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ACC > RRAPID > Flashcards

RRAPID Flashcards

1
Q

what are the features of life-threatening asthma attack?

A 
33 (PEF<33%)
92 (pO2 <92)
Cyanosis
Hypotension
Exhaustion
Silent chest
Tachycardia
ABG- pO2 <8, PaCO2> 6
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2
Q

Treatment of asthma attack?

A 
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
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3
Q

what mask would you use for O2 in COPD?

A

venturi- start at 24% (blue) aim for sats of 88-92%

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4
Q

how much salbutamol in a neb?

A

5mg

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5
Q

ipratropium bromide in a neb?

A

500mcg

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6
Q

iv Hydrocortisone/ oral pred for asthma/ COPD

A

40mg pred/ 200mg hydrocortisone

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7
Q

what must be present to diagnose a tension pneumothorax?

A

hypotension, tracheal deviation

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8
Q

needle decmpression- where do you insert the needle?

A

large bore cannula 2nd intercostal space, mid-clavicular line

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9
Q

where do you insert chest drain?

A

triangle of safety- 5th intercostal space, lat dorsi posterior, pec major anterior

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10
Q

what is the immediate treatment of PE?

A

LMWH, consider thrombolysis

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11
Q

who should you contact if life threatening asthma?

A

critical care outreach team

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12
Q

What bloods would you do in ACS?

A

FBC, U&E, LFT, glucose, Mg, Ca, troponin

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13
Q

What are the 4 Hs and 4Ts?

A

hypothermia, hypoxia, hypovolaemia, hyper/hypokalaemia

toxins, thrombosis, tamponade, tension pneumothorax

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14
Q

morphine in ACS?

A

2.5-10mg (titrate slow IV bolus)

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15
Q

aspirin in ACS?

A

300mg

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16
Q

nitrates in ACS?

A

2 sprays or 500mcg sublingual tablet

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17
Q

clopidogrel in ACS?

A

300mg

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18
Q

AKI- describe diagnostic criteria

A

serum creatinine >26umol/L in 48hrs
serum creatinine 1.5x baseline value in 1 wk
Urine output <0.5ml/kg/hr for 6 hours

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19
Q

Stage 1/2/3 AKI

A

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

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20
Q

pre-renal causes of AKI

A

hypovolaemia, hypotension, sepsis, cardiac failure

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21
Q

renal causes of AKI

A

nephrotoxins, glomerulonephritis, vasculitis

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22
Q

post-renal causes of AKI

A

obstruction

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23
Q

bloods in AKI

A

FBC, U&E, LFT, bicarbonate, Calcium, phosphate

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24
Q

STOP AKI?

A

Sepsis screen?
Toxic drugs- NSAIDs, metformin, gentamicin, contrast, ACEIs/ARBs, diuretics
Optimise BP
Prevent harm treat complications (hyperkalaemia, pulmoary oedema, acidosis)

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25
Q

Hyperkalaemia K level?

A

> 5.5

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26
Q

ECG changes in hyperkalaemia

A

tall tented T, small P, wide QRS, sine wave, VF

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27
Q

treat hyperkalaemia at what levels?

A

K>6 +ECG changes/

K>6.5

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28
Q

treatment of hyperkalaemia- calcium gluconate?

A

cardioprotection- 10% 30mls IV over 2 minutes

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29
Q

treatment of hyperkalaemia, Insulin and glucose

A

50mls 50% glucose IV over 5-10 minutes+ 10 units insulin novarapid?

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30
Q

treatment of hyperkalaemia, salbutamol

A

5mg 2-4 back to back

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31
Q

causes of hyperkalaemia

A 
MACHINE
Medications- ACEIs/ NSAIDs
Acidosis
Cellular destruction (burns, rhabdomyolis)
Hypoaldosteronism/ haemolysis
Intake
Nephrosis (renal failure)
Excretion
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32
Q

treatment of anaphylaxis

A 
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

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33
Q

ECG changes of broad complex tachycardia

A

rate >100bpm
QRS> 0.12S
note- presence of pulse

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34
Q

treatment of broad complex tachycardia

A

amiodarone 300mg over 1 hour-> 900mg IV over 24 hours

DC shock

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35
Q

treatment of narrow complex tachycardia

A

vagal manouvres
adenosine (6mg, 12mg, 12mg)
if AF treat as such
synchronised DC shock/ amiodarone 300mg

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36
Q

bradyarrhythmia definition?

A

<50bpm

37
Q

treatment of bradyarrhythmias?

A

atropine 500mg every 3-5minutes up to 3mg, consider transcutaneous pacing

38
Q

treatment of pulmonary oedema?

A 
Position
O2
Diuretic (furosemide 40mg)
Morphine -diamorphine 2.5mg IV slow
Antiemetic
Nitrates (2 sprays/ 500mcg sublingual)
39
Q

Treatment of status epilepticus

A

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

40
Q

in TARMS what additional step would you take at A

A

C-spine immobilisation

41
Q

how do you measure a cervical collar?

A

tip of chin-> trapezius, not foam

42
Q

Canadian C spine rules?

A

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

43
Q

what does ATOM FC stand for?

A 
injuries that could impair ventilation?
Airway obstruction
Tension pneumothorax
Open chest wound
Massive haemothorax
Flail chest
Cardiac tamponade
44
Q

what are causes of shock?

A 
hypovolaemic
obstructive (PE/ Tamponade/ tension pneumothorax)
cardiogenic
neurogenic
Distributive (sepsis/ anaphylaxis)
45
Q

in TARMS if haemorrhaging what can you give?

A

IV tranexamic acid

46
Q

what would you look for in A?

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?

47
Q

at what level of GCS would you consider intubation?

A

8 or below`

48
Q

what is respiratory failure?

A

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

49
Q

What do you look for in B?

A

look for cyanosis, use of accessory muscles
O2 stats
tracheal deviation
Resp rate, percussion, chest expansion

50
Q

what % O2 sats does a PaO2 of 8 equate to?

A

94%

51
Q

what extra investigations might you want to do in the B part?

A

ABG

portable CXR

52
Q

how would you assess circulation in ABCDE?

A 
capp refill
pulse oximeter able to get a reading?
peripheries- cool + clammy?
pulse
NIBP
mucous membranes
JVP
heart sounds
urine output?
oedema
53
Q

treatments you may want to complete in Circulation?

A

ECG
IV access- 2 large bore cannulae, +/- fluids challenge
bloods

54
Q

GCS- what are the scores for eye opening?

A

1 none
2 responds to pain
3 responds to voice
4 spontaneous

55
Q

GCS- what are the scores for verbal?

A 
1 none
2 non-specific sounds
3 inappropriate words
4 confused
5 orientated
56
Q

GCS- what are the scores for motor?

A 
1 none
2 extension to pain
3 abnormal flexion to pain
4 normal flexion
5 localises pain
6 follows command
57
Q

what would you want to do as part of Disability of ABCDE?

A

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

58
Q

how do you treat a hypo?

A

if conscious encourage to eat sugary food

if unconscious rub hypostop gel into mucosa or 150ml 10% glucose over 15 minutes

59
Q

what is used to reverse an opioid overdose?

A

naloxone

60
Q

what is used to reverse a benzo overdose?

A

flumazenil

61
Q

If a patient is at risk of alcohol withdrawal what would you prescribe?

A

a reducing regime of chlordiazepoxide

62
Q

What are you looking for on exposure?

A

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

63
Q

do you do an ABG in a child?

A

no, VBG preferred or capillary in small infant

64
Q

what is the paediatric fluid bolus calculation?

A

20ml/kg

65
Q

if a child is hypoglycaemic how much glucose should be given?

A

2mls/kg 10% dextrose

66
Q

how do airway manoeuvres differ in paediatrics?

A

older child: head tilt chin lift

infant: neutral position

67
Q

if unable to get IV access in acutely unwell child what would you do?

A

consider IO access

68
Q

how do you calculate estimated weight in kids?

A

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

69
Q

at what age do children stop being obligate nasal breathers?

A

6 months

70
Q

What is the modified westley croup score?

A

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

71
Q

How much salbutamol in pRRAPID asthma?

A

2.5mg for children up to 5

5mg in children over 5

72
Q

How much ipratropium in pRRAPID asthma?

A

up to 11 years 250mcg 23-30minutes for first 2 hours then 4-6hrly
child 12-17 500mcg 4-6hrly

73
Q

what is the normal RR of an infant?

A

30-40

74
Q

what is the normal RR of a 1-2year old?

A

25-35

75
Q

What is the normal RR of a 2-5 year old?

A

25-30

76
Q

What is the normal RR of a 5-12 year old

A

20-25

77
Q

whate is the normal HR of an infant

A

110-160

78
Q

what is the normal HR of a 1-2 year old?

A

100-150

79
Q

what is the normal HR of a 2-5 year old?

A

95-140

80
Q

what is the normal HR of a 5-12 year old?

A

80-120

81
Q

what is the normal SBP of an infant?

A

80-90

82
Q

what is the normal SBP of a 1-2 year old?

A

85-95

83
Q

what is the normal SBP of a 2-5 year old?

A

85-100

84
Q

what is the normal SBP of a 5-12 year old?

A

90-100

85
Q

when doing CPR how often should you assess?

A

every 2 minutes

86
Q

what are the ratios for CPR?

A

30:2 for adults

87
Q

what differs in paediatric BLS?

A

5 rescue breaths

15:2 compressions

88
Q

what is cushing’s triad?

A

sign of raised ICP; bradycardia, hypertension, irregular respirations

ACC (4 decks)

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