Course 5: ED course Flashcards
1
Q
CBC
A
Complete Blood Count
2
Q
WBC
A
White blood cells
Abnormal level:
High (Leukocytosis)
Infection
3
Q
Hgb
A
Hemoglobin
Abnormal level:
Low
Anemia
4
Q
Hct
A
Hematocrit
Abnormal level:
Low
Anemia
5
Q
Plt
A
Platelets
Abnormal level:
Low (Thrombocytopenia)
Prone to bleeding
6
Q
Differential
A
CBC with Diff
7
Q
Bands
A
Band Cells
Abnormal level:
High (Bandemia)
Serious infection
8
Q
Segs
A
Segmented Neutrophils
Abnormal level:
High (Left Shift)
Acute infection
9
Q
Lymphs
A
Lymphocytes
Abnormal level:
High
Viral infection
10
Q
Monos
A
Monocytes
Abnormal level:
High
Bacterial infection
11
Q
Eos
A
Eosinophils
Abnormal level:
High
Parasitic infection
12
Q
BMP
A
Basic Metabolic Panel,, Chem -7
13
Q
Na
A
High (hypernatremia)
Low (hyponatremia)
Dehydration (both)
14
Q
K
A
High (hyperkalemia)
Poor kidney function
Low (hypokalemia)
May cause arrhythmia
15
Q
BUN
A
Blood Urea Nitrogen
High
Renal insufficiency or failure
16
Q
Creat
A
Creatinine
High
Renal insufficiency or failure
17
Q
Gluc
A
Glucose High (hyperglycemia) High blood sugar Low (hypoglycemia) Low blood sugar
18
Q
HCO3-
A
Bicarbonate High (hypercarbia) Possible respiratory disease Low (hypocarbia) Hyperventilation (Possible DKA)
19
Q
Cl-
A
High (hyperchloremia)
Possible dehydration
20
Q
CMP
A
Comprehensive Metabolic Panel, Chem12
21
Q
T Prot/Alb
A
Total Protein/Albumin
Low
Poor nutrition
22
Q
T bili
A
Total bilirubin
High
Jaundice/liver failure
23
Q
AST (SGOT)
A
Aspartate Transaminase
High
Liver damage
24
Q
Alk Phos
A
Alkaline Phosphatase
High
Liver damage
25
ALT (SGPT)
Alanine Transaminase
High
Liver damage
26
Liver function tests
- AST (SGOT)
- ALT (SGPT)
- Alk Phos
27
CEP
Cardiac Enzyme Panel
28
Trop
Troponin
High
Specific to heart damage
29
CK
Creatine Kinase
High
Hear damage or Rhabdomyolysis
30
CK-MB
Creatine Kinase-Muscle Breakdown
High
Heart damage
31
CK-RI
Creatine Kinase Relative Index
High
Heart damage
32
Myo
Myoglobin
High
Heart damage
33
D-Dimer
Positive:
means there is a blood clot somewhere, not necessarily PE, follow up with a CTA Chest or VQ scan
Negative:
PE can be excluded from DDx
34
BNP
B-Type Natriuretic Peptide
High
CHF
35
ABG
```
Arterial Blood Gas
Low pH
Acidosis
High/Low HCO3
Metabolic problem
High/Low pCO2
Respiratory problems
Low pO2
Hypoxia
```
36
VBG
```
Venous Blood Gas
Low pH
Acidosis
High pH
Alkalosis
```
37
Cardiac Order Set
- CBC
- BMP
- CK, CK-MB
- Troponin
- EKG
- CXR
38
CSF Analysis
Cerebrospinal Fluid Micro Analysis
39
CSF Gluc
Cerebrospinal Fluid Glucose
Low
Possible bacterial meningitis
40
CSF Prot
Cerebrospinal Fluid Protein
High
Possible Meningitis
41
CSF RBC
Cerebrospinal Fluid Red Blood Cells
>0 in Tube 4
Subarachnoid Hemorrhage (brain bleed)
42
CSF WBC
Cerebrospinal Fluid White Blood Cells
>3 in Tube 4
Possible Meningitis
43
CSF Gram Stain
Cerebrospinal Fluid Gram Stain
Positive bacteria
Likely bacterial Meningitis
44
COAGS
Coagulation Studies, Coumadin Level
45
PT
Prothrombin Time
High
Blood is too thin
46
INR
International Normalized Ratio
>3.0 (Supertherapeutic)
Too much Coumadin
47
PTT
Partial Thromboplastin Time
High
Blood is too thin
48
PT/INR
They are the same test, different representation of the results.
49
ENT labs
Ears, Nose and Throat Labs
50
Strep
Strep Rapid Strep Test
Positive
Strep Throat
51
Monospot
Mononucleosis test
Positive
Mononucleosis
52
Influenza A + B
Positive
| "The FLu"
53
RSV
Respiratory Syncytial Virus
Positive
Likely Bronchitis
54
Lip
Lipase
High
Specific to pancreatitis
(the pancreas is the only organ that releases these enzyme)
55
Amy
Amylase
High
Possible pancreatitis
(the pancreas is not the only organ that releases this enzyme)
56
TSH
```
Thyroid Stimulating Hormone
High
Possible hypothyroidism
Low
Possible hyperthyroidism
```
57
T3
Triiodothyronine
Low
Hypothyroidism
58
T4
Thyroxine
Low
Hypothyroidism
59
CRP
C-Reactive Protein
High
Active inflammation in the body
60
ESR or Sed Rate
Erythrocyte Sedimentation Rate
High
Active inflammation in the body
61
HCG
```
Urine betaHCG
Positive
Pregnant
Negative
Not pregnant
```
62
Serum HCG Qual
```
Serum beta-HCG Qualitative
Positive
Pregnant
Negative
Not pregnant
```
63
Serum HCG Quant
```
Serum beta-HCG Quantitative
Higher
Further along in pregnancy
Unchanged/lower
Failed pregnancy
```
64
T+S/ABORh
Type and Screen/ Blood Type
- Rh Negative
- Needs RhoGAM shot if pregnant
65
T+X
Type and Cross
- Gets blood ready for transfusion
- Possible blood transfusion
66
Wet Prep
Vaginal Wet Mount
- Many Clue Cells
- Bacterial Vaginosis (BV)
- Many Trichomonas
- Trichomonas (STD)
- Many Yeast
- Vaginal Yeast infection
67
GC
Gonococcus
Positive
Gonorrhea (STD)
68
CT
Chlamydia Trachomatis
- Positiive
- Chlamydia (STD)
69
Genital Cx
Genital Culture
- Positive growth
- Pending results: ED will call pt if Cx is positive
70
Urine dip
Qualitative Urinalysis
71
Leuks
Leukocyte Esterase
- Positive
- Likely UTI
72
Nit
Nitrite
- Positive
- UTI
73
Gluc
Glucose
- Positive (Glycosuria)
- UTI
74
Blo
Blood
- Positive (Hematuria)
- Kidney stone vs. UTI
75
Microscopic Urinalysis
Quantitative Microscopic Urinalysis
76
WBC- Urinalysis
White Blood Cells in urine
- >6 (Pyuria)
- UTI
77
RBC- Urinalysis
Red blood cells in urine
- >6 (Hematuria)
- UTI vs.kidney stone
78
Bact- Urinalysis
Bacteria
- Many
- UTI
79
Epi- Urinalysis
Epithelial cells
- Many
- Contaminated sample
80
CBC
-High WBC (Leukocytosis)
High Bands (Bandemia)
-Possible
81
Lactate
Lactic Acid
- High
- Sepsis or cell death in the body
82
Blood Cx
- Positive Growth
| - Definitive sepsis
83
BCx
Blood Culture
- Positive growth
- Sepsis
84
UCx
Urine Culture
- Positive growth
- UTI
85
Wound Cx
Wound culture
| -results pending
86
Stool Cx
Stool Culture
| -results pending
87
ASA
Serum Acetylsalicylic Acid
- High
- Toxic ASA level
88
APAP
Serum Acetaminophen
- High
- Toxic tylenol level
89
EtOH
Serum Ethanol, alcohol
- High
- Alcohol intoxication
90
UTox
Urine Drug Screen
- Positive for Opiates, Cannabinoids, Cocaine, Methamphetamines, PCP
- Drug Abuse
91
Ketones
Serum Ketones
- Large
- Likely DKA
92
Accu-Chek
Finger-Stick Blood Glucose (FSBG)
-Less than 80 mg
more than 110mg
-Low or high blood sugar
93
Dilantin
Serum Phenytoin
- Low
- Subtherapeutic; at risk for Sz
94
INR
Coumadin level
- Low
- Subtherapeutic; at risk for clots
- High
- Supertherapeutic; risk for bleed
95
Dig
Digoxin
- Low
- Subtherapeutic; at risk for Afib
96
Tegretol
Serum Carbamazepine
- Low
- Subtherapeutic; at risk for Sz
97
Keppra
Serum Keppra
- Low
- Subtherapeutic; at risk for Sz
98
Depakote
Serum Valproic Acid
- Low
- Subtherapeutic; at risk for Sz
99
Neurontin
Serum Gabapentin
- Low
- Subtherapeutic; at risk for Sz
100
D-Dim
D-Dimer
- High
- Must order CTA Chest or VQ Scan (first need Creatin from BMP before CTA)
101
Trop
Troponin
- High
- Acute MI: give ASA, NTG, beta-Blocker, Heparin
102
Creat
Creatinine (from the BMP)
- >1.4
- Assesses kidney function. Creatinine must be obtained prior to ordering any CT with IV contrast due to IV contrast stressing the kidneys. Any pt with a Creatinine > 1.4 cannot receive IV contrast.
103
Obtaining a Serum (Blood) Lab Result
1. The lab order is placed by a physician
2. The nurse draws the blood into specific vials used for each lab study
3. The tubes are placed in plastic bags, and delivered to lab
4. The lab tech runs the samples through analysis machines
5. After the machine produces the results the lab tech loads the results into an electronic system, making the results available to view.
104
Hemolyzed sample
The blood cells have broken down, which may skew some results of the blood sample. If a sample is hemolyzed the nurse must often "re-draw" the blood and send another sample to lab. Alert your physician as soon as possible if a blood sample ever results as "hemolyzed".
105
CBC w/ Diff- assesses:
Infection (WBC) or anemia (Hgb + Hct = H&H)
106
BMP assesses:
Electrolytes (Na + K), renal function (BUN + Creat), glucose
107
CMP assesses:
BMP + LFT's (liver function)
108
Trop assesses:
Acute MI (if high)
109
uDrip + UA assesses:
UTI or blood (possible kidney stone)
110
BNP assesses:
Acute CHF (if high)
111
Coags assesses:
Risk for bleeding (if high)
112
ABG assesses:
Respiratory function (hypoxia?)
113
D-Dimer assesses:
Possible blood clot (if high, need Creat for CTA Chest)
114
CBC tests:
1. WBC
2. Hgb
3. Hctt
4. Plt
115
Differential tests:
1. CBC
2. Bands
3. Segs
4. Lymphs
5. Monos
6. Eos
116
BMP tests:
1. Na
2. K
3. BUN
4. Creat
5. Gluc
6. HCO3-
7. Cl-
117
CMP tests:
1. BMP
2. T Prot/Alb
3. T bili
4. AST (SGOT)
5. ALT (SGPT)
6. Alk Phos
118
CEP tests:
1. Trop
2. CK
3. CK-MB
4. CK-RI
5. Myo
119
Respiratory labs:
1. BNP
2. ABG
3. VBG
120
CSF Analysis:
1. CSF Gluc
2. CSF Prot
3. CSF RBC
4. CSF WBC
5. CSF Gram Stain
- Typically four tubes of CSF are collected during LP
- If it is only abnormal for two tube=contamination
- If abnormal on all four, then it's valid.
121
Coags tests:
1. PT
2. INR
3. PTT
INR=0 any pt not on Coumadin and should not be 1 for pts on Coumadin
122
ENT labs:
1. Strep
2. Monospot
3. Influenza A + B
4. RSV
123
Pancreatic enzymes:
1. Lip
| 2. Amy
124
Thyroid labs:
1. TSH
2. T3
3. T4
125
Inflammation labs:
1. CRP
| 2. ESR or Sed Rate
126
Ob/Gyn labs:
1. HCG
2. Serum HCG Qual
3. Serum HCG Quant
4. T + S/ABORh
5. T + X
127
Pelvic Exam Labs:
1. Wet Prep
2. GC
3. CT
4. Genital Cx
128
Urine Dip Tests:
1. Leuks
2. Nit
3. Gluc
4. Blo
129
Microscopic Urinalysis Tests:
1. WBC
2. RBC
3. Bact
4. Epi
130
Sepsis Labs:
1. CBC
2. Lactate
3. Blood Cx
- Anticipate ordering a CXR (r/o PNA), UA (r/o UTI), and even possibly an LP (r/o meningitis)
- Blood Cx will also be ordered to diagnose the type of sepsis, and what Abx the bacteria is sensitive to.
131
Cx:
1. BCx
2. UCx
3. Wound Cx
4. Stool Cx
132
Toxicology Labs:
1. ASA
2. APAP
3. EtOH
4. UTox
133
Diabetes Labs:
1. Ketones
| 2. Accu-Chek
134
Medication Levels:
1. Dilantin
2. INR
3. Dig
4. Tegretol
5. Keppra
6. Depakote
7. Neurontin
135
Three Key labs for efficiency:
1. D-Dimer
2. Troponin
3. Creatinine (from the BMP)
136
Urine Dip timing:
1-15 min
137
uHCG timing:
1-15 min
138
CBC timing:
15-30 min
139
BMP/CMMP timing:
20-40 min
140
Trop/CK/CKMB timing:
25-40 min
141
D-Dimer timing:
30-60 min
142
Urinalysis/Micro UA
45-60 min
143
Obtaining imaging results:
1. Imaging order is placed by a physician
2. A transport tech (or radiology tech) comes to get the pt and takes them to the XR, CT, or US room
3. The study is performed
4. The films (pictures) are loaded into PACS and become available to view.
5. A physician views and interprets the films (Preliminary read vs. Final read)
144
PACS
Picture Archiving and Communication
145
X-Rays
1. CXR
| 2. AAS/KUB
146
CXR findings:
1. PNA
2. PTX
3. Widened mediastinum (dissection)
4. Pleural effusion
5. CHF
147
AAS/KUB findings:
1. Free air (rupture)
2. SBO
3. Constipation
4. Large kidney stones
148
AAS
Acute Abdominal Series
149
KUB
Kidneys Ureters Bladder
150
All other X-Rays
1. Fx
2. Dislocation
3. Joint effusion
151
CT w/o
CT without IV Contrast "Dry CT"
152
CTA
CT Angiogram
153
CT A/P w/ PO
CT abd/Pelvis with PO Contrast
154
CT Scans:
1. CT w/o
2. CTA, CT w/
3. CT A/P w/ PO
155
CT w/o: CT Head findings
Large hemorrhagic or ishcemic CVA
156
CT w/o: CT C-Spine/T-Spine/L-Spine findings
Fracture or subluxation (partial dislocation)
157
CT w/o: CT Chest findings
1. PNA
2. PTX
3. Pleural effusion
4. Rib fracture
158
CT w/o: CT Abd/Pel findings
1. Kidney Stones
| 2. Pyelonephritis
159
CTA, CT w/: CTA Chest findings
1. PE
| 2. Aortic Dissection
160
CTA, CT w/: CTA Head findings
1. Hemorrhagic CVA
| 2. Ischemic CVA
161
CTA, CT w/: CTA Neck findings
1. Appendicitis
2. SBO
3. Diverticulitis
4. Ischemic Gut
162
US Doppler LE
Ultrasound Doppler Lower Extremities
| -DVT
163
US RUQ
Abdominal Ultrasound of RUQ
- Cholelithiasis
- Cholecystitis
- Bile sludge
- Gallbladder wall thickening
- Bile duct obstruction
164
US OB/Transvag/Pelvis
Ultrasound Obstetrics/Transvaginal
- IUP
- Ectopic pregnancy
- Ovarian cyst
- Ovarian Torsion
165
US Scrotum
- Testicular torsion
| - Testicular mass
166
US scans:
1. US Doppler LE
2. US RUQ
3. US OB/Transvag/Pelvis
4. US Scrotum
167
Portable XR timing:
10-30 min
168
XR timing:
1 hr or less
169
CT w/o contrast timing:
45 min- 1.5 hrs
170
CTA timing:
1-2.5 hrs
171
US timing:
1-3 hrs
172
CT w/ PO
2-4 hrs
173
Orthopedic Procedures:
1. Splint Application
2. Joint Reduction
3. Arthrocentesis
174
Skin Procedures:
1. Laceration Repair
| 2. I&D
175
Lumbar Puncture:
Sterile field and technique. Betadine prep. Local anesthesia with 1% Lido.
176
Bedside US:
Ultrasound to bedside, pt positioned
177
Conscious Sedation:
Suction at bedside. Pt on cardiac monitor and continuous pulse oximetry. RT at bedside.
178
Endotracheal Intubation:
Suction at bedside. Consent precluded by clinical urgency.
179
Central Line Placement:
Sterile field. Chlorhexidine prep. Local anesthesia 1% Lidocaine
180
Chest Tube Placement:
Sterile field. Betadine prep. Consent precluded by clinical urgency
181
Cardioversion:
Conscious sedation. Attached to cardiac monitor and pulse oximetry.
182
Low Acuity Procedures:
1. Splint/Sling Application
2. Laceration Repair
3. I&D
4. Foreign Body Removal
5. Cerumen Disimpaction
6. Rectal Disimpaction
7. Nail Trephination
8. Epistaxis Management
183
Splint/Sling Application:
Document:
| Distal CSMT intact
184
Laceration Repair
Document:
| Good closure and hemostasis
185
Incision and Drainage
Document:
| Amount of type of purulence obtained
186
Foreign Body Removal
Document:
| Technique of removal, description of object removed
187
Cerumen Disimpaction
Document:
| Tools used and total time spent
188
Rectal Disimpact
Document:
| Impaction resolved, symptoms improved
189
Nail Trephination
Document:
| Distal CSMT intact
190
Epistaxis Management
Document:
| Good hemostasis
191
12-LEAD EKG
For any pt with complaints of CP, SOB, or syncope
192
EKG: Rhythm:
- NSR
- SB
- ST
- A Fib
- A flutter
- Paced
- SVT
193
EKG: Ectopy
- PVC
| - PAC
194
EKG: Axis
- LAD
- RAD
- LAFB
195
EKG: Intervals
- Prolonged PR
- Prolonged QT
- LBBB
- RBBB
- 1 degree AVB
196
SB
Sinus Bradycardia
197
ST
Sinus Tachycardia
198
A flutter
Atrial Flutter
199
Paced
Pacemaker is functioning
200
SVT
Supraventricular Tachycardia
201
PVC
Premature Ventricular Contraction
202
PAC
Premature Atrial Contraction
203
LAD
Left Axis Deviation
204
RAD
Right Axis Deviation
205
LAFB
Left Anterior Fascicular Block
206
LBBB
Left Bundle Branch Block
207
RBBB
Right Bundle Branch Block
208
1 degree AVD
First Degree AV Block (2 and 3 degree)
209
EKG Leads
- I
- II
- III
- aVR
- aVL
- aVF
- V1
- V2
- V3
- V4
- V5
- V6
210
EKG documentation:
Must have a rate, rhythm and at least two other findings in order for the physician to be reimbursed for their interpretations
211
Doctor says:
| "normal EKG at 80 (bpm)"
Document:
| NSR at a rate of 80bpm, no acute ST/T changes
212
Doctor says:
| sinus at 72 (between 60 and 100bpm)
Document:
| Normal sinus rhythm at a rate of 72 bpm
213
Doctor says:
| Sinus at 114 (greater than 100)
Document:
| Sinus tachycardia at a rate of 114 bpm
214
Doctor says:
| Sinus at 56 (less than 60bpm)
Document:
| Sinus bradychardia at a rate of 56 bpm
215
Doctor says:
| Sinus braddy
Document:
| Sinus bradycardia
216
Doctor says:
| Sinus tachy
Document:
| Sinus tachycardia
217
Doctor says:
| Left bundle
Document:
| LBBB
218
Doctor says:
| Right bundle
Document:
| RBBB
219
Doctor says:
| left axis
Document:
| LAD
220
Doctor says:
| nothing acute
Document:
| No acute ST/T changes
221
Doctor says:
| non-specific changes
Document:
| Non-specific ST/ changes
222
Doctor says:
| Lead one, Lead two, or Lead three
Document:
| Lead I, Lead II, or Lead III
223
Doctor says:
| V one, V two, or V three
Document:
| V1, V2, V3
224
Critical Care
Care provided to any pt that is at serious risk for deterioration that may lead to permanent bodily harm or death.
225
Critical Care Billing levels:
- 30-74min
- 75-119min
- 120+ min
226
Critical Care Diagnoses
- Acute MI
- Unstable Angina
- ACS
- A-Fib with RVR
- Aortic Dissection
- Bowel Perforation
- Appendicitis with rupture
- Ectopic Pregnancy
- Severe GI Bleed
- Severe AMS
- Acute CVA
- OD
- DKA
- Acute CHF
- Acute COPD Exacerbation
- Severe Hypoxia
- Allergic Reaction
- Pneumothorax
- PE
- Sepsis
- Severe Trauma
- Critically Abnormal Lab Test Results
- Renal Failure
- Rhabdomyolysis
- Severe dehydration
227
ACS
Acute Coronary Syndrome
228
Critical care procedure:
| Intubation
Associated Diagnosis
| Respiratory failure
229
Critical care procedure: central line placement
Associated diagnosis:
| Sepsis
230
Critical care procedure: chest tube
Associated diagnosis:
| PTX
231
Critical care procedure: cardioversion
Associated diagnosis:
| Abnormal heart rhythm
232
Critical care procedure: CPR
Associated diagnosis:
| Cardiac arrest
233
Critical care procedure: CPAP/BiPAP
Associated diagnosis:
| COPD/CHF Exacerbation
234
Consultations 3 reasons
1. The ED doctor 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 pts PCP to inform them their pt was evaluated in the ED.
235
Re-evaluations 5 reasons
1. The pt is about to be discharged and doctor needs to share discharge instructions, ensure the pt's Sx improved and is ready for discharge
2. The pt is about to be admitted and the doctor needs to update the pt on the plan to admit, and check on the pt's Sx and status.
3. The pt needs abnormal vital signs re-checked
4. A particular physical exam finding needs to be re-checked
5. The doctor needs the determine if particular treatment was effective
236
Arterial Blood Gas
Blood taken from an artery
237
Serum
The clear liquid separated from the clotted blood
238
Coagulation
The change of blood from liquid to solid
239
Anesthesia
Medication that suppresses the central nervous system that results unconsciousness and lack of sensation
240
POC
Point of care
241
Cultures
The propagation of microorganisms or of living tissue cells in media conducive to their growth.
