RRAPID revision Flashcards
4 features of acute severe asthma (any one of)
- inability to complete sentences in 1 breath (SOB)
- RR >25/min
- HR >110/min
- PEFR 33-50% of predicted
13 features of life threatening asthma (any one of)
- PEFR <33% best or predicted
- O2 <92% on air
- paO2 <8kPa
- rising paCO2
- silent chest
- cyanosis
- feeble respiratory effort
- bradycardia
- dysarrhythmia
- hypotension
- exhaustion
- confusion
- coma
feature of near fatal asthma
paCO2 >6kPa and/or requiring mechanical ventilation with raised pressures
O SHIT ME response for acute asthma (only really need to know O SHI)
- O2 15L/min non-rebreathe mask
- Salbutamol 5mg NEB
- Hydrocortisone 200mg IV
- Ipratropium bromide 500mcg NEB
- Theophylline
- Magnesium sulphate 2g IV/20min
- Escalate
6 signs/symptoms of acute exacerbation of COPD
increasing cough reduced exercise tolerance accessory muscles for breathing tachypnoea cyanosis wheeze
O SHIT ME response for acute exacerbation of COPD
- O2 15L/min non-rebreathe mask
- Salbutamol 5mg NEB
- Hydrocortisone 200mg IV
- Ipratropium bromide 500mcg NEB
- Theophylline
- Magnesium sulphate 2g IV/20min
- Escalate
should you always treat hypoxia with increasing O2 in COPD exacerbation even if aiming for 88-92%
yes regardless
ABG result in chronic COPD
decreased paO2
raised paCO2
raised bicarbonate
what to consider in acute COPD exacerbation if type 2 respiratory failure
non invasive ventilation (NIV)
why do ECG in acute COPD exacerbation
cor pulmonale?
3 specific features of a tension pneumothorax
hypotension
trachea deviated away
distended neck veins
4 responses for tension pneumothorax
- O2 15/L min
- NO CXR
- needle decompression - 14-16G 2nd intercostal space mid-clavicular line (leave in place before insertion of chest tube)
- insertion of chest tube
when to do CTPA for PE
only if patient is stable
8 responses for PE
- O2 15L/min
- support respiration with non-invasive or invasive ventilation
- IV access (FBC, U&Es, glucose)
- ABG
- attach to cardiac monitor
- fluid bolus for hypotension
- LMWH for anticoagulation
- thrombolysis?
when do troponins rise in STEMI and NSTEMI
after 12 hours
8 responses for NSTEMI and STEMI
- O2 15L/min
- IV access - bloods
- serial ECGs
- morphine 2.5-10mg slow IV bolus
- GTN (2 sprays or 500mg tablet) sublingual
- aspirin 300mg orally
- ticagrelor 180mg orally
- LMWH subcutaneously (after discussion with cardiologist)
response for STEMI in addition to those above
primary percutaneous coronary intervention (PCI) - if ongoing ischaemia and within 12 hours of onset
thrombolysis if PCI not available
6 things to check for in bloods for NSTEMI/STEMI
FBC U&Es calcium magnesium glucose troponin
definition of AKI
- rise in serum creatinine >26umol/L in 48 hours OR
- rise in serum creatinine 1.5 x baseline within 1 week OR
- urine output <0.5ml/kg/hr for 6 consecutive hours
