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Yr 2 - Renal > RRAPID > Flashcards

RRAPID Flashcards

(57 cards)

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1
Q

What is the ABCDE approach?

A 
Airway
Breathing
Circulation
Disability
Exposure
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2
Q

What should you look for in airway examination?

A
  • Chest movements
  • Accessory muscle use
  • Foreign body obstruction
  • Misting of oxygen mask
  • Is airway patent?
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3
Q

What should you listen for in airway examination?

A
  • Abnormal breath sounds

- Absent breath sounds

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4
Q

What should you feel for in airway examination?

A

Airflow on inspiration and expiration

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5
Q

If patient’s airway is not clear due to relaxed tongue blocking, what manoeuvres can be done?

A

Head tilt/chin lift

Jaw thrust

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6
Q

Describe the head tilt/chin lift

A

Finger under chin and tilt head backwards to open airway

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7
Q

Describe the jaw thrust

A

Fingers underneath angle of jaw and pull up towards ceiling to pull tongue forward

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8
Q

What else may be needed if patient airway is not clear / not breathing?

A
  • Oxygen (15L/min via reservoir mask)
  • Suction
  • Remove foreign objects
  • Airway adjuncts
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9
Q

What airway adjuncts are used?

A
  • Nasopharyngeal tube

- Oropharyngeal tube

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10
Q

When would you use a naso tube over an oro one?

A
  • Naso tubes better tolerated

- If oro can’t be used due to oral traumas

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11
Q

How can a naso tube me measured?

A

When held against the side of the face, a correctly sized airway will extend from the tip of the nose to the tragus of the ear.

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12
Q

When are oro tubes used?

A

If patient is unconscious

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13
Q

How can an oro tube be measured?

A

Hold the airway beside the patient’s cheek with the flange at the corner of the mouth. The tip of an appropriately sized airway should just reach the angle of the mandibular ramus.

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14
Q

What should you look for in breath examination?

A
  • Respiratory rate
  • Depth and symmetry
  • Accessory muscle use (respiratory effort)
  • Sweating
  • Cyanosis (lips, under tongue)
  • Ability to clear secretion by coughing
  • Oxygen saturation
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15
Q

What is normal respiratory rate?

A

12-20 breaths per minute

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16
Q

What can asymmetrical expansion of chest suggest?

A

Pneumonia, a large pleural effusion, rib fracture, or pneumothorax.

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17
Q

What is normal oxygen saturation range?

A

95-100%

N.B. this is lower in COPD patients

Below 90% –> hypoxaemia
Below 80% –> chance of organ damage

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18
Q

What should you listen for in breathing examination?

A
  • Ability to talk in complete sentences
  • Coughing/noising breathing
  • Percussion
  • Chest auscultation
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19
Q

What is auscultation?

A

Listening to sounds from the heart, lungs, or other organs, typically with a stethoscope

Chest auscultation can assess airflow through trachea and bronchial tree

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20
Q

What are some upper airway noises?

A
  • Stridor
  • Snoring
  • Gurgling
  • Choking
  • Hoareness
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21
Q

What does stridor indicate?

A

Harsh/high pitched noise on inspiration suggesting obstruction

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22
Q

What does snoring indicate?

A

Partially occluded pharynx

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23
Q

What does gurgling indicate?

Study These Flashcards
A

Secretions in the upper airway

24
Q

What does choking indicate?

Study These Flashcards
A

Mechanical obstruction to the airway with reflexes present

25
What does hoarseness indicate?
May be due to irritation or injury of the vocal cords
26
What are some lower airway noises?
- Wheeze - Bronchial breathing - Crackles - Absent breath sounds
27
What do crackles indicate?
Fluid or pus in the lung space Pneumonia, pulmonary oedema, COPD, lung infection, heart failure
28
What can crackles be defined as?
Coarse or fine
29
What can wheezes indicate?
Narrowing of the small airways E.g. asthma
30
What can bronchial breathing indicate?
Consolidated lung
31
What is bronchial breathing?
Tubular, hollow sounds which are heard when auscultating over the large airways (e.g. second and third intercostal spaces). They will be louder and higher-pitched than vesicular breath sounds.
32
What do absent breath sounds indicate?
Pleural effusion, collapsed lung, pneumothorax Conditions that prevent airflow reaching parts of the lung
33
What is normal sound of percussion over healthy lung?
Resonant note
34
What does dull or flat sound over lung indicate?
Abnormal lung density Atelectasis, tumour, pleural effusion, lobar pneumonia
35
What does hyperresonant sound over lung indicate?
Too much air present in lung tissue Emphysema, pneumothorax
36
What should you feel for in breathing examination?
- Deviation of trachea - Chest expansion - Percussion note
37
What can tracheal deviation indicate?
Tension pneumothorax, swelling or internal bleeding Get chest x-ray
38
What is ABG (arterial blood gas)?
A blood test that measures the acidity, or pH, and the levels of oxygen (O2) and carbon dioxide (CO2) from an artery. The test is used to check the function of the patient's lungs and how well they are able to move oxygen into the blood and remove carbon dioxid
39
When would ABG be taken?
If deemed necessary (if patient not very well)
40
If patient is wheezing, what medication can be considered?
Nebulised salbutamol
41
What should be investigated during circulation examination?
- Capillary refill time - Pulse rate and character - Blood pressure - Jugular venous pressure - Skin turgor - Heart sounds - Lungs - Oedema (sacral/peripheral) - Urine output - Agitation / reduced consciousness
42
What is normal capillary refill time?
Pinch finger, hold down for 5 seconds and should come back to normal in 2 seconds
43
What is JVP?
Indirectly observed pressure over the venous system via visualisation of the internal jugular vein
44
What is skin turgor?
Taken over clavicle or on back of hand A decrease in skin turgor is indicated when the skin is pulled up for a few seconds and does not return to its original state. A decrease in skin turgor is a late sign of dehydration.
45
What is peripheral oedema?
Oedema in lower legs
46
What is sacral oedema?
Oedema accumulates in lower back
47
What is response to circulatory problems?
- Treat underlying problem - Blood tests / ECG - Fluid challenge
48
What is the fluid challenge?
The rapid administration of a bolus of fluid in critically ill patients (usually crystalloids) Monitor response - can boost blood pressure and increase urine output
49
What is used to assess disability?
ACVPU - scale of how conscious patient is A - Alert (do they remember name, why they're in hospital) C - Confusion V - Voice (is patient responding to voice) P - Pain (is patient responding to pain, eyebrow push) U - Unresponsive (not responding to voice or pain)
50
What is the Glasgow Coma Scale (GCS)?
Scoring system used to describe the level of consciousness in a person
51
What else should be recognised in disability examination?
Pupillary response - size/reactive Capillary blood glucose (may explain reduced level of consciousness, normal level between 4-7)
52
What is response to low capillary glucose?
Give glucose if hypoglycaemic
53
What should be recognised in disability examination?
- Top to toe examination (injury, sources of infection) - Adequate exposure - Prevent cold / preserve dignity - Check temperature
54
What should be followed during exposure examination?
BART B - Bruising / bleeding A - Abdominal examination R - Rashes T - Thrombus (DVT)
55
After completing A-E, should should be done?
You will need to reassess patient to evaluate if patient has made clinical improvement (e.g. if giving O2 has brought oxygen saturation up)
56
What is NEWS 2?
National early warning score which can indicate deterioration or improvement. Higher score = sicker patient
57
What is SBARR?
Structured way to hand over patients and give clear information to another member of staff. S – Situation (who I am, where I am, what I think is wrong with patient) B – Background (when they came in, situation over past couple of days/hours) A – Assessment (what have I done since being there, results of my assessments) R – Recommendation (mine) (what I think should be done) R – Read back/review (get them to read back information to you to double check)

Yr 2 - Renal (16 decks)

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