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3rd year > RRAPID > Flashcards

RRAPID Flashcards

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1
Q

What are the characteristics of acute severe asthma?

A

HR >110, RR >25, PEFR (33-55%), cant speak in full sentences

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2
Q

What are the characteristics of life threatening asthma?

A

PEFR <33%, O2 sats <92%, PaO2 down

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3
Q

What are the characteristics of near fatal asthma?

A

Cyanosed, PaCO2 > 6 , silent resp effort

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4
Q

Drug treatment of acute asthma?

A

ABCDE Asessment then OH SHIT

O2 15L non rebreathe
Salbutamol nebs 5mg (every 20 mins)
Ipatropium bromide nebs 500mcg (every 4-6 hours)
Hydrocortisone (200mg) IV or 40mg pred PO
Mg Sulfate IV 2g IV

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5
Q

What investigations do you want to do for acute asthma?

A

ABG
PEFR
CXR
FBC and U+E, cultures if sepsis

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6
Q

What are symptoms/signs of acute COPD exacerbation?

A 
Cough up
exercise tolerance down
tachpnoeic
thick green mucopurulent sputum
Wheeze 
cyanosis
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7
Q

What is one of the first things you do to any resp patient?

A

Sit them up (yes loads of other answers too)

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8
Q

What Ix you wanna do for COPD exacerbation?

A 
ABG
Sputum mc and s
Blood cultures - sepsis
FBC, u+E
ECG - cor pulmonale
CXR?
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9
Q

What is the drug treatment for COBP exacerbation?

A 
O2 15L non re breathe
Salbuatamol nebs 5mg every 20 mins
Ipatropium bromide neps 500mcmg
Hydrocortisone 200mg IV or PRed 40mg PO
Abx - trust guidelines
I would consider ventilating too
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10
Q

What are the signs and symptoms of a tension pneumothorax?

A

Dyspnoea (pleuritic chest pain)
SOB

Hyperesonance
Decrease ae
Decreased vocal resonance
Trachea deviated away
hypotension  (some debate about cant be tension without hypotension hmmm blah blah)
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11
Q

What Ix you wanna do if pneummothorax?

A

ABG
FBC u+E
Glucose apparently!!!

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12
Q

What is the treatment for a tension pneumothorax?

A

Probs give them some O2 firsts (15L non re breathe) Insert large bore needle into second intercostal space midclavicular line. Leave and insert test tube.

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13
Q

What are signs and symptoms of PE?

A

SOB
Sudden pleuritic chest pain
Haemoptysis
syncope collapse

JVP up
Tachy all round
May get T1 resp failure
RV heaves

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14
Q

What is your immediate treatment for a PE?

A

ABCDE assessment

LMWH and consider thrombolysis

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15
Q

What are the ix in PE?

A 
Take bloods and glucose
Give fluids
ABG
Monitor cardiac output
No CT angiogram til stable
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16
Q

What are the signs and symptoms of an ACS?

A

Central crushing chest pain can radiate down arm and to jaw
sweating
Palpitations
nausea
vomiting
sweaty
Diabetics and old people can get none of this

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17
Q

Do you give oxygen in ACS?

A

Only if sats below 94% but if in doubt give

trying to avoid free radicals in reperfusion

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18
Q

What are you doing for the C aspect in ACS?

A

Two wide bore cannulas
Take blood: FBC, UE, glucose, Ca, Mg, troponin
Blood cultures?

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19
Q

Other investigations for ACS?

A

ECG

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20
Q

What is the immediate treatment for ACS?

A 
Reassure
O2 if less that 94%
Morphine 5mg (and an anti emetic)
Aspirin 300mg
Nitrates (2 spray GTN)
Clopidogrel 300mg/ Ticagrelor 180mg
Enoxaparin/ECG
PCI - all about ambulance to balloon time
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21
Q

What are the definition of AKI? (there are 3)

Study These Flashcards
A
  1. > 36umol/L 48h
  2. 1.5x normal creatinine 1 week
  3. Urine output = <0.5ml/kg/hour 6 hours
22
Q

What are the signs and symptoms of AKI?

Study These Flashcards
A 
hypovolaemia
dehydration - skin turgor
oliguria
maybe signs vasculitis
maybe signs of renal bruits
23
Q

What are you gonna do in C element for AKI? (its a fair chunk of stuff)

Study These Flashcards
A 
Standard two cannulas
Bloods:
FBC U and E
Bicarbonate
LFTs
Ca
Phosphate
Creatinine ( can i compare this to earlier creatinine?)
THINK ABOUT SEPSIS (maybe get a BP here)
if thinking sepsis get going on BUFFALO

Fluids 500ml NaCl ( NOT HAARTMANS, they might have high potassium christtt)

24
Q

They have just told you that because of the AKI the person has hyperkalaemia what you going to do?

Study These Flashcards
A

Calcium gluconate 30mls IV over 15 mins
Insulin and glucose mix
(50ml 50% glucose, 10 units insulin) 5-10 mins and monitor glucose
^^ thats your standard

E book mentions more…
Salbutamol nebs 5mg 20 mins
Calcium resonate - 15mg oral every 6-8hr (give with lactulose as constipation)

25
How high must the Potassium level be to be high? hmm
over 5.5
26
When do you treat hyperkalaemia?
over 6 with ecg changes | over 6.5 irrelevant of anything else
27
How do you spot hyperkalaemia on an ECG?
small p waves tall tented t waves wide QRS
28
What is anaphylaxis?
A life threatening allergic reaction - T1 hypersensitivity reaction. IgE mediated
29
What are the main features of anaphylaxis?
``` Angioedema Laryngeal oedema Broncho constriction Rash/uticaria hypotension and shock nausea/vomit/diarrhoea ```
30
What you definitely going to be thinking about doing in A in anaphylaxis?
Sercure the airway - adjunct? | Any difficulty anaesthetist
31
Drug treatment of anaphylaxis?
Adrenaline 0.5mg IM every 5 mins and reasess Chorphenamine 10mg IV Hydrocortisone 200mg IV Haartmaans 500ml STAT (15 mins)
32
What is an easy way to help circulation in anaphylaxis?
lift legs up
33
What is a broad complex tachycardia?
QRS > 0.12s BPM >100 there IS a pulse
34
What is the go to treatment for a broad complex tachycardia?
Amiodarone 300mg IV over 1h | Then 900mg IV over 24h
35
What is a treatment for bradycardia?
Hr below 50bpm | Atropine
36
Averse features of broad complex tachycardia?
Shock, hypotension, syncope MI, HF
37
How are you going to find out if there is a broad complex tachycardia?
ECG
38
What to do when you enter a RRAPD station?
``` Hi whatup im a 3rd year med student Is the patient conscious? (if not BLS) (they will be conscious) 30s history. history from nurse Can I see a NEWS chart? I am gonna do ABCDE assessment ```
39
What are you going to recognise and look for for A?
Patent airway - if talking all good Partial obstruction - eg stridor, grunting, snoring, gurgling Full obstruction - cyanosis, silence If worried about airway get anaesthetis asap
40
How do you respond to A?
Head tilt chin lift jaw thrust if spinal Adjunct/anaesthetist (measure incisor to angle mandible) Get some o2 going
41
What do you recognise in B?
``` General inspection RR o2 sats Tracheal deviation percussion Auscultation PEFR ```
42
How you gonna respond to B?
15L o2 non rebreathe Sit the patient up ABG Portable CXR
43
What do you recognise in C?
``` Feel peripheries CRT Pulse BP JVP Skin turgor clavicle Hydration mouth Urine output- do they have a catheter ```
44
What do you do in C?
2 wide bore cannulas anterior cubital fossa Bloods - FBC, u+e, CRP, ESR (plus whatever is relevant) If bleeding crossmatch 6 units I think do a blood glucose now Give any fluids (500ml NaCl STAT (15 mins)) VBG- can look at haemoglobin and lactate (more than 2 =high lactate)
45
What to do for disability?
``` 1. AVPU Alert Voice Pain Unresponsiveness (Treat/identify cause for lack consciousness) 2. Check pupils 3. Cap glucose if haven't already 4. Wiggle toes and squeeze hands ```
46
What to do for exposure?
1. I'M ENSURING PATIENT DIGNITY 2. BARTS Bruises Abdo Rashes ( i would look @ back) Thrombus (squeeze calf for tenderness) Scars 3. Drug chart review and prescribe abx
47
What is SBARR?
``` Situation Background Assessment Recommendation Review ```
48
What is BUFALO for Sepsis?
``` Blood cultures Urine output (.05ml/kg/hour) Fluids (500ml Haartmans) Abx - trust guidelines Lactate (>2) O2 ```
49
Signs of Sepsis?
Temp >38.3 HR >90 RR > 20 WCC >12 or <4
50
What is septic shock?
Sepsis and hypotension (BP <90)
51
What are the 10 questions for and AMTS?
``` what is your date of birth What is your age What is the time What year is it Who am I and who is this Where are we Can you remember this address 30 West street Can you buy count back 20 to 1 What year did World War I start Who is the current reigning Monarch ``` What was the address I told you turn number

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