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Block 4 - Emergency Medicine > Clin Lab - EM Diagnostics > Flashcards

Clin Lab - EM Diagnostics Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What is the workup as needed for Trauma?

A

Imaging:
- US: eFAST exam
–> Bedside US – checks for blood where it tends to gather in abd/pelvis as well as pneumothorax/hemothorax
–> Blood = dark

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2
Q

What are the areas evaluated for trauma?

A
  • RUQ – around liver/ Morrison’s pouch
  • LUQ – around spleen b/t spleen & L kidney
  • Pelvic – around bladder
  • Pericardial
  • Hemothorax
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3
Q

What is assessed via US the RUQ?

A

around liver/Morrison’s pouch

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4
Q

What is assessed via US in the LUQ?

A
  • around spleen
  • b/t spleen & L kidney
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5
Q

Describe location of Morrison’s pouch.

A

b/t liver & right kidney

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6
Q

Where would you more likely find blood in the LUQ

A

more around the spleen rather than b/t spleen & L kidney

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7
Q

Typical order eFAST probe positions?

A
  • RUQ / RIH
  • Subxiphoid
  • Parasternal
  • LUQ/LIH
  • Suprapubic
  • Anterior thoracic L/R
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8
Q

Which side of the pt should you stand on during the eFAST exam?

A

right side

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9
Q

What does the e stand for in the eFAST?

A

looking for the lung stuff

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10
Q

Describe the subxiphoid view & what we’re looking for

A
  • Dig into patient’s abdomen
  • Looking a pericardial sac for blood around heart
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11
Q

Describe parasternal view.

A
  • Upper left of chest
  • Probe faces right shoulder
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12
Q

Describe LUQ/LIH view.

A

Knuckles should be hitting the table

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13
Q

What is being assessed in the suprapubic view?

A

Assessing the bladder, sagittal & transverse views

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14
Q

What is being assessed in the anterior thoracic L/R view?

A

Assessing the pleural sliding

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15
Q

What does a pneumothorax look like on US?

A

“Barcode” sign & no movement

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16
Q

If indicated, what X-ray imaging is used for trauma?

A
  • Spine imaging
  • Extremities imaging
  • Head/neck imaging
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17
Q

If indicated, what CT/CTA imaging is used for trauma?

A
  • Facial
  • Cervical spine
  • Chest/abdominopelvic
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18
Q

Labs ordered get during a trauma?

A
  • Type & screen
  • CBC (anemia)
  • CMP (kidney/liver issues)
  • UA (blood)
  • PT/INR, PTT / clotting
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19
Q

Labs ordered as indicated during a trauma?

A
  • EtOH / UDS
  • pregnancy test
  • EKG
  • bedside glucose
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20
Q

What is trauma associated with?

A

significant hemorrhage

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21
Q

__% of trauma pts can develop ___ w/ resultant ____.

A
  • 30%
  • coagulopathy
  • massive hemorrhage
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22
Q

If coagulopathy occurs, how does this affect mortality?

A

increases by 3-4x

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23
Q

Causes of coagulopathy

A
  • Acidosis from poor perfusion
  • Consumption of clotting factors (disseminated intravascular coagulation)
  • Hemodilution from fluids (resuscitation associated coagulopathy)
  • Trauma-induced coagulopathy
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24
Q

In traumatic situations, why would acidosis from poor perfusion cause coagulopathy?

A
  • Can change the ability to clot
  • PROs (clotting factors) denature
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25
Q

Describe a trauma transfusion.

A

1:1:1
- plasma, prbcs, plts vs targeted transfusion vs whole blood

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26
Q

Describe Thromboelastography (TEG) & rotational thromboelastometry (RoTEM).

A
  • Bedside, real time evaluation of clotting
  • Evaluates clot formation time, clot strength & degree of fibrinolysis
  • Protocols being developed to use TEG &/or RoTEM info to guide what to transfuse next
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27
Q

Meds that can cause Poisonings / ODs/Exposures.

A
  • Analgesics – acetaminophen, salicylic acid, NSAIDS
  • Opioids
  • Cardiac meds (BBs, etc)
  • Insulin & oral DM meds
  • Anticoags
  • Antiepileptics
  • Antidepressants – serotonin syndrome
  • Antipsychotics – neuroleptic malignant syndrome
  • Anticholinergics –”red as a beet…”
  • Vitamins/herbals
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28
Q

Illicit drugs that can cause Poisonings / ODs/Exposures.

A
  • Cocaine
  • Heroin
  • Marijuana
  • LSD
  • Methamphetamine
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29
Q

Industrial toxins that can cause Poisonings / ODs/Exposures.

A
  • Asbestos
  • Silicone
  • Pesticides - cholinergics
  • Hydrocarbons, including toluene
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30
Q

Heavy metals that can cause Poisonings / ODs/Exposures.

A

mercury & lead

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31
Q

Metabolic disruptors that can cause Poisonings/ ODs/Exposures.

A

Carbon monoxide & cyanide

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32
Q

NOTE

A

alcohol, methanol & ethanol can cause Poisonings/ODs/Exposures

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33
Q

Serotonin Syndrome S/Sx

A
  • more abrupt
  • myoclonus/tremor
  • mydriasis
  • incr reflexes
  • rapidly resolves
34
Q

Neuroleptic malignant syndrome

A
  • more prolonged
  • tachycardia
  • AMS
  • diffuse muscle rigidity
  • diaphoresis
  • decr reflexes
35
Q

Anticholinergic ODs S/Sx

A
  • tachycardia
  • urinary retention
  • mydriasis
  • agitation
36
Q

Aspirin OD

A

resp alkalosis that turns into metabolic acidosis

37
Q

What diagnostics are needed for a suspected poisonings/ODs?

A
  • Pregnancy test
  • Glucose
  • CMP
  • ABG
  • UA
  • UDS
  • EKG
38
Q

For suspected poisonings/ODs, what are we looking for on CMP?

A
  • renal & liver function
  • electrolyte abnormalities
39
Q

For suspected poisonings/ODs, what are we looking for on ABG?

A
  • Will give carboxyhemoglobin & methemoglobin levels
  • Carboxyhemoglobin–>CO
    Methemoglobin–> industrial solvents, nitrates
  • Many poisonings will cause a metabolic acidosis
40
Q

If acidosis is severe what can be given for treatment?

A

IV sodium bicarb

41
Q

For suspected poisonings/ODs, what are we looking for on UA?

A
  • Evidence of rhabdomyolysis
  • Crystals (ex – ethylene glycol = Ca+ oxalate crystals)
42
Q

What will show up on UA for Rhabdomyolysis?

A
  • myoglobin
  • blood
  • no RBC
43
Q

For suspected poisonings/ODs, what are we looking for on UDS?

A
  • Opioids
  • Barbiturates
  • Cocaine
  • Methamphetamine, etc
44
Q

What opioids are not measure on standard UDS?

A
  • Fentanyl
  • Methadone
  • Tramadol
45
Q

For suspected poisonings/ODs, what are we looking for on EKG?

A

QT prolongation

46
Q

Why do we get a serum osmolality & osmol gap for suspected poisonings/OD?

A

Most helpful if pt is obtunded & it is not clear if there was an OD

47
Q

What is an osmol gap?

A

difference b/t measured osmolality & calculated osmolality

48
Q

Calculated osm formula?

A

(2*Na) + (glucose / 18) + (BUN / 2.8) + (ethanol/4.6)

49
Q

Describe the results when comparing the calc osm vs measured osm.

A

If measured osm – calculated osm is > 10, there is another substance increasing the osmolality

50
Q

Why would there be an elevate osmol gap?

A
  • methanol
  • isopropyl alcohol
  • ethylene glycol, etc.
51
Q

Why do we get a lactate for suspected poisonings/OD?

A

Indicator of perfusion
- usually elevated

52
Q

Why do we get x-rays for suspected poisonings/OD?

A
  • Abdominal–> drug packets
  • Chest–> pneumonitis, pulm edema; ground glass opacities
53
Q

What drug levels can be tested w/ suspected poisonings/OD?

A
  • Acetaminophen *
  • Salicylic acid *
  • Lithium
  • Dilantin
  • Valproic acid
  • Carbamazepine
54
Q

Acetaminophen: measured when? Initial management? Tx?

A
  • Measure levels 4hrs after ingestion if unsure go ahead & order
  • Initial management: suction, activated charcoal
  • Tx: call poison control
55
Q

What metal levels can be tested w/ suspected poisonings/OD?

A

Lead & mercury

56
Q

What other drug can be tested w/ suspected poisonings/OD?

A

Toluene

57
Q

Bio/Chemical terrorism NOTE

A

Rare & unlikely, but need to recognize the possibility

58
Q

What is used in bioterrorism?

A

microorganisms

59
Q

Describe what happens if someone is affected w/ bioterrorism?

A
  • Sx develop over days/wks
  • May or may not know about exposure
60
Q

Describe what happens if someone is affected w/ bioterrorism?

A
  • Sx develop acutely, often after gaseous exposure
61
Q

Which Sx develops faster, bioterrorism or chemoterrorism?

A

chemoterrorism

62
Q

What are the diagnostics for Bioterrorism?

A
  • CBC, CMP
  • Swabs & samples – get guidance from the experts! CDC
    –> Swabs – nasal, skin
    –> Samples – sputum, blood, stool, urine, CSF, BAL
63
Q

Bioterrorism: Category A

A
  • Arenaviruses (Lassa, Junin)
  • Bacillus anthracis (Anthrax)
  • Clostridium botulinum toxin (botulism)
  • Filoviruses (Ebola, Marburg)
  • Francisella tularensis (tularemia)
  • Variola Major (smallpox)
  • Yersinia pestis (plague)
64
Q

Bioterrorism: Category B

A
  • alphaviruses
  • B. pseudomallei (melioidosis )
  • Brucella spp. (brucellosis)
  • Burkholderia mallei (glanders)
  • Chlamydia psittaci (psittacosis)
  • Cryptosporidium parvum
  • Coxiella burnetii (Q fever)
  • E. coli (O157:H7)
  • Epsilon toxin of C. perfringens
  • Ricin toxin
  • Rickettsia prowazekii (typhus fever)
  • Salmonella spp.
  • Shigella dysenteriae
  • Staph enterotoxin B
  • Vibrio cholerae
65
Q

Bioterrorism: Category C

A
  • Hantaviruses
  • Nipah virus
  • Multidrug-resistant TB
  • Tickborne encephalitis viruses
  • Tickborne hemorrhagic fever viruses
  • Yellow Fever
66
Q

What are the categories of chemical terrorism?

A
  • Pulmonary
  • blood
  • nerve
  • vesicant
  • incapacitating
67
Q

Examples of chemical terrorism?

A
  • Sarin
  • “tear gas”
  • mustard gas
  • BZ
  • VX
68
Q

What is included in the diagnostic evaluation for chemical terrorism?

A
  • Clinical toxidrome
  • Supportive testing
    –> ABG
    –> CXR
    –> CBC (daily)
    –> CMP
  • Specific tests – not readily available & results aren’t timely
69
Q

What is required when collecting forensic evidence for sexual assault occurs?

A
  • informed consent & is not mandatory
  • Separate providers in separate areas if both victim & suspect are evaluated
70
Q

What is collected from the sexual assault victim?

A
  • Clothing
  • Any materials used in transport (sheet, blanket, etc)
  • Swabs from cheek, vagina, rectum, areas identified by UV light
  • Combings from scalp & pubic hair
  • Hair samples (pulled)
  • Fingernail clippings & scrapings
  • Blood
  • Saliva
71
Q

What is collected from the sexual assault suspect?

A
  • Hair combings
  • Swabs – wounds, hands, penis
  • Fingernail scrapings/clippings
  • Blood for HIV/Hep B
72
Q

What further diagnostics are needed for sexual assault victim?

A
  • Trauma imaging
  • Screening for HIV, hep B, syphilis, gonorrhea, chlamydia, trichomonas
  • Pregnancy test (depending on timing)
  • Presence of drugs: flunitrazem (Rohypnol), gamma hydroxybutyrate (GHB), etc…
73
Q

A physical abuse workup depends on ___.

A

suspected or evident trauma as well as age of victim

74
Q

What should be done/order when suspect physical abuse in adult/adolescents?

A

Hx/PE guides workup
- X-rays or CT
- CBC, CMP
- Pregnancy test
- If obtunded – CT head

75
Q

What is evidence of abuse?

A
  • Bruising
  • Fractures
  • Burns
  • Any unexplained visceral or intracranial injury
76
Q

What does the evaluation of child abuse include?

A
  • Bruising w/ petechiae
  • Only frax, low suspicion for abuse
  • Visceral injury
  • Neurologic impairment
  • Skeletal survey
  • Retinal evaluation
77
Q

What needs to be evaluated when bruising w/ petechiae is seen? What do you order?

A

evaluate for bleeding disorder:
- CBC,
- PT/INR, PTT

78
Q

What needs to be evaluated when Only frax, low suspicion for abuse is seen ? What do you order?

A

evaluate for bone disorder: Calcium, PTH, phosphorus vitamin D

79
Q

What needs to be evaluated when visceral injury is seen? What do you order?

A

LFTs
- Lipase
- Abdo imaging (CT w/ contrast)

80
Q

What needs to be evaluated when neurologic impairment is seen? What do you order?

A

CT or MRI

81
Q

What a skeletal survey?

A

21 separate xrays to assess frax; mostly used w/ younger children or those w/ developmental or communication issues

Block 4 - Emergency Medicine (4 decks)

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