RRAPID

Question 1

What are the main causes of airway obstruction

Answer 1

CNS depression: Opiates
Foreign body: Vomit, blood, food, secretions
Blocked tracheostomy
Tongue
Swelling: Inflammation, anaphylaxis, infection, bronchospasm
Trauma

Question 2

In airway obstruction what will kill the patient?

Answer 2

Not getting oxygen.

Leads to: pulmonary oedema, cerebral hypoxia, exhaustion, hypoxic brain injury, secondary apnoeas

Question 3

What can cause breathing problems

Answer 3

Cancer
PE
Pneumothorax
CNS depression
Mechanics: muscle wasting, MS
Lungs: asthma, COPD, infection

Question 4

In breathing problems what will kill the patient?

Answer 4

Hypercapnia, apnoeas, pulmonary oedema, exhaustion, hypoxic brain injury, secondary cardiac ischaemia

Question 5

What are causes of circulatory problems?

Answer 5

MI
Ischaemia
Arrhythmia
Cardiac failure
Tamponade
Rupture
Myocarditis

Question 6

In circulatory problems what will kill the patient?

Answer 6

Cardiac arrest

Question 7

What are the red flag signs to look out for in an airway assessment?

Answer 7

Absent breath sounds
Snoring/stridor/gurgling
Hoarse voice
Obtundation/cyanosis
Paradoxical movements
Retraction/accessory muscle use
Tracheal deviation
Laryngeal crepitus

Question 8

What are specific signs of airway obstruction?

Answer 8

Stridor
Gurgling
Complete silence/ absence of breath sounds
Snoring
Vomiting
Cyanosis

Question 9

What is the order of management for an obstructed airway?

Answer 9

Head tilt, chin lift/ jaw thrust
Oropharyngeal tube/ nasopharyngeal tube
I-gel/LMA
Endotracheal tube
Mechanical ventilation

Question 10

What injuries may compromise an airway?

Answer 10

Facial fractures/burns
Neck wounds
Epistaxis/vomiting
Head injury w/low GCS

Question 11

How is the ‘B’ section of RRAPID assessed?

Answer 11

Look, listen, feel
Speak in full sentences/laboured breathing
Count RR
Assess quality of breathing/ asymmetry
Assess deformities
Record FiO2 & sats (on air/oxygen?)
Listen near face, palpate, percuss, auscultate the chest
Tracheal position
Initiate treatment

Question 12

What injuries compromise ventilation?

Answer 12

Airway obstruction
Tension pneumothorax
Open chest wound
Massive haemothorax
Flail chest
Cardiac tamponade

Question 13

In a trauma patient, how is inadequate ventilation managed?

Answer 13

• Optimsie oxygen
• Nebuliser (salbutamol, atravent)
• Nitrates
• Needle/tube thoracocentesis/pericardiocentesis
• Resuscitative thoracotomy
• Consider intubation

Question 14

What colours and percentages are the different venturi masks?

Answer 14

Blue=24%
White=28%
Yellow=35%
Red=40%
Green=60%

Question 15

How much oxygen can be delivered through the different airway devices?

Answer 15

Nasal= 2-4L/min (inspired O2 conc: 24-48%)
Hudson= 5-10L
Non-rebreathe= 15L (inspired O2 conc: 60%)
Bag&mask= 15L

Question 16

What are the ranges of oxygen sats for healthy & COPD patients?

Answer 16

94-98%

88-92%

Question 17

How is circulation assessed?

Answer 17

Look & feel hands
Assess peripheral & central CRT
Assess venous filling
Count HR & assess cardiac monitor
Palpate central & peripheral pulses
Listen to heart
Measure BP (Hypo/hyperT)
Signs of poor CO
Signs of haemorrhage
Tx cause of circulatory collapse

Question 18

How is circulatory inadequacy from a haemorrhage treated?

Answer 18

Optimise oxygenation
Splints/tourniquet/pressure on active bleed
x2 large bore IVs
Fluid resus: Blood, warm crystalloid
IV tranexamic acid for bleed
?Massive transfusion protocol

Question 19

What should be assessed in ‘disability’?

Answer 19

Review ‘ABC’
Check drug chart for reversible drug SE/Dec GCS
Examine pupils
Assess GCS/AVPU
Lateralising signs (Both sides of the body moving equally)
Capillary glucose
Ensure airway protection

Question 20

What is assessed in ‘exposure’ section of RRAPID?

Answer 20

Examine the patient

Check temperature

Question 21

What are the possible causes of irregular board QRS complexes

Answer 21

AF w/BBB

Pre-excited AF

Question 22

What are inotopes? How do they work?

Answer 22

Inotropes are agents that increase myocardial contractility

Adrenaline, dobutamine, isoprenaline, ephedrine, NorA

Question 23

What are vasopressors? How do they work?

Answer 23

Vasopressors are agents that cause vasoconstriction leading to increased systemic and/or pulmonary vascular resistance
Noradrenaline, metaraminol, methylene blue, Adrenaline, Penylephrine

Question 24

What are the indications for each inotrope?

Answer 24

Adrenaline: cardiac arrest, low CO state, cardiac surgery
Dobutamine: low CO state, part of EGDT, cardiac surgery
Ephedrine: Reversal of hypoT from spinal/epidural

Question 25

What are the indications for each vasopressor?

Answer 25

Noradrenaline: septic shock, vasodilation
Vasopressin: septic shock (cardiac arrest}
Metaraminol: Emergency/acute hypotension

Question 26

When is advanced airway management indicated?

Answer 26

Failure to oxygenate/ventilate
Failure to maintain/protect
Anticipated clinical course

Question 27

What is a cricothyrotomy?

Answer 27

Needle in through the cricoid membrane (quick)

Question 28

In what situation would a compromised airway need to be reported to the police?

Answer 28

Strangulation as part of domestic violence (high likelihood that the next attack will lead to death)

Question 29

How is hypotension defined? What needs to be assessed?

Answer 29

SBP <90mmHg

HR
Vol status
Cardiac performance
Systemic vascular resistance

Answers: why the patient is hypoT & how this can be addressed

Question 30

What types of vasopressors & inotropes are used in shock?

Answer 30

I: Dobutamine (cariogenic shock)
V: Noradrenaline (distributive shock)

Question 31

How do chronotropes work?

Answer 31

Inc HR

e.g: Adrenaline, Dobutamine

Question 32

What receptors do the following act on:
Adrenaline
Dobutamine
NorA
Phenylephrine

Answer 32

A: α1
, β1
, β2
D: β1
, β2
NorA: α1, 
β1
Phenyl: α1