RRAPID Management

Question 1

Acute asthma? (5)

Answer 1

1. Salbutamol 5mg nebulised with O2
2. Ipratropium bromide 500mcg nebulised with O2
3. Hydrocortisone 200mg IV OR prednisolone 40mg orally
4. Magnesium sulphate 2g IV
5. Chest X-ray to exclude infection/pneumothorax

Question 2

NSTEMI? (6)

Answer 2

1. Morphine 2.5-10mg slow IV bolus
2. Glyceryl trinitrate (2 sprays or 500mcg tablet)
3. Aspirin 300mg orally
4. Clopidogrel 300mg orally
5. Fondaparinux 2.5mg subcut
6. Refer to cardiology

Question 3

STEMI? (6)

Answer 3

1. Morphine 2.5-10mg slow IV bolus
2. Glyceryl trinitrate
3. Aspirin 300mg orally
4. Clopidogrel 300mg orally
5. PCI within 12 hours
6. Thrombolysis if PCI not available

Question 4

AKI? (5)

Answer 4

1. Treat underlying cause (fluids/abx etc)
2. Treat complications of AKI (oedema, hyperkalaemia, acidosis)
3. Review drug chart
4. Renal replacement therapy if indicated
5. Monitor (daily volume assessment, fluid balance, U&E)

Question 5

Anaphylaxis? (8)

Answer 5

1. Remove antigen if identified
2. Raise legs to help restore circulation
3. Adrenaline 0.5mg (0.5ml of 1:1000 IM) (repeat as necessary)
4. Chlorphenamine 10mg IV
5. Hydrocortisone 200mg IV
6. Fluid challenge (500ml Hartmann’s)
7. Inotropes/vasopressers to maintain BP
8. Transfer to ICU if unstable

Question 6

Hyperkalaemia? (5)

Answer 6

1. 10% calcium gluconate (cardioprotection) 10ml IV ovr 2 minutes
2. Insulin and glucose 10 units in 50ml 50% glucose over 5-10 minutes
3. Salbutamol nebuliser 10-20mg 10-20 minutes
4. Calcium Resonium - 15g orally every 6-8 hours
5. RRT - for intractable cases

Question 7

Pulmonary oedema? (5)

Answer 7

1. Diamorphine 2.5mg IV slowly
2. Ferusomide 40-80mg IV slowly
3. Glyceryl trinitrate (2 sprays)
4. Consider CPAP
5. Salbutamol nebuliser if wheeze predominant feature

Question 8

Sepsis? (6)

Answer 8

Blood cultures
Urine output hourly
Fluid resuscitation (500ml hartmann's)
Antibiotics as per hospital guidlines
Lactate levels and haemoglobin
O2 15 L/min via a reservoir bag

Question 9

Tension pneumothorax? (3)

Answer 9

1. O2 15 L/min via a reservoir mask
2. Needle decompression - large bore needle 2nd intercostal space mid-clavicular line
3. Insertion of chest tube

Question 10

Broad/narrow complex tachycardia with adverse features?

Answer 10

Synchronised DC shock

Question 11

Bradycardia with adverse features? (2)

Answer 11

Atropine 500mcg IV

Consider transcutaneous pacing

Question 12

Broad complex tachycardia with no adverse features? (2)

Answer 12

Amiodarone 300mg loading dose IV over 1 hour, followed by amiodarone 900mg IV over 24 hours.

Question 13

Regular narrow complex tachycardia with no adverse features? (3)

Answer 13

1. Treat for SVT
2. Use vagal manoeuvres
3. Adenosine

Question 14

Irregular narrow complex tachycardia without adverse features? (3)

Answer 14

1. Treat for AF
2. Digoxin or Beta Blockers for rate control
3. Amiodarone for chemical cardioversion and rate control

Question 15

Bradycardia without adverse features?

Answer 15

1. Assess for risk of asystole
2. Observe if no risk of asystole
3. If risk of asystole treat as for bradycardia with adverse features