- pH 6.0 - raised bicarb = Chronic respiratory acidosis

O2 to maintain sats at 88-92% - Salbutamol 5mg Neb (with air if necessary) - Ipratropium 500mcg - Hydrocortisone 200mg IV - Broad spectrum abx if sepsis suspected e. g. Co-amoxiclav and clarithromycin CALL FOR HELP!

ECG - ST elevation - New LBBB Troponin - Raised

ECG - ST depression - T wave inversion Troponin - Raised

- Diamorphine 2.5-10mg IV - Aspirin 300mg - Clopidogrel 300mg - GTN 2 puffs every 5 minutes until no pain - Metocloperamide 10mg PCI in 12 hours

- Diamorphine 2.5-10mg IV - Aspirin 300mg - Clopidogrel 300mg - GTN 2 puffs every 5 minutes until no pain - Metocloperamide 10mg Thromboylysis with LMWH after discussion with cardiology

- Fluid status - Optimise BP IV access and fluids - STOP nephrotoxic drugs - Monitor Fluid balance - Bloods UEs, bicarbonate, eGFR

rRAPID Flashcards by Anna Todd

Acute Asthma - Investigations

ABG

O2 sats

PEFR

CXR - exclude pneumothorax

Bloods - FBC, UEs, Glucose

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Acute Asthma - Response

15L O2, sit patient up

Sabutamol 5mg Nebuliser
Ipratropium 500mcg Nebuliser
Hydrocortisone 200mg IV
Magnesium Sulphate 2g IV

CALL FOR HELP!

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COPD - ABG Result

pH <7.35
low O2
CO2 >6.0
raised bicarb

= Chronic respiratory acidosis

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COPD - Investigations

ABG
O2 Sats (aim 88-92)
CXR
ECG (may show cor pulmonale)
Bloods (FBC, UEs, Glucose)
Blood cultures

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COPD - Response

O2 to maintain sats at 88-92%

Salbutamol 5mg Neb (with air if necessary)
Ipratropium 500mcg
Hydrocortisone 200mg IV
Broad spectrum abx if sepsis suspected
e. g. Co-amoxiclav and clarithromycin

CALL FOR HELP!

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Tension Pneumothorax - Recognition

SOB
Hypotension
Distended neck veins
Trachea deviated AWAY from affected side

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Tension Pneumothorax - Response

15 L O2

Needle decompression
2nd intercostal space, mid-clavicular line
Chest drain insertion

CALL FOR HELP!
- Expose patient, may required log roll

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Chest Drain - Triangle of Safety Borders

Anterior to mid axillary line
Posterior to pectoral groove
Above 5th intercostal space (avoid VAN under rib)

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Massive PE - Investigations

ABG
Bloods (FBC, UEs, Glucose)
ECG (sinus tachycardia, S1QT3 wave)

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Massive PE - Response

Fluid resus
500ml 0.9% saline
Treatment dose LMWH
Unfractionated heparin if eGFR <30

CALL FOR HELP!
- Diagnostic CTPA when stable

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Massive PE - Follow Up

3 months NOAC therapy (rivaroxaban)

If unprovoked, must investigated for cancer

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ACS - STEMI

ECG

ST elevation
New LBBB

Troponin
- Raised

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ACS - NSTEMI

ECG

ST depression
T wave inversion

Troponin
- Raised

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ACS - Unstable Angina

ECG

ST depression
T wave inversion

Troponin
- No Change

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Troponin Measurement

Rises 4-8 hours

Peaks at 24 hours

Cardiac specific

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ACS - Response

15 O2 to maintain sats 94-98%

Serial ECGs

IV Access
- Bloods (FBC, UEs, Ca2+, Mg, Glucose, TROPONIN)

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STEMI - Mx

Diamorphine 2.5-10mg IV
Aspirin 300mg
Clopidogrel 300mg
GTN 2 puffs every 5 minutes until no pain
Metocloperamide 10mg

PCI in 12 hours

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NSTEMI - Mx

Diamorphine 2.5-10mg IV
Aspirin 300mg
Clopidogrel 300mg
GTN 2 puffs every 5 minutes until no pain
Metocloperamide 10mg

Thromboylysis with LMWH after discussion with cardiology

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AKI - Rx

Fluid status
Optimise BP
IV access and fluids
STOP nephrotoxic drugs
Monitor
Fluid balance
Bloods
UEs, bicarbonate, eGFR

Referral for Renal Replacement Therapy

Intractible

Hyperkalaemia
Pulmonary oedema
pH <7.15

Uraemic pericarditis
Encephalopathy

Hyperkalaemia - Investigations

ABG - for quick K+ level

IV Access

FBC
UEs
Glucose
LFTs

ECG

Hyperkalaemia - ECG Findings

Tall, tented T-waves

Broad QRS

Ventricular Fibrillation

Hyperkalaemia - When to treat?

K+ > 6 with ECG changes

K+ >6.5 regardless of ECG

Hyperkalaemia - Rx

Calcium gluconate

Cardio protective
30ml 10% over 20mins

Salbutamol 5mg Nebuliser

Insulin/Glucose

10U actrapid
50ml 50% dextrose

Calcium Resonium
- 15mg orally (with lactulose)

Anaphylaxis - Airway

Secure - Head tilt, chin lift - Jaw thrust - Adjunct - LMA if LOC (CALL ANAESTHETIST)

Anapylaxis - Response

- 15 L O2 - REMOVE ALLERGEN - Raise legs - IV Access (500ml 0.9% Saline) - Bloods (FBC, UEs, LFTs, Ca2+, Glucose)

Anaphlaxis - Mx

- Adrenaline 0.5mg 1:1000 IM - Chloramphenamine 10mg IV - Hydrocortisone 200mg IV

Adverse Features

- Shock (systolic less than 90) - MI - Syncope - Heart failure

Broad Complex Tachycardia - Investigations

- 15L O2 IV Access - FBC, UEs, Ca2+, Mg, Glucose, LFTs 12 LEAD ECG

Broad Complex Tachycardia - Adverse Features

Synchronised DC shock

Broad Complex Tachycardia - No Adverse Features

- Amiodarone 300mg IV over 1 hour | - Amiodarone 900mg IV over 24 hours

Narrow Complex Tachycardia - Adverse Features

Synchronised DC Shock

Narrow Complex Tachycardia - REGULAR (No Adverse)

Treat as SVT Vagal manouvres - Blow out syringe - Carotid massage 15 secs Adenosine

Narrow Complex Tachycardia - IRREGULAR (No Adverse)

Treat as AF - Beta blocker for rate control - Chemical Cardioversion with Amiodarone

Bradyarrhythmia - Adverse Features

Atropine 500mcg - Repeat 3-5 minutes, max 3g Consider transcutaneous pacing

Bradyarrhythmia - No Adverse Features

Assess risk of asystole - If risk = treat as with adverse features If no risk - observe

Risk Factors for Asystole (4)

- Recent aystole - Mobitz type II heart block - Complete heart block - Ventricular pause >3 seconds

Heart Failure - CXR

Alveolar bats wing oedema Kerley B lines Cardiomegaly Distended vessels

Pulmonary Oedema - Investigations

IV Access - Bloods (FBC, UEs, Glucose, Ca2+, Mg, LFTs) ECG CXR

Pulmonary Oedema - Investigations

O - 15 L O2 M - Diamorphine 2.5mg IV F - Furusomide 40-80mg IV G - GTN spray/50mg in 50ml saline over 2 hours

SIRS - Criteria

Temp <36 or >38 Heart rate >90 RR >20 or PaCO2 <4.3 WCC <4 or >12

Sepsis

SIRS with source of infection

Septic Shock

Sepsis + organ dysfunction

Severe Sepsis

Low BP despite adequate fluid resus

Sepsis - Investigations

ABG - lactate and PaO2 IV Access - Bloods (FBC, UEs, LFTs, CRP) - Blood cultures

BUFALO

Within 1 hour ``` Blood cultures Urine output Fluids (500ml 0.9% saline) Abx (broad spectrum) Lactate >2 O2 (15L NRBM) ```

Status Epilepticus - Mx

- Rectal diazapam/buccal midazolam - Lorazepam 1-2mg IV - Phenytoin IV - 20mg/kg - CALL FOR HELP!! RSI with thiopentone (cerbro-protective)