RRAPID Flashcards
What are the main causes of airway obstruction
CNS depression: Opiates
Foreign body: Vomit, blood, food, secretions
Blocked tracheostomy
Tongue
Swelling: Inflammation, anaphylaxis, infection, bronchospasm
Trauma
In airway obstruction what will kill the patient?
Not getting oxygen.
Leads to: pulmonary oedema, cerebral hypoxia, exhaustion, hypoxic brain injury, secondary apnoeas
What can cause breathing problems
Cancer PE Pneumothorax CNS depression Mechanics: muscle wasting, MS Lungs: asthma, COPD, infection
In breathing problems what will kill the patient?
Hypercapnia, apnoeas, pulmonary oedema, exhaustion, hypoxic brain injury, secondary cardiac ischaemia
What are causes of circulatory problems?
MI Ischaemia Arrhythmia Cardiac failure Tamponade Rupture Myocarditis
In circulatory problems what will kill the patient?
Cardiac arrest
What are the red flag signs to look out for in an airway assessment?
Absent breath sounds Snoring/stridor/gurgling Hoarse voice Obtundation/cyanosis Paradoxical movements Retraction/accessory muscle use Tracheal deviation Laryngeal crepitus
What are specific signs of airway obstruction?
Stridor Gurgling Complete silence/ absence of breath sounds Snoring Vomiting Cyanosis
What is the order of management for an obstructed airway?
Head tilt, chin lift/ jaw thrust Oropharyngeal tube/ nasopharyngeal tube I-gel/LMA Endotracheal tube Mechanical ventilation
What injuries may compromise an airway?
Facial fractures/burns
Neck wounds
Epistaxis/vomiting
Head injury w/low GCS
How is the ‘B’ section of RRAPID assessed?
Look, listen, feel Speak in full sentences/laboured breathing Count RR Assess quality of breathing/ asymmetry Assess deformities Record FiO2 & sats (on air/oxygen?) Listen near face, palpate, percuss, auscultate the chest Tracheal position Initiate treatment
What injuries compromise ventilation?
Airway obstruction Tension pneumothorax Open chest wound Massive haemothorax Flail chest Cardiac tamponade
In a trauma patient, how is inadequate ventilation managed?
- Optimsie oxygen
- Nebuliser (salbutamol, atravent)
- Nitrates
- Needle/tube thoracocentesis/pericardiocentesis
- Resuscitative thoracotomy
- Consider intubation
What colours and percentages are the different venturi masks?
Blue=24% White=28% Yellow=35% Red=40% Green=60%
How much oxygen can be delivered through the different airway devices?
Nasal= 2-4L/min (inspired O2 conc: 24-48%) Hudson= 5-10L Non-rebreathe= 15L (inspired O2 conc: 60%) Bag&mask= 15L
What are the ranges of oxygen sats for healthy & COPD patients?
94-98%
88-92%
How is circulation assessed?
Look & feel hands Assess peripheral & central CRT Assess venous filling Count HR & assess cardiac monitor Palpate central & peripheral pulses Listen to heart Measure BP (Hypo/hyperT) Signs of poor CO Signs of haemorrhage Tx cause of circulatory collapse
How is circulatory inadequacy from a haemorrhage treated?
Optimise oxygenation Splints/tourniquet/pressure on active bleed x2 large bore IVs Fluid resus: Blood, warm crystalloid IV tranexamic acid for bleed ?Massive transfusion protocol
What should be assessed in ‘disability’?
Review ‘ABC’
Check drug chart for reversible drug SE/Dec GCS
Examine pupils
Assess GCS/AVPU
Lateralising signs (Both sides of the body moving equally)
Capillary glucose
Ensure airway protection
What is assessed in ‘exposure’ section of RRAPID?
Examine the patient
Check temperature
What are the possible causes of irregular board QRS complexes
AF w/BBB
Pre-excited AF
What are inotopes? How do they work?
Inotropes are agents that increase myocardial contractility
Adrenaline, dobutamine, isoprenaline, ephedrine, NorA
What are vasopressors? How do they work?
Vasopressors are agents that cause vasoconstriction leading to increased systemic and/or pulmonary vascular resistance
Noradrenaline, metaraminol, methylene blue, Adrenaline, Penylephrine
What are the indications for each inotrope?
Adrenaline: cardiac arrest, low CO state, cardiac surgery
Dobutamine: low CO state, part of EGDT, cardiac surgery
Ephedrine: Reversal of hypoT from spinal/epidural
What are the indications for each vasopressor?
Noradrenaline: septic shock, vasodilation
Vasopressin: septic shock (cardiac arrest}
Metaraminol: Emergency/acute hypotension
When is advanced airway management indicated?
Failure to oxygenate/ventilate
Failure to maintain/protect
Anticipated clinical course
What is a cricothyrotomy?
Needle in through the cricoid membrane (quick)
In what situation would a compromised airway need to be reported to the police?
Strangulation as part of domestic violence (high likelihood that the next attack will lead to death)
How is hypotension defined? What needs to be assessed?
SBP <90mmHg
HR
Vol status
Cardiac performance
Systemic vascular resistance
Answers: why the patient is hypoT & how this can be addressed
What types of vasopressors & inotropes are used in shock?
I: Dobutamine (cariogenic shock)
V: Noradrenaline (distributive shock)
How do chronotropes work?
Inc HR
e.g: Adrenaline, Dobutamine
What receptors do the following act on: Adrenaline Dobutamine NorA Phenylephrine
A: α1
, β1
, β2
D: β1
, β2
NorA: α1,
β1
Phenyl: α1
