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Yr 3 - RRAPID > RRAPID Scenarios > Flashcards

RRAPID Scenarios Flashcards

1
Q

Give brief history taking structure at beginning of RRAPID station

A

SAMPLE

  • Signs & symptoms
  • Allergies
  • Medications
  • PMH
  • Last wee/last meal
  • Events leading up
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2
Q

General overview of what you would do to assess patient’s airway

A

See if patient was talking to me → if yes, airway patent

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3
Q

General overview of what you would do to assess patient’s breathing

A
  • Respiratory rate
  • O2 sats
  • Chest expansion
  • Trachea position
  • Percussion
  • Auscultation
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4
Q

General overview of what investigations you would do to assess patient’s breathing

A
  • CXR
  • ABG
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5
Q

General overview of some interventions you may need to do in ‘breathing’

A

Low O2 sats → oxygen (15L non rebreathe - check if COPD)

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6
Q

General overview of what you would do to assess patient’s circulation

A
  • Temperature of hands
  • CRT
  • Radial pulse (rate, rhythm character)
  • BP
  • JVP
  • Apex beat
  • Auscultation of heart valves
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7
Q

General overview of what investigations you would do to assess patient’s circulation

A
  • Bloods e.g. FBC, U&Es, LFTs, CRP, troponin, blood cultures, VBG
  • 12-lead ECG
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8
Q

General overview of some interventions you may need to do in ‘circulation’

A
  • Insert 2x wide bore cannulae, one in each antecubital fossa
  • Give fluid if hypotensive → 500ml 0.9% sodium chloride over 15 minutes (250ml in HF)
  • Catheterise patient - monitor fluid output
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9
Q

General overview of what you would do to assess patient’s disability level

A
  • Conscious level - ACVPU
  • Blood glucose
  • Temperature
  • Pupils
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10
Q

General overview of what you would do to assess ‘everything else’

A
  • Abdominal exam
  • Check skin for bleeding, rashes
  • Check legs - DVT, cellulitis?
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11
Q

What PMH specifically should you ask about in ACS patients? Why?

A

Ask about history of diabetes as these patients are at higher risk of a silent MI.

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12
Q

Signs seen in ACS?

A
  • Dyspnoea
  • Pale
  • Raised JVP
  • Hypotensive
  • Tachycardic
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13
Q

RRAPID response to a STEMI?

A
  • Morphine
  • Oxygen
  • Nitrates (GTN)
  • Antiplatelets - 300mg aspirin & ticagrelor 180mg
  • PCI - if presents within 12 hours of onset of pain

Also - give fluids if hypotensive

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14
Q

What should you always do in a RRAPID scenario if concerned about patient?

A

Call for senior help

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15
Q

What should you always do before giving any medications in a RRAPID scenario?

A

Ask for trust guidelines

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16
Q

RRAPID response to an NSTEMI?

A
  • Inform senior immediately
  • Morphine (IV bolus)
  • Oxygen
  • Nitrates (GTN spray)
  • Aspirin 300mg & ticagrelor 180mg
  • LMWH as per local guidelines
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17
Q

Future pharmacological management of ACS?

A
  • Beta blocker (bisoprolol)
  • Statin (atorvastatin)
  • Dual antiplatelet therapy (aspirin & ticagrelor)
  • ACEi (ramipril)
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18
Q

Give some signs seen in CHF with pulmonary oedema

A
  • Tachypnoea
  • Low O2 sats
  • Use of accessory muscles
  • Dullness to percussion at lung bases
  • Wheeze (cardiac asthma)
  • Inspiratory crackles
  • Reduced air entry at lung bases
  • Pale
  • Hypotension
  • Tachycardia
  • Raised JVP
  • Triple/gallop rhythm
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19
Q

What signs may you seen on a CXR in CHF with pulmonary oedema?

A
  • Cardiomegaly
  • Fluffy bilateral shadowing with peripheral sparing (‘bat wings’)
  • Kerley B lines
  • Pleural effusions
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20
Q

What specific blood would you want in ACS?

A

Troponin

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21
Q

What specific blood would you want in CHF with pulmonary oedema?

A

troponin and brain natriuretic peptide (BNP)

22
Q

What is the pharmacological response to CHF with pulmonary oedmea?

A
  • Morphine
  • Nitrates
  • Furosemide (IV)
  • Oxygen
23
Q

What is the future management for CHF with pulmonary oedema?

A
  • Beta blocker
  • ACEi
  • Furosemide
  • Aldosterone-antagonist (spironolactone)
24
Q

Signs of an acute exacerbation of COPD?

A
  • Tachypnoea
  • Low O2 sats
  • Cyanosis
  • Use of accessory muscles
  • Pale
  • Tachycardia
  • Hypotensive
  • Decreased breath sounds
  • Expiratory wheeze
  • Coarse crackles
  • Hyper resonant (2ary pneumothorax)
25
Q

How should O2 be delivered in COPD patients?

A

If patient at risk of hypercapnic respiratory failure due to conditions such as COPD à give O2 via a venturi mask with target sats 88-92%

26
Q

What is the pharmacological response to acute exacerbation of COPD?

A

Oxygen

Bronchodilators:

  • Salbutamol 5mg nebulised - as required
  • Ipratropium bromide 500mg nebulised - given 4-6 hourly

Corticosteroids:

  • Oral prednisolone 30mg
  • IV hydrocortisone 100mg IV

Antibiotics:

  • If evidence of infection
  • Sepsis 6 if indicated (low BP, low O2 sats, tachycardia, high temp)
27
Q

Signs seen in AKI?

A
  • SOB from pulmonary oedema
  • Cyanosis
  • Prolonged CRT
  • Reduced skin turgor
  • Dry mucous membranes
  • Hypotensive
  • Tachycardia
  • Decreased urine output
  • Peripheral oedema
28
Q

What is the RRAPID response to AKI?

A

STOP AKI

  • Sepsis → sepsis 6 if indicated
  • Toxins → stop nephrotoxins e.g. gentamicin/NSAIDs/IV contrast
  • Optimise BP & volume status
  • Prevent harm → treat complications (acidosis, pulmonary oedema, hyperkalaemia)

Identify cause!

29
Q

Give some signs seen in acute severe asthma

A
  • RR >/= 25
  • HR >/= 110
  • Inability to complete sentences in one breath
  • PEFR 33-55% of best or predicted
30
Q

Give some signs seen in life threatening asthma

A
  • O2 sats <92% on air
  • PaO2 <8 kPa
  • PaCo2 normal (4.6-6.0 kPa)
  • Silent chest
  • Cyanosis
  • Poor respiratory effort
  • Arrhythmia
  • Hypotension
  • Exhaustion
  • Altered conscious level
  • PEFR <33% of best or predicted
31
Q

Give some signs seen in near fatal asthma

A
  • Raised PaCO2
  • Requiring mechanical ventilation with raised inflation pressures
32
Q

What is the pharmacological response to an acute severe asthma attack?

A

Bronchodilators:

  • Salbutamol 5mg nebulised - when required
  • Ipratropium bromide - 4-6 hourly

Corticosteroids:

  • Oral prednisolone 30mg
  • IV hydrocortisone
33
Q

Pharmacological response for anaphylactic shock?

A

Follow resus guidelines:

  • IM adrenaline 500 micrograms
  • Chlorphenamine IV
  • Hydrocortisone IV
  • IV challenge if hypotensive

General:

  • Call for help if airway compromised
  • Assess face for swelling
  • Once anaphylaxis is recognised – give immediate management and remove antigen if identified
34
Q

Blood glucose diagnostic criteria for DKA?

A

Raised blood glucose >11mmol/L (or known diabetes)

35
Q

Capillary & ketones diagnostic criteria for DKA?

A

Capillary ketones <3mmol/L (or ketones >/= 2 in urine)

36
Q

Venous pH diagnostic criteria for DKA?

A

Venous pH <7.3 or venous bicarbonate <15 mmol/L

37
Q

Give some symptoms of DKA

A
  • Blurred vision
  • Increased thirst
  • Increased urine production
  • Infective symptoms
  • N&V
38
Q

Give some signs of DKA

A
  • Tachypnoea
  • Acetone smell on breath
  • Delayed CRT
  • Reduced skin turgor
  • Dry mucous membranes
  • Hypotensive
  • Tachycardia
  • Tender abdomen
  • Confusion
  • Reduced GCS
39
Q

Extra investigations needed in RRAPID DKA?

A
  • Blood/urine ketones
  • Consider sepsis 6 if indicated
  • Urinalysis
40
Q

Response to DKA?

A

F → Fluids (0.9% saline)

I → Insulin fixed rate (0.1 units/kg/hr)

G → Glucose (monitor levels and give 10% dextrose if needed)

P → Potassium (monitor levels and give extra if needed as insulin causes hypokalaemia)

I → Infection (may be underlying trigger of DKA)

C → Chart fluid balance

K → Ketones (monitor - want <0.6mmol/l)

41
Q

Causes of an upper GI bleed?

A
  • Peptic ulcer
  • Oesophageal varices
  • Oesophagitis
  • Mallory-Weiss tear
  • Coagulopathies
  • Tumours
42
Q

Causes of a lower GI bleed?

A
  • Diverticular disease
  • Ischaemic colitis
  • Crohn’s disease
  • Ulcerative colitis
  • Cancer
  • Internal haemorrhoids
  • Anal fissure
  • Polyps
43
Q

Symptoms of upper vs lower GI bleed

A
44
Q

Signs seen in GI bleed?

A
  • Tachypnoea
  • Delayed CRT
  • Reduced skin turgor
  • Hypotensive
  • Tachycardia
  • Decreased urine output
  • Signs of liver disease if associated with live failure:
    • Palmar erythema
    • Liver flap
    • Telangiectasia
    • Ascites
    • Gynaecomastia
45
Q

What 2 scales are used to grade the severity of an upper GI bleed?

A
  • Glasgow Blatchford score
  • Rockall score
46
Q

Which scoring system estimates the risk of a patient with an upper GI bleed requiring intervention, such as transfusion or endoscopy?

A

Glasgow Blatchford Score

47
Q

Which scoring system estimates the risk of rebleeding or death in patients with upper GI bleed?

A

Rockall

48
Q

What scales is used to grade the severity of a lower GI bleed?

A

Oakland score

49
Q

What does the Oakland score predict?

A

This is used to predict whether it is safe to discharge a patient with a lower GI bleed.

50
Q

If a massive haemorrhage is suspected in a RRAPID station, what should you do?

A
  • Initiate the massive haemorrhage protocol
  • 12-lead ECG
  • Keep patient nil by mouth
  • Withhold precipitant factors after considered risk-benefit ratio e.g. anticoagulants, antiplatelets
51
Q

What criteria can be used to determine if an oesophago-gastro-duodenoscopy (OGD) is required in an upper GI bleed?

A
  • Ongoing bleeding
  • Suspected variceal bleed
  • Unstable episode requiring transfusion
  • Lost >/= 30% blood volume
52
Q

Investigations in lower GI Bleed?

A
  • Colonoscopy
  • Likely to require OGD to rule out upper GI bleed

Yr 3 - RRAPID (4 decks)

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