The RRAPID Approach


The ABCDE Approach

ABCDE APPROACH

The RRAPID approach promotes the identification of patients at risk of acute illness and deterioration followed by the appropriate response.

The RRAPID assessment is based on the traditional systematic, Airway, Breathing, Circulation, Disability and Exposure (ABCDE) approach.

Start with looking at the patient from the end of the bed to get a general impression and decide if the patient ‘looks ill’.

Life-threatening problems must be treated first before moving on to the next system and regularly reassess.

If the patient is not breathing and does not have a pulse – start cardiopulmonary resuscitation (CPR) immediately and call for help.

Following the initial recognition and response to acute illness it is important that the patient has a comprehensive management plan to allow continued recovery.

A

Recognition

  • Is the patient talking?
  • Look, listen, feel
  • Signs of airway obstruction?
    • Paradoxical chest and abdominal movements
    • Grunting, gurgling
    • Foreign body visible?
    • Fully obstructed airway will be silent
  • Cyanosis/hypoxia is a late sign

Response

  • Call for help if signs of airway obstruction
  • Head tilt, chin lift
  • Jaw thrust
  • Oropharyngeal airway
  • Nasopharyngeal airway
  • Suction secretions (Yankauer)
  • Give oxygen (O2)
  • Call an anaesthetist for definitive airway management
B

Recognition

  • Look, listen, feel
    1. Is the patient breathing?
    2. Signs of respiratory distress including sweating, central cyanosis and use of accessory muscles of respiration?
  • Respiratory rate, depth and rhythm
  • Equal air entry?
  • Added sounds?
  • Percussion note?
  • Trachea central?

Response

  • Sit the patient up
  • Give O2 15 L/min via a reservoir mask
  • Aim O2 saturations 94-98%

    If patient at risk of hypercapnic respiratory failure (chronic lung disease) aim O2 saturations 88-92%

  • Peak expiratory flow rate (PEFR)
  • Arterial blood gas (ABG)
  • Chest X-ray (CXR)
  • If not breathing- ventilate with a bag and mask
C

Recognition

  • Look at, and feel peripheries
    • Pulse rate and character
    • Blood Pressure
    • Capillary refill time
    • Jugular venous pressure
    • Auscultate heart sounds
  • Signs of poor end organ perfusion?
    • Agitation
    • Reduced consciousness
    • Urine output < 0.5 mls/kg/hr
  • Evidence of blood loss?

Response

  • Treat the underlying problem
  • 2 large bore cannula, 14G or 16G
  • Blood tests (routine haematological, biochemical, coagulation and group and save)
  • 12 lead ECG
  • Fluid challenge and assess response
D

Recognition

  • Patient response: alert, verbal, pain, unresponsive (AVPU)
  • Glasgow Coma Scale (GCS)
  • Pupils - size and reaction to light
  • Blood glucose
  • Focussed neurological examination
  • Evidence of seizure activity?
  • Check the patients drug chart for reversible causes (e.g. opioid overdose)

Response

  • Protect airway
  • Endotracheal tube if GCS < 8 (call for anaesthetic help)
  • Recovery position if airway not protected
  • Give glucose if hypoglycaemia (glucose < 4 mmol/L)
  • Treat seizure activity with benzodiazepines
E

Recognition

  • Expose the patient (maintain dignity and minimise heat loss) to assess for injuries, signs of infection, bleeding etc.
  • Check temperature
  • Focussed history and examination
  • Chart review
  • Drug chart
  • Investigation results

Response

  • Communication (SBARR)
  • Senior medical advice
  • Management plan
  • Documentation
  • Organise transfer to High Dependency Unit (HDU)/Intensive Care Unit (ICU) if appropriate