RRAPID

Question 1

Acute severe asthma

Answer 1

Call for help
Airway
- Sit patient up

Breathing

• Sats, ABG
• 15L/min oxygen via non-rebreathe mask
• 5mg salbutamol nebulised back to back
• 500mcg ipratropium bromide nebulised 4-6 hourly
• Chest X-ray

Circulation

• 2 wide bore cannulas in antecubital fossae
• Take bloods - FBC, U&Es, CRP
• IV hydrocortisone 200mg
• IV magnesium sulphate 2g

Question 2

Acute exacerbation of COPD

Answer 2

Call for help
Airway
- Sit patient up

Breathing

• Sats
• ABG - low oxygen, high carbon dioxide (type 2 resp failure), raised bicarb if chronic
• Chest X-ray - flattened hemidiaphragms
• Controlled O2 - venturi mask
• Salbutamol 5mg neb back to back
• Ipratropium bromide 500mcg neb

Circulation

• ECG - cor pulmonale
• IV access
• Bloods
• Antibiotics if infection

Question 3

Tension pneumothorax

Answer 3

Call for help
Breathing
- Trachea deviated away from affected side
- Reduced air entry
- 15L/min oxygen via non rebreathe mask
- ABG
- Large bore needle in 2nd intercostal space mid-clavicular line
- Insertion of chest drain

Question 4

STEMI

Answer 4

Call for help
Breathing
- 15L oxygen via non rebreathe mask
- ABG

Circulation

• Serial ECGs
• IV access
• Bloods: troponin, FBC, calcium, magnesium
• Morphine 2.5mg
• GTN 2 sprays
• Aspirin 300mg
• LMWH

Disability

• Glucose
• AVPU

Refer to cardiologist for PCI within 12 hours of onset
Thrombolysis if PCI not available

Question 5

AKI

Answer 5

STOP AKI
Call for help

Sepsis - BUFALO
Toxins - stop nephrotoxins
Optimise blood pressure - volume status assessment; 500ml 0.9% sodium chloride in 15 min; monitor urine output
Prevent harm - treat complications, review drug chart, renal replacement therapy

Question 6

Hyperkalaemia

Answer 6

Call for help
Circulation
- IV access
- Take bloods - FBC, U&Es, LFTs, glucose
- ECGs

1. Calcium gluconate 30ml over 2 min, repeat every 5-10 min (provides cardio-protection)
2. Insulin 10units with 50ml of 50% glucose IV over 5-10 min
3. Salbutamol 10-20mg
4. Calcium resonium 15g orally with lactulose
5. Review potassium intake, medications, renal replacement therapy

Question 7

Anaphylaxis

Answer 7

Check wristband for allergies!!!
Call for help

Airway

• Call anaesthetist
• Head-tilt chin-lift to open airway
• Oropharyngeal airway adjunct to secure airway
• Raise legs
• Adrenaline 0.5mls of 1:1000 IM; repeat every 5 mins if necessary

Breathing

• 15L/min oxygen via non rebreathe mask
• ABG
• If audible wheeze, give 5mg salbutamol neb back to back

Circulation

• IV access
• Take bloods
• Fluid bolus
• Inotropes/vasopressors to maintain BP
• Chlorphenamine 10mg IV
• Hydrocortisone 200mg IV

Exposure

• Check drug chart/allergies
• Transfer to ICU

Question 8

Broad complex tachycardia

Answer 8

Call for help
Breathing
- 15L oxygen via non rebreathe mask
- ABG

Circulation

• Attach cardiac monitor
• ECG - broad QRS complexes, tachycardic
• IV access
• Bloods: FBC, calcium, magnesium, LFTs, U&Es
• Synchronised DC shock
• Amiodarone 300mg loading dose IV over 1 hour followed by amiodarone 900mg IV over 24 hours

Question 9

Narrow complex tachycardia

Answer 9

Call for help
Breathing
- 15L oxygen via non rebreathe mask
- ABG

Circulation

• Attach cardiac monitor
• ECG - narrow QRS complexes, tachycardic
• IV access
• Bloods: FBC, calcium, magnesium, LFTs, U&Es
• Synchronised DC shock
• Vagal manoeuvres
• Adenosine
• Digoxin/beta-blocker
• Amiodarone

Question 10

Bradyarrhythmias

Answer 10

Call for help
Breathing
- 15L oxygen via non rebreathe mask
- ABG

Circulation

• Attach cardiac monitor
• ECG - less than 50bpm
• IV access
• Bloods: FBC, calcium, magnesium, LFTs, U&Es
• Atropine 500mcg IV

Question 11

Pulmonary oedema

Answer 11

Call for help
Airway
- Sit patient up

Breathing

• Sats
• ABG
• Chest X-ray - alveolar effusions, kerley B lines, cardiomegaly, pleural effusions
• 15L/min oxygen via non-rebreathe
• Salbutamol 5mg neb back to back if wheeze present
• Consider CPAP machine

Circulation

• Attach to cardiac monitor
• IV access
• Bloods
• Morphine 2.5mg IV slowly
• Furosemide 40-80mg IV slowly
• GTN spray 2 sprays
• GTN 50mg in 50ml sodium chloride IV at 2ml/hr
• Monitor urine output

Question 12

Sepsis

Answer 12

BUFALO

Blood cultures
Urine output
Fluid resuscitation 
Antibiotics (broad spectrum)
Lactate levels
Oxygen 15L/min via non rebreathe mask

Question 13

Status epilepticus

Answer 13

Call for help
Airway
- Head-tilt chin-lift manoeuvre 
- Airway adjunct
- Call anaesthetist/ICU

Breathing

• Sats
• ABG
• Oxygen 15L/min via non-rebreathe mask

Circulation

• IV access
• Bloods - calcium, magnesium, glucose
• 1-2mg lorzepam IV slowly; repeat after 5 mins
• Phenytoin 20mg/kg IV

Disability

• AVPU
• Glucose
• Pupils
• Neurological test

Question 14

Pulmonary embolism

Answer 14

Call for help
Airway
- Sit patient up

Breathing

• Sats
• ABG
• 15L/min O2 via non-rebreathe mask
• Chest Xray, order CTPA

Circulation

• IV access
• Bloods - D-dimer, coagulation screen
• Fluid bolus
• Attach cardiac monitor
• LMWH
• Consider thrombolysis

Exposure

• Check swellings in leg
• Calculate Well’s score

Question 15

Upper GI bleed

Answer 15

Breathing

• 15L/min oxygen via non-rebreathe mask
• ABG

Circulation

• IV access
• Bloods - Group & save, FBC, LFT, U&E, coagulation screen
• Fluid challenge - 500ml 0.9% sodium chloride in 15 min
• Monitor urine output
• If massive blood loss, give blood transfusion, FFP, platelets

Disability
- AVPU

Exposure

• Abdominal Xray
• Order endoscopy