RRAPID Flashcards
what are the features of life-threatening asthma attack?
33 (PEF<33%) 92 (pO2 <92) Cyanosis Hypotension Exhaustion Silent chest Tachycardia ABG- pO2 <8, PaCO2> 6
Treatment of asthma attack?
O SHIT ME O2 Salbutamol- 5mg neb back-to-back Hydrocortisone 200mg IV/ 40mg PO pred Ipratropium Bromide 500mcg every 4-6hrs theophyline/ Mg consult senior
what mask would you use for O2 in COPD?
venturi- start at 24% (blue) aim for sats of 88-92%
how much salbutamol in a neb?
5mg
ipratropium bromide in a neb?
500mcg
iv Hydrocortisone/ oral pred for asthma/ COPD
40mg pred/ 200mg hydrocortisone
what must be present to diagnose a tension pneumothorax?
hypotension, tracheal deviation
needle decmpression- where do you insert the needle?
large bore cannula 2nd intercostal space, mid-clavicular line
where do you insert chest drain?
triangle of safety- 5th intercostal space, lat dorsi posterior, pec major anterior
what is the immediate treatment of PE?
LMWH, consider thrombolysis
who should you contact if life threatening asthma?
critical care outreach team
What bloods would you do in ACS?
FBC, U&E, LFT, glucose, Mg, Ca, troponin
What are the 4 Hs and 4Ts?
hypothermia, hypoxia, hypovolaemia, hyper/hypokalaemia
toxins, thrombosis, tamponade, tension pneumothorax
morphine in ACS?
2.5-10mg (titrate slow IV bolus)
aspirin in ACS?
300mg
nitrates in ACS?
2 sprays or 500mcg sublingual tablet
clopidogrel in ACS?
300mg
AKI- describe diagnostic criteria
serum creatinine >26umol/L in 48hrs
serum creatinine 1.5x baseline value in 1 wk
Urine output <0.5ml/kg/hr for 6 hours
Stage 1/2/3 AKI
creatinine- Stage 1 >26/ 1.5-1.9x baseline
stage 2 2-2.9x baseline
stage 3 3x baseline, <0.3ml/kg/hr for 24hrs/ anuric for 12 hours or started dialysis
pre-renal causes of AKI
hypovolaemia, hypotension, sepsis, cardiac failure
renal causes of AKI
nephrotoxins, glomerulonephritis, vasculitis
post-renal causes of AKI
obstruction
bloods in AKI
FBC, U&E, LFT, bicarbonate, Calcium, phosphate
STOP AKI?
Sepsis screen?
Toxic drugs- NSAIDs, metformin, gentamicin, contrast, ACEIs/ARBs, diuretics
Optimise BP
Prevent harm treat complications (hyperkalaemia, pulmoary oedema, acidosis)
Hyperkalaemia K level?
> 5.5
ECG changes in hyperkalaemia
tall tented T, small P, wide QRS, sine wave, VF
treat hyperkalaemia at what levels?
K>6 +ECG changes/
K>6.5
treatment of hyperkalaemia- calcium gluconate?
cardioprotection- 10% 30mls IV over 2 minutes
treatment of hyperkalaemia, Insulin and glucose
50mls 50% glucose IV over 5-10 minutes+ 10 units insulin novarapid?
treatment of hyperkalaemia, salbutamol
5mg 2-4 back to back
causes of hyperkalaemia
MACHINE Medications- ACEIs/ NSAIDs Acidosis Cellular destruction (burns, rhabdomyolis) Hypoaldosteronism/ haemolysis Intake Nephrosis (renal failure) Excretion
treatment of anaphylaxis
raise legs Adrenaline 0.5mg 1:1000 (repeat every 5 mins) Steroid hydrocortisone 200mg Antihistamine chlorphenamine 10mg IV Saline 500mg bolus
if wheeze tx as if asthma, may need inotropes/ vasopressors
ECG changes of broad complex tachycardia
rate >100bpm
QRS> 0.12S
note- presence of pulse
treatment of broad complex tachycardia
amiodarone 300mg over 1 hour-> 900mg IV over 24 hours
DC shock
treatment of narrow complex tachycardia
vagal manouvres
adenosine (6mg, 12mg, 12mg)
if AF treat as such
synchronised DC shock/ amiodarone 300mg
bradyarrhythmia definition?
<50bpm
treatment of bradyarrhythmias?
atropine 500mg every 3-5minutes up to 3mg, consider transcutaneous pacing
treatment of pulmonary oedema?
Position O2 Diuretic (furosemide 40mg) Morphine -diamorphine 2.5mg IV slow Antiemetic Nitrates (2 sprays/ 500mcg sublingual)
Treatment of status epilepticus
1-2mg lorazepam slow IV blous (or 10mg PR diazepam)
repeat after 5 if no result, no more than 4mg lorazepam in 24 hours
phenytoin
continued seizures call anaesthetics/ ICU
in TARMS what additional step would you take at A
C-spine immobilisation
how do you measure a cervical collar?
tip of chin-> trapezius, not foam
Canadian C spine rules?
help decide need for further imaging, include factors such as age (> 65), mechanism of injury (>5 stairs), delayed neck pain, able to rotate head 45 degree L+R
what does ATOM FC stand for?
injuries that could impair ventilation? Airway obstruction Tension pneumothorax Open chest wound Massive haemothorax Flail chest Cardiac tamponade
what are causes of shock?
hypovolaemic obstructive (PE/ Tamponade/ tension pneumothorax) cardiogenic neurogenic Distributive (sepsis/ anaphylaxis)
in TARMS if haemorrhaging what can you give?
IV tranexamic acid
what would you look for in A?
look for paradoxical “see-saw” breathing, use of accessory muscles, tracheal tug
abnormal sounds- stridor, snoring, choking
head tilt chin lift/ jaw thrust
may use an airway adjunct?
at what level of GCS would you consider intubation?
8 or below`
what is respiratory failure?
PaO2< 8kPa,
type 1 normal PaCO2, due to V/Q mismatch eg pneumonia, pneumothorax, PE, pulmonary oedema etc type 2 raised (>6.7) COPD, respiratory depression due to opioids/ benzos. or in asthma when getting fatigued
What do you look for in B?
look for cyanosis, use of accessory muscles
O2 stats
tracheal deviation
Resp rate, percussion, chest expansion
what % O2 sats does a PaO2 of 8 equate to?
94%
what extra investigations might you want to do in the B part?
ABG
portable CXR
how would you assess circulation in ABCDE?
capp refill pulse oximeter able to get a reading? peripheries- cool + clammy? pulse NIBP mucous membranes JVP heart sounds urine output? oedema
treatments you may want to complete in Circulation?
ECG
IV access- 2 large bore cannulae, +/- fluids challenge
bloods
GCS- what are the scores for eye opening?
1 none
2 responds to pain
3 responds to voice
4 spontaneous
GCS- what are the scores for verbal?
1 none 2 non-specific sounds 3 inappropriate words 4 confused 5 orientated
GCS- what are the scores for motor?
1 none 2 extension to pain 3 abnormal flexion to pain 4 normal flexion 5 localises pain 6 follows command
what would you want to do as part of Disability of ABCDE?
GCS
Pupils- 1 fixed dilated pupil suggests coning, bilateral fixed dilated-> brain death (but also amphetamines and cocaine or hypothermia), pinpoint pupils-> opioid overdose incl heroin
BM
consider imaging
how do you treat a hypo?
if conscious encourage to eat sugary food
if unconscious rub hypostop gel into mucosa or 150ml 10% glucose over 15 minutes
what is used to reverse an opioid overdose?
naloxone
what is used to reverse a benzo overdose?
flumazenil
If a patient is at risk of alcohol withdrawal what would you prescribe?
a reducing regime of chlordiazepoxide
What are you looking for on exposure?
Abdo- jaundice, rashes, wounds, distention, palpate, percuss, auscultate
Other- rash, sources of bleeding, DVT? temperature
medications and NEWS, fluid chart, collateral history if none available from patient
do you do an ABG in a child?
no, VBG preferred or capillary in small infant
what is the paediatric fluid bolus calculation?
20ml/kg
if a child is hypoglycaemic how much glucose should be given?
2mls/kg 10% dextrose
how do airway manoeuvres differ in paediatrics?
older child: head tilt chin lift
infant: neutral position
if unable to get IV access in acutely unwell child what would you do?
consider IO access
how do you calculate estimated weight in kids?
up to a year: (age in months/2)+4
1-5 years: (age in years x 2)+ 8
up to 12 years: (age in years x 3) +7
at what age do children stop being obligate nasal breathers?
6 months
What is the modified westley croup score?
used in croup, assesses stridor, intercostal recessions, air entry, cyanosis and consciousness. If >2 moderate, >5 severe
moderate/ severe give oral dex/ neb budesonide, may need neb adrenaline
How much salbutamol in pRRAPID asthma?
2.5mg for children up to 5
5mg in children over 5
How much ipratropium in pRRAPID asthma?
up to 11 years 250mcg 23-30minutes for first 2 hours then 4-6hrly
child 12-17 500mcg 4-6hrly
what is the normal RR of an infant?
30-40
what is the normal RR of a 1-2year old?
25-35
What is the normal RR of a 2-5 year old?
25-30
What is the normal RR of a 5-12 year old
20-25
whate is the normal HR of an infant
110-160
what is the normal HR of a 1-2 year old?
100-150
what is the normal HR of a 2-5 year old?
95-140
what is the normal HR of a 5-12 year old?
80-120
what is the normal SBP of an infant?
80-90
what is the normal SBP of a 1-2 year old?
85-95
what is the normal SBP of a 2-5 year old?
85-100
what is the normal SBP of a 5-12 year old?
90-100
when doing CPR how often should you assess?
every 2 minutes
what are the ratios for CPR?
30:2 for adults
what differs in paediatric BLS?
5 rescue breaths
15:2 compressions
what is cushing’s triad?
sign of raised ICP; bradycardia, hypertension, irregular respirations
