Safety Borders
- Anterior to mid axillary line
- Posterior to pectoral groove
- Above 5th intercostal space (avoid VAN under rib)
Massive PE - Investigations
- ABG
- Bloods (FBC, UEs, Glucose)
- ECG (sinus tachycardia, S1QT3 wave)
Massive PE - Response
- Fluid resus
500ml 0.9% saline - Treatment dose LMWH
- Unfractionated heparin if eGFR <30
CALL FOR HELP!
- Diagnostic CTPA when stable
Massive PE - Follow Up
3 months NOAC therapy (rivaroxaban)
If unprovoked, must investigated for cancer
ACS - STEMI
ECG
- ST elevation
- New LBBB
Troponin
- Raised
ACS - NSTEMI
ECG
- ST depression
- T wave inversion
Troponin
- Raised
ACS - Unstable Angina
ECG
- ST depression
- T wave inversion
Troponin
- No Change
Troponin Measurement
Rises 4-8 hours
Peaks at 24 hours
Cardiac specific
ACS - Response
15 O2 to maintain sats 94-98%
Serial ECGs
IV Access
- Bloods (FBC, UEs, Ca2+, Mg, Glucose, TROPONIN)
STEMI - Mx
- Diamorphine 2.5-10mg IV
- Aspirin 300mg
- Clopidogrel 300mg
- GTN 2 puffs every 5 minutes until no pain
- Metocloperamide 10mg
PCI in 12 hours
NSTEMI - Mx
- 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
AKI - Rx
- Fluid status
- Optimise BP
IV access and fluids - STOP nephrotoxic drugs
- Monitor
Fluid balance - Bloods
UEs, bicarbonate, eGFR
Referral for Renal Replacement Therapy
Intractible
- Hyperkalaemia
- Pulmonary oedema
- pH <7.15
Uraemic pericarditis
Encephalopathy
Hyperkalaemia - Investigations
ABG - for quick K+ level
IV Access
- FBC
- UEs
- Glucose
- LFTs
ECG
Hyperkalaemia - ECG Findings
Tall, tented T-waves
Broad QRS
Ventricular Fibrillation
Hyperkalaemia - When to treat?
K+ > 6 with ECG changes
K+ >6.5 regardless of ECG
Hyperkalaemia - Rx
Calcium gluconate
- Cardio protective
- 30ml 10% over 20mins
Salbutamol 5mg Nebuliser
Insulin/Glucose
- 10U actrapid
- 50ml 50% dextrose
Calcium Resonium
- 15mg orally (with lactulose)
Anaphylaxis - Airway
Secure
- Head tilt, chin lift
- Jaw thrust
- Adjunct
- LMA if LOC (CALL ANAESTHETIST)
Anapylaxis - Response
- 15 L O2
- REMOVE ALLERGEN
- Raise legs
- IV Access (500ml 0.9% Saline)
- Bloods (FBC, UEs, LFTs, Ca2+, Glucose)
Anaphlaxis - Mx
- Adrenaline 0.5mg 1:1000 IM
- Chloramphenamine 10mg IV
- Hydrocortisone 200mg IV
Adverse Features
- Shock (systolic less than 90)
- MI
- Syncope
- Heart failure
Broad Complex Tachycardia - Investigations
- 15L O2
IV Access
- FBC, UEs, Ca2+, Mg, Glucose, LFTs
12 LEAD ECG
Broad Complex Tachycardia - Adverse Features
Synchronised DC shock
Broad Complex Tachycardia - No Adverse Features
- Amiodarone 300mg IV over 1 hour
- Amiodarone 900mg IV over 24 hours
Narrow Complex Tachycardia - Adverse Features
Synchronised DC Shock
Narrow Complex Tachycardia - REGULAR (No Adverse)
Treat as SVT
Vagal manouvres
- Blow out syringe
- Carotid massage 15 secs
Adenosine
Narrow Complex Tachycardia - IRREGULAR (No Adverse)
Treat as AF
- Beta blocker for rate control
- Chemical Cardioversion with Amiodarone
Bradyarrhythmia - Adverse Features
Atropine 500mcg
- Repeat 3-5 minutes, max 3g
Consider transcutaneous pacing
Bradyarrhythmia - No Adverse Features
Assess risk of asystole
- If risk = treat as with adverse features
If no risk - observe
Risk Factors for Asystole (4)
- Recent aystole
- Mobitz type II heart block
- Complete heart block
- Ventricular pause >3 seconds
Heart Failure - CXR
Alveolar bats wing oedema
Kerley B lines
Cardiomegaly
Distended vessels
Pulmonary Oedema - Investigations
IV Access
- Bloods (FBC, UEs, Glucose, Ca2+, Mg, LFTs)
ECG
CXR
Pulmonary Oedema - Investigations
O - 15 L O2
M - Diamorphine 2.5mg IV
F - Furusomide 40-80mg IV
G - GTN spray/50mg in 50ml saline over 2 hours
SIRS - Criteria
Temp <36 or >38
Heart rate >90
RR >20 or PaCO2 <4.3
WCC <4 or >12
Sepsis
SIRS with source of infection
Septic Shock
Sepsis + organ dysfunction
Severe Sepsis
Low BP despite adequate fluid resus
Sepsis - Investigations
ABG - lactate and PaO2
IV Access
- Bloods (FBC, UEs, LFTs, CRP)
- Blood cultures
BUFALO
Within 1 hour
Blood cultures Urine output Fluids (500ml 0.9% saline) Abx (broad spectrum) Lactate >2 O2 (15L NRBM)
Status Epilepticus - Mx
- Rectal diazapam/buccal midazolam
- Lorazepam 1-2mg IV
- Phenytoin IV - 20mg/kg
- CALL FOR HELP!!
RSI with thiopentone (cerbro-protective)
