RRAPID Flashcards
Acute severe asthma
Call for help
Airway
- Sit patient up
Breathing
- Sats, ABG
- 15L/min oxygen via non-rebreathe mask
- 5mg salbutamol nebulised back to back
- 500mcg ipratropium bromide nebulised 4-6 hourly
- Chest X-ray
Circulation
- 2 wide bore cannulas in antecubital fossae
- Take bloods - FBC, U&Es, CRP
- IV hydrocortisone 200mg
- IV magnesium sulphate 2g
Acute exacerbation of COPD
Call for help
Airway
- Sit patient up
Breathing
- Sats
- ABG - low oxygen, high carbon dioxide (type 2 resp failure), raised bicarb if chronic
- Chest X-ray - flattened hemidiaphragms
- Controlled O2 - venturi mask
- Salbutamol 5mg neb back to back
- Ipratropium bromide 500mcg neb
Circulation
- ECG - cor pulmonale
- IV access
- Bloods
- Antibiotics if infection
Tension pneumothorax
Call for help Breathing - Trachea deviated away from affected side - Reduced air entry - 15L/min oxygen via non rebreathe mask - ABG - Large bore needle in 2nd intercostal space mid-clavicular line - Insertion of chest drain
STEMI
Call for help
Breathing
- 15L oxygen via non rebreathe mask
- ABG
Circulation
- Serial ECGs
- IV access
- Bloods: troponin, FBC, calcium, magnesium
- Morphine 2.5mg
- GTN 2 sprays
- Aspirin 300mg
- LMWH
Disability
- Glucose
- AVPU
Refer to cardiologist for PCI within 12 hours of onset
Thrombolysis if PCI not available
AKI
STOP AKI
Call for help
Sepsis - BUFALO
Toxins - stop nephrotoxins
Optimise blood pressure - volume status assessment; 500ml 0.9% sodium chloride in 15 min; monitor urine output
Prevent harm - treat complications, review drug chart, renal replacement therapy
Hyperkalaemia
Call for help Circulation - IV access - Take bloods - FBC, U&Es, LFTs, glucose - ECGs
- Calcium gluconate 30ml over 2 min, repeat every 5-10 min (provides cardio-protection)
- Insulin 10units with 50ml of 50% glucose IV over 5-10 min
- Salbutamol 10-20mg
- Calcium resonium 15g orally with lactulose
- Review potassium intake, medications, renal replacement therapy
Anaphylaxis
Check wristband for allergies!!!
Call for help
Airway
- Call anaesthetist
- Head-tilt chin-lift to open airway
- Oropharyngeal airway adjunct to secure airway
- Raise legs
- Adrenaline 0.5mls of 1:1000 IM; repeat every 5 mins if necessary
Breathing
- 15L/min oxygen via non rebreathe mask
- ABG
- If audible wheeze, give 5mg salbutamol neb back to back
Circulation
- IV access
- Take bloods
- Fluid bolus
- Inotropes/vasopressors to maintain BP
- Chlorphenamine 10mg IV
- Hydrocortisone 200mg IV
Exposure
- Check drug chart/allergies
- Transfer to ICU
Broad complex tachycardia
Call for help
Breathing
- 15L oxygen via non rebreathe mask
- ABG
Circulation
- Attach cardiac monitor
- ECG - broad QRS complexes, tachycardic
- IV access
- Bloods: FBC, calcium, magnesium, LFTs, U&Es
- Synchronised DC shock
- Amiodarone 300mg loading dose IV over 1 hour followed by amiodarone 900mg IV over 24 hours
Narrow complex tachycardia
Call for help
Breathing
- 15L oxygen via non rebreathe mask
- ABG
Circulation
- Attach cardiac monitor
- ECG - narrow QRS complexes, tachycardic
- IV access
- Bloods: FBC, calcium, magnesium, LFTs, U&Es
- Synchronised DC shock
- Vagal manoeuvres
- Adenosine
- Digoxin/beta-blocker
- Amiodarone
Bradyarrhythmias
Call for help
Breathing
- 15L oxygen via non rebreathe mask
- ABG
Circulation
- Attach cardiac monitor
- ECG - less than 50bpm
- IV access
- Bloods: FBC, calcium, magnesium, LFTs, U&Es
- Atropine 500mcg IV
Pulmonary oedema
Call for help
Airway
- Sit patient up
Breathing
- Sats
- ABG
- Chest X-ray - alveolar effusions, kerley B lines, cardiomegaly, pleural effusions
- 15L/min oxygen via non-rebreathe
- Salbutamol 5mg neb back to back if wheeze present
- Consider CPAP machine
Circulation
- Attach to cardiac monitor
- IV access
- Bloods
- Morphine 2.5mg IV slowly
- Furosemide 40-80mg IV slowly
- GTN spray 2 sprays
- GTN 50mg in 50ml sodium chloride IV at 2ml/hr
- Monitor urine output
Sepsis
BUFALO
Blood cultures Urine output Fluid resuscitation Antibiotics (broad spectrum) Lactate levels Oxygen 15L/min via non rebreathe mask
Status epilepticus
Call for help Airway - Head-tilt chin-lift manoeuvre - Airway adjunct - Call anaesthetist/ICU
Breathing
- Sats
- ABG
- Oxygen 15L/min via non-rebreathe mask
Circulation
- IV access
- Bloods - calcium, magnesium, glucose
- 1-2mg lorzepam IV slowly; repeat after 5 mins
- Phenytoin 20mg/kg IV
Disability
- AVPU
- Glucose
- Pupils
- Neurological test
Pulmonary embolism
Call for help
Airway
- Sit patient up
Breathing
- Sats
- ABG
- 15L/min O2 via non-rebreathe mask
- Chest Xray, order CTPA
Circulation
- IV access
- Bloods - D-dimer, coagulation screen
- Fluid bolus
- Attach cardiac monitor
- LMWH
- Consider thrombolysis
Exposure
- Check swellings in leg
- Calculate Well’s score
Upper GI bleed
Breathing
- 15L/min oxygen via non-rebreathe mask
- ABG
Circulation
- IV access
- Bloods - Group & save, FBC, LFT, U&E, coagulation screen
- Fluid challenge - 500ml 0.9% sodium chloride in 15 min
- Monitor urine output
- If massive blood loss, give blood transfusion, FFP, platelets
Disability
- AVPU
Exposure
- Abdominal Xray
- Order endoscopy
