Course 5 Flashcards
Arterial Blood Gas
Blood taken from an artery
Serum
The clear liquid separated from clotted blood. Serum is also another word for blood
Coagulation
The change of blood from liquid to solid
what does POC stand for ?
Point of care
What are cultures?
The propagation of microorganisms or of living tissue cells in media conducive to their growth
What is Critical care time ?
Any Pt. at serious risk for deterioration that may lead to permanent bodily harm or death
Define Hemolyzed Samples
The blood cells have broken down due to the incorrect drawing and storing of Blood
What does CBC mean?
Complete Blood Count
What does WBC stand for?
White blood cells
What does it mean when the blood contains high levels of WBC?
-This indicates that there is an infection. A key assoc DDx is Leukocytosis
What does Hgb stand for
Hemoglobin
When there are low amounts of hemoglobin in the blood what does this mean?
Anemia
What does Hct stand for?
Hematocrit
What does it means when there are low levels of hematocrit?
anemia
If the doctor puts in a lab work order for H&H what does this mean?
Hemoglobin and Hematocrit
What does Plt stand for?
Platelets
What does it mean when the platelets count is low?
The Pt. is prone to bleeding and might have Thrombocytopenia.
Which DDx has low platelets count is associated with?
Thrombocytopenia
Which DDx has high white blood cellc count?
Leukocytosis
The physician puts in a lab order for CBC. What does this lab order entail?
It entails find the count for:
- WBC
- Plts
- Hgb
- Hct
What are band cells?
Immature Neutrophil
What is another way of saying the Band cells are high?
Bandemia
When the band cells are high what does this indicate?
A serious infection
What does Seg stand for ?
Mature neutrophils also referred to as Segmented Neutrophils
When the levels of segmented neutrophils are high what does this indicate?
An acute infection
What does Monos stand for?
Monocytes
What does high leves of Monocytes indicate?
bacterial infection
What does Lymph stand for?
Lymphocytes
What type of infection high levels of Lymphocytes indicate?
Viral infection
What does Eos stand for?
Eosinophils
What type of infection does high levels of Eosinophils indicate?
Parasitic infection
The physician puts in an order for CBC with Differentials what does this mean?
The order is requesting to check the levels of: -WBC -Plts -Hgb -Hct in addition to: -Band cell -Segs -Lymphs = viral infection -Monos = bacterial infection -Eos =parasitic infection
What does BMP stand for?
Basic Metabolic Panel
What is the term for low sodium?
Hyponatremia
What is the term for high sodium?
Hypernatremia
What does it mean when the levels of sodium is too high or low?
Dehydration
What is the term for high potassium?
Hyperkalemia
What does hyperkalemia indicates?
Poor kidney function
What does the term for low potassium mean?
Hypokalemia
What does hypokalemia indicate?
May cause arrhythmias
Which labs can signify dehydration?
Chloride and Sodium
What does BUN stand for?
Blood Urea Nitrogen
What do high levels for blood urea nitrogen signify?
Renal insufficiency or failure
Where is Creatinine filtered out of the body?
Kidneys
So if there are high levels in the blood then the kidneys aren’t working properly
Which labs can signify renal failure or insufficiency?
Creatinine and Blood Urea Nitrogen
What does Gluc stand for?
Glucose
What is the term for high levels of glucose?
Hyperglycemia
What does hyperglycemia signify?
High blood sugar
What is the term for low glucose?
Hypoglycemia
What does hypoglycemia indicate?
Low blood sugar
What does HCO3- stand for?
Bicarbonate
What is the term for high HCO3?
Hypercarbia
What is the significance of hypercarbia?
Possible respiratory disease
What is the term for low HCO3?
Hypocarbia
What is the significance of hypocarbia?
Hyperventilation (Possible DKA)
What is the term for high chloride?
Hyperchloremia
What is the term for low chloride?
Hypochloremia
The physician puts in a BMP order. What does this order entail?
-BMP stands for Basic Metabolic Panel It entails testing for : -Na -Cl- -BUN -K -HCO3- -Creat -Gluc
What does LFT’s stand for?
Liver Function Test
The LFT’s is apart of which set of tests?
CMP
What are the 3 LFTs? What do they assess?
They all test for liver function AST (SGOT) --Aspartate Transaminase ALT (SGPT) --Alanine Transaminase ALK Phos --Alkaline Phosphatase
What does AST stand for?
Aspartate Transaminase
What does ALT stand for?
Alanine Transaminase
What does Alk Phos stand for?
Alkaline Phosphatase
What does CMP stand for?
Comprehensive Metabolic Panel
What does the CMP include?
The 3 LFT’s and
T bili = Total Bilirubin
T Prot/Alb = Total protein/albumin
What does low T Prot/Alb signify?
Poor Nutrition
What does high T bili signify?
Jaundice/Liver failure
What are the labs in the CEP?
When these levels are high they indicate heart damage
Trop = Troponin
CK= Creatine Kinase
CK- MB = Creatine Kinase- Muscle Breakdown
CK-RI = Creatine Kinase Relative Index
Myo = Myoglobin
Define Rhabdomyolysis
s the breakdown of damaged skeletal muscle. Muscle breakdown causes the release of myoglobin into the bloodstream.
A symptom of high Creatine Kinase (CK)
What does a troponin diagnose? (be as specific as possible):
Non-STEMI Myocardial Infractions
What does a D-dimer detect?
Helps to detect clots in the body but does not specify the type of location
The amount of D-Dimer circulating in the body
What is D-Dimer ?
a protein secreted by clots of blood
If a D-dimer is possible what is the significance?
If the Physician orders a D-Dimer. She is considering PE as a DDx
If the D-dimer is positive what must we order to r/o a PE?
CTA chest (with IV contrast) or a VQ scan
If the D-dimer is negative what can be excluded from the DDx?
PE
What lab is significant for CHF if it is elevated?
BNP
B-type Natriuretic Peptide
What does the ABG (Arterial Blood Gas) check for?
Low pH = Acidosis
High/Low HCO3 = Metabolic problems
High/Low pCO2 (carbon dioxide) = Respiratory problems
Low pO2 = Hypoxia
What does the VBG (Venous Blood Gas) check for?
1) Low pH = Acidosis
2) High pH = Alkalosis
What is the cardiac order set?
CBC BMP Troponin EKG CXR
A lumbar puncture can diagnose:
Hemorrhagic Cerebrovascular Accident
—-If the CSF red blood cells are >0 in tube 4 then its a brain bleed
Meningitis
—If the CSF white blood cells are >3 in tube 4 then it’s possible meningitis
Supratherapeutic means:
Too much Coumadin
Subtherapeutic means:
Not enough Coumadin
We check INR because:
Is used to check the levels of Coumadin in the blood. Coumadin is a blood thinner giving to Pt. with Afib.
What does COAGS stand for?
Coagulation
What is a Normal INR
For Pt. that are not on Coumadin, they have an INR of 1.0
What does INR stand for?
International Normalized Ratio
If a provider says: I am going to check the enzymes in your pancreas… what will they order?
1) Lip = Lipsae is only found in the Pancreas
2) Amy= Amylase is found in both the pancreas and saliva
If a pt had a serum HCG quant that was 500 yesterday, but today it is 300… what do you think is happening?
A failed or ectopic pregnancy
Nitrites and Leukocyte Esterase are part of what order? What are their significance?
Urine Dip. They test for UTIs
Name 3 sepsis labs:
Blood Cx
Lactate
Complete Blood Count
Name the 3 abnormal vitals of septic patients:
-Febrile: temp greater than 100.5 degree F or 38.0 degrees Celsius
Tachycardic: HR greater than 100 bpm
Hypotensive : BP less than 90/60
A positive Rapid Step Test indicates?
Strep Throat
A positive Mononucleosis Test indicates?
Mononucleosis
A positive influenza A + B test indicates ?
“The Flu”
A positive Respiratory Syncytial Virus test (RSV) indicates?
Bronchiolitis
High levels of Lipase indicates Pancreatitis while high levels of Amylase indicates the possibility of Pancreatitis. Why?
Lipase is only found in the pancreas so high levels of this would indicate Pancreatitis. While Amylase is found in both the saliva and the pancreas so its hard to be confident that high levels of amylase mean pancreatitis
What does TSH stand for?
Thyroid Stimulating Hormone
What is the term for High levels of Thyroid Stimulating Hormone (TSH)? note: think carefully about this one.
Hypothyroidism
What is the term for low Thyroid Stimulating Hormone (TSH)? note: think carefully about this one.
Hyperthyroidism
Low levels of T3 (Triiodothronine) signify?
Hypothyroidism
Low levels of T4 (Thyroxine) signify?
Hypothyroidism
What are the inflammation labs?
CRP : C-Reactive Protein
ESR or Sed Rate: Erythrocyte Sedimentation Rate
What does CRP stand for?
C-Reactive Protein
What does ESR or Sed Rate stand for?
Erythrocyte Sedimentation Rate
State the significance of a Positive and negative HCG ?
Positive HCG in Urine indicates pregnancy
Negative HCG in urine indicates no pregnancy
What does T + S/ABORh mean?
Type and Screen/Blood Type
What does Rh negative of a T + S/ABORh indicates ?
Pt. needs RhoGam shot is pregnant
What is the purpose of the T + X ?
Gets blood ready for transfusion
What is the significance of a Wet Prep (Vaginal Wet Mount)?
Test for Bacterial Vaginosis (BV)
- Trichomoniasis (STD)
- Vaginal Yeast Infection
Wet Prep is done in the ED
What 3 labs are known as the rate limiting step?
D-Dimer
Troponin
Creatinine
What is the significance of Chlamydia Trachomatis?
It test for Chlamydia (STD)
Not done in the ED
What is the significance of GC (Gonococcus)?
Test for Gonorrhea (STD)
Not done in the ED
What does positive Gluc in the urine indicates?
High Blood Sugar and could mean the Pt. has DM
What does Gylcosuria mean?
Glucose in Urine
What is the significance of hematuria ?
Kidney stone Vs. UTI
If Epi (Epithelial cells) are found in the urine sample, what does the mean?
Contaminated sample
What does pyuria mean?
Pus in urine
If a Pt. is found to have sepsis, what lab test can you anticipate them ordering and why?
- CXR to r/o PNA
- UA to r/o UTI
- LP to r/o Meningitis
List the 4 types that is typically ordered.
- BCx (Blood Culture)—Sepsis
- UCx– Urine Culture —UTI
- Wound Cx–wound culture
- Stool Cx–Stool Culture
What lab checks for toxicity for Aspirin?
ASA
Serum Acetysalicylic Acid
What lab checks for toxicity for Tylenol?
APAP
Serum Acetaminophen
What would signify likely DKA?
Large amounts of Ketones in the blood (Ketones serum)
What lab checks for toxicity for alcohol intoxication?
EtOH
Serum EtOH Alcohol
What lab checks for toxicity for Drug abuse?
Utox
Urine Drug Screen
What is a Portable XR?
XR that are conducted at the Pt bedside. It is brought to the Pt.
List the critical care procedures.
Headache fever- Lumbar Puncture Joint reduction -Procedural Sedation Respiratory failure -Intubation Sepsis- Central Line Placement Pneumothorax- Chest Tube Abnormal heart rhythm- Cardioversion Cardiac Arrest-CPR COPD/CHF Exacerbation CPAP/BiPAP
What does Low levels of INR mean ?
Subthrapeutic; risk of clots
What does high levels of coumadin indicate?
supratherapeutic risk for toxicity
What is the risk of having low levels of Digoxin?
risk for having Afib
What is the risk of having high levels of Digoxin?
risk for toxicity
List the four medications that can result in seizure at low levels?
-Tegretol
-Keppra
Depakote
-Neurontin
What can a CXR diagnose?
PNA PTX Widened Mediastinum (dissection) Pleural effeusion CHF
What can an AAS/KUB diagnose?
Free Air (Rupture)
SBO
Constipation
Large kidney stones
What does AAS/KUB stand for ?
Acute Abdominal Series/Kidney Ureters Bladder
All other X-rays can diagnose?
Fracture
Dislocation
Joint effusion
X-rays are great for evaluating what?
Bones in the body
What can a “dry CT” diagnose?
CT Head : Ischemic CVA or Hemorrhagic
CT Cervical-spine, Thoracic-spine, lumbar spine
CT Chest: PNA, PTX, Pleural Effusion, Rib fracture
CT A/P: Kidney Stones, Pyelonephritis
What does a Dry CT refer to?
CT w/o IV contrast
What can a CTA w/ IV contrast diagnose?
CTA chest: Pulmonary Embolism, Aortic Dissection
CTA Head: Hemorrhagic CVA. Ischemic CVA
CTA Neck: Carotid Dissection, Carotid Occlusion
CT A/P with PO contrast: (This requires a 2 hour prep!) this can diagnose what?
Appendicitis, SBO, Diverticulitis, Ischemic Gut
what is the catch with CT’s with IV contrast? There is a lab that needs to be done…why?
Contrast is hazardous to kidney but gives great images.
To ensure that the Pt. is able to do a CTA w/ Iv contrast we check their renal function using the Creatinine test from BMP
What does US Doopler LE diagnose?
Deep Venous Thrombosis (DVT)
What does US RUQ diagnose?
Cholelithiasis, Cholecystitis, Bile sludge, Gallbladder wall thickening, Bile duct obstruction
What does US Obstetrics/Transvaginal diagnose?
Intrauterine Pregnancy (IUP) Ectopic Pregnancy Ovarian Cyst. Ovarian Torsion
What does US Scrotum diagnose?
Testicular Torsion. Testicular mass
Ultrasounds are great for evaluating what?
Investigative the flow by providing real time images
What procedure would be conducted for a joint injury?
Splint Application
A dislocation would call for what kind of procedure?
Joint reduction
A joint effusion would call for what kind of procedure?
Arthrocentesis
What procedure would be done on a laceration and what information should we document about the laceration?
- Laceration repair would be conducted
- –Key information to record: location, length and depth of the laceration. In addition to what caused the laceration
What procedure would be done on an abscess?
Incision & drainage
What procedure would be done on a meningitis or hemorrhage?
Lumbar puncture
-require a sterile environment, betadine prep and local anesthesia with 1% Lido
Which Pt. would get bedside US?
Trauma, Suspected acute disease or Ultrasound-guided procedure
What preparations are required for a conscious sedation procedure?
Suction at bedside.
Pt on cardiac monitor and continuous pulse oximetry.
Why would a pt. get an endotracheal intubation?
If the Pt. experience respiratory failure. Airway control
What preparation are need for a endotracheal intubation?
Suction at bedside.
Consent precluded by clinical urgency
What preparation are needed for a Central Line Placement?
Sterile field, chlorhexidine prep, local anesthesia 1% lidocaine
Why would a Pt. need a central line placement?
For intravenous access for abx or fluid resuscitation
Where are the 3 major sites for central line placement?
Internal Jugular
Subclavian
Femoral
Would would need a chest tube placement?
Pt. with PTX or Hemothorax(blood in lungs)
Who would need a cardioversion?
Pt. with Atrial fib or abnormal rhythm
What is the difference between an electronic cardioversion and a pharmacologic cardioversion?
electronic cardioversion sends an electrical shock to the heart to adjust the abnormal rhythm
Pharmacologic cardioversion is giving a medication to fix the heart’s abnormal rhythm
When would a physician order a 12 lead-EKG?
If a Pt. complains of chest pain, SOB or syncope
What are the two questions we should ask the provider about critical care time?
1) Does this Patient qualify for critical care?
2) How many mins of critical care time were provided?
What is the min amount of critical care time given?
30 mins
What are the reasons for re-evaluations?
1) discharged
2) Admitted
3) abnormal vital signs
4) physical exam finding
5) treatment was effective
What are the 3 reasons for consultations?
1) the Ed doctors needs to admit a pt. to the hospital
2) the ed doctor needs specialist advice regarding a particular disease, treatment or need for follow up
3) the ed doctor calls the patient’s PCP to inform them their pt. was evaluated in the ED
What are the critical care procedures?
Intubation---respiratory failure Central line placement--sepsis chest tube- PTX Cardioversion---abnormal heart rhythm CPR--cardiac arrest CPAP/BiPAP--COPD/CHF Exacerbation