RRAPID revision

Question 1

4 features of acute severe asthma (any one of)

Answer 1

• inability to complete sentences in 1 breath (SOB)
• RR >25/min
• HR >110/min
• PEFR 33-50% of predicted

Question 2

13 features of life threatening asthma (any one of)

Answer 2

• 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

Question 3

feature of near fatal asthma

Answer 3

paCO2 >6kPa and/or requiring mechanical ventilation with raised pressures

Question 4

O SHIT ME response for acute asthma (only really need to know O SHI)

Answer 4

• O2 15L/min non-rebreathe mask
• Salbutamol 5mg NEB
• Hydrocortisone 200mg IV
• Ipratropium bromide 500mcg NEB
• Theophylline
• Magnesium sulphate 2g IV/20min
• Escalate

Question 5

6 signs/symptoms of acute exacerbation of COPD

Answer 5

increasing cough 
reduced exercise tolerance
accessory muscles for breathing
tachypnoea
cyanosis
wheeze

Question 6

O SHIT ME response for acute exacerbation of COPD

Answer 6

• O2 15L/min non-rebreathe mask
• Salbutamol 5mg NEB
• Hydrocortisone 200mg IV
• Ipratropium bromide 500mcg NEB
• Theophylline
• Magnesium sulphate 2g IV/20min
• Escalate

Question 7

should you always treat hypoxia with increasing O2 in COPD exacerbation even if aiming for 88-92%

Answer 7

yes regardless

Question 8

ABG result in chronic COPD

Answer 8

decreased paO2
raised paCO2
raised bicarbonate

Question 9

what to consider in acute COPD exacerbation if type 2 respiratory failure

Answer 9

non invasive ventilation (NIV)

Question 10

why do ECG in acute COPD exacerbation

Answer 10

cor pulmonale?

Question 11

3 specific features of a tension pneumothorax

Answer 11

hypotension
trachea deviated away
distended neck veins

Question 12

4 responses for tension pneumothorax

Answer 12

• 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

Question 13

when to do CTPA for PE

Answer 13

only if patient is stable

Question 14

8 responses for PE

Answer 14

• 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?

Question 15

when do troponins rise in STEMI and NSTEMI

Answer 15

after 12 hours

Question 16

8 responses for NSTEMI and STEMI

Answer 16

• 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)

Question 17

response for STEMI in addition to those above

Answer 17

primary percutaneous coronary intervention (PCI) - if ongoing ischaemia and within 12 hours of onset

thrombolysis if PCI not available

Question 18

6 things to check for in bloods for NSTEMI/STEMI

Answer 18

FBC
U&Es
calcium
magnesium
glucose
troponin

Question 19

definition of AKI

Answer 19

• 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