Course 5: Lab Studies Flashcards
Complete Blood Count (CBC):
4 components
WBC (white blood cells)
Hgb (hemoglobin)
Hct (hematocrit)
Plt (platelets)
Complete Blood Count (CBC):
4 components, abnormal level (assoc dx)
WBC (white blood cells), high (leukocytosis)
Hgb (hemoglobin), low
Hct (hematocrit), low
Plt (platelets), low (thrombocytopenia)
Complete Blood Count (CBC):
4 components, abnormal level (assoc dx), significance
WBC (white blood cells), high (leukocytosis), infection
Hgb (hemoglobin), low, anemia
Hct (hematocrit), low, anemia
Plt (platelets), low (thrombocytopenia), prone to bleeding
Differential - CBC with Diff:
5 components + CBC
Bands (band cells) Segs (segmented neutrophils) Lymphs (lymphocytes) Monos (monocytes) Eos (eosinophils)
Differential - CBC with Diff:
5 components + CBC, abnormal level (assoc dx)
Bands (band cells), high (bandemia) Segs (segmented neutrophils), high (left shift) Lymphs (lymphocytes), high Monos (monocytes), high Eos (eosinophils), high
Differential - CBC with Diff:
5 components + CBC, abnormal level (assoc dx), significance
Bands (band cells), high (bandemia), serious infection
Segs (segmented neutrophils), high (left shift), acute infection
Lymphs (lymphocytes), high, viral infection
Monos (monocytes), high, bacterial infection
Eos (eosinophils), high, parasitic infection
Basic Metabolic Panel (BMP):
7 components
Na (sodium) K (potassium) BUN (blood urea nitrogen) Creat (creatinine) Gluc (glucose) HCO3 (bicarbonate) Cl- (chloride)
Basic Metabolic Panel (BMP):
7 components, abnormal level (assoc dx)
Na (sodium), high (hypernatremia)/low (hyponatremia)
K (potassium), high (hyperkalemia)/low (hypokalemia)
BUN (blood urea nitrogen), high
Creat (creatinine), high
Gluc (glucose), high (hyperglycemia)/ low (hypoglycemia)
HCO3 (bicarbonate), high (hypercarbia)/low (hypocarbia)
Cl- (chloride), high (hyperchloremia)
Basic Metabolic Panel (BMP):
7 components, abnormal level (assoc dx), significance
Na (sodium), high (hypernatremia)/low (hyponatremia), dehydration
K (potassium), high (hyperkalemia)/low (hypokalemia), high (poor kidney function) / low (may cause arrhythmias)
BUN (blood urea nitrogen), high, renal insufficiency or failure
Creat (creatinine), high, renal insufficiency or failure
Gluc (glucose), high (hyperglycemia)/ low (hypoglycemia), high blood sugar/ low blood sugar
HCO3 (bicarbonate), high (hypercarbia)/low (hypocarbia), high (possible respiratory disease)/low (hyperventilation, pos DKA)
Cl- (chloride), high (hyperchloremia), possible dehydration
Comprehensive Metabolic Panel (CMP):
5 components + BMP
T Prot/Alb (total protein/albumin) T bili (total bilirubin) AST (SGOT) (aspartate transaminase) -LFT ALT (SGPT) (alanine transaminase) -LFT Alk Phos (alkaline phosphatase) -LFT
Comprehensive Metabolic Panel (CMP):
5 components + BMP, abnormal level,
T Prot/Alb (total protein/albumin), low T bili (total bilirubin), high AST (SGOT) (aspartate transaminase), high ALT (SGPT) (alanine transaminase), high Alk Phos (alkaline phosphatase), high
Comprehensive Metabolic Panel (CMP):
5 components + BMP, abnormal level, significance
T Prot/Alb (total protein/albumin), low, poor nutrition
T bili (total bilirubin), high, jaundice/liver failure
AST (SGOT) (aspartate transaminase), high, liver damage
ALT (SGPT) (alanine transaminase), high, liver damage
Alk Phos (alkaline phosphatase), high, liver damage
Cardiac Enzyme Panel (CEP):
5 components
Trop (troponin) CK (creatine kinase) CK-MB (creatine kinase- muscle breakdown) CK-RI (creatine kinase relative index) Myo (myoglobin)
Cardiac Enzyme Panel (CEP):
5 components, abnormal level
Trop (troponin), high
CK (creatine kinase), high
CK-MB (creatine kinase- muscle breakdown), high
CK-RI (creatine kinase relative index), high
Myo (myoglobin), high
Cardiac Enzyme Panel (CEP):
5 components, abnormal level, significance
Trop (troponin), high, specific to heart damage
CK (creatine kinase), high, heart damage or rhabdomyolysis
CK-MB (creatine kinase- muscle breakdown), high, heart damage
CK-RI (creatine kinase relative index), high, heart damage
Myo (myoglobin), high, heart damage
D-Dimer
negative (rule out PE)
positive or high (must receive CTA chest, VQ scan to rule out)
BNP (B-type natriuretic peptide)
abnormal high, CHF
ABG (arterial blood gas)
low pH, acidosis
high/low bicarb, metabolic problem
high/low pCO2, respiratory problem
low pO2, hypoxia
VBG (venous blood gas)
low pH, acidosis
high pH, alkalosis
The Cardiac Order Set:
7 components
CBC, BMP, CK, CK-MB, Trop, EKG, CXR
CSF Analysis:
5 components, abnormal level, significance
CSF Gluc, low, possible bacterial meningitis
CSF Prot, high, possible meningitis
CSF RBC, >0 in Tube 4, subarachnoid hemorrhage (brain bleed)
CSF WBC, >3 in Tube 4, possible meningitis
CSF Gram Stain, positive bacteria, likely bacterial meningitis
CSF Analysis Details:
How many tubes are obtained? Why?
4 tubes of CSF during a LP; because if abnormal results only seen in two tubes (contamination), if in all four tubes, then results are valid.
COAGS - Coagulation Studies and Coumadin Levels
3 components
PT (prothrombin time)
INR (international normalized ratio)
PTT (partial thromboplastin time)
COAGS - Coagulation Studies and Coumadin Levels
3 components, abnormal level (assoc dx)
PT (prothrombin time), high
INR (international normalized ratio), >3.0 (supertherapeutic)/
COAGS - Coagulation Studies and Coumadin Levels
3 components, abnormal level (assoc dx), significance
PT (prothrombin time), high, blood too thin
INR (international normalized ratio), >3.0 (supertherapeutic)/
COAGS Details:
PT v INR?
What is the INR?
PT and INR are the same test; just two different representations of the results. They’re ordered as “PT/INR”.
The INR is an adjusted PT value accounting for differences between patients. It is normalized so that the INR=1.0 for every pt that is not on Coumadin. NORMAL INR= 1.0
Strep
- Rapid Strep Test
if positive, step throat
Monospot
- Mononucleosis Test
if positive, mononucleosis
Influenza A + B
if positive, “the flu”
RSV
- respiratory syncytial virus
if positive, likely bronchiolitis
Lip
- lipase
high, specific to pancreatitis
(the more common test)
Amy
- amylase
high, possible pancreatitis
Thyroid Labs:
3 components
TSH (thyroid stimulating hormone), high/low, pos hypothyroidism/hyperthyroidism
T3 (triiodothyronine), low, hypothyroidism
T4 (thyroxine), low, hypothyroidism
TSH Lab - why opposite result for abnml levels?
high - pos hypothyroidism
low - pos hyperthyroidism
Because it is a negative feedback system. Increased levels shut down the precursor.
Inflammation Labs:
2 components, abnormal level, significance
CRP (C-Reactive Protein), high, active inflammation
ESR or Sed Rate (Erythrocyte sedimentation rate), high, active inflammation
OB/GYN Labs (5)
HCG, Serum HCG Qual, Serum HCG Quant, T+S/ABORh, T+X
HCG
Urine beta-HCG
positive, pregnant
negative, not pregnant
Serum HCG Qual
Serum beta-HCG Qualitative
positive, pregnant
negative, not pregnant
Serum HCG Quant
Serum beta-HCG Quantitative
higher, further along in pregnancy
unchanged/lower, failed pregnancy
T+S/ABORh
Type and Screen/Blood Type
Rh Neg, needs RhoGAM shot if pregnant
T+X
Type and Cross
possible blood transfusion
Wet Prep
Vaginal Wet Mount
abnormal:
many clue cells, bacterial vaginosis (BV)
many trichomonas, trichomonas (STD)
many yeast, vaginal yeast infection
GC
Gonococcus
positive, gonorrhea, will call pt with results
CT
Chlamydia Trachomatis
positive, chlamydia, will call pt with results
Genital Cx
Genital Culture
positive growth, pending results: ED will call if Cx is pos.
Urine Dip:
4 components
Leuks (leukocyte esterase)
Nit (nitrite
Gluc
Blo (blood)
Done at bedside. If dip is abnormal, will get sent for UA and UCx
Urine Dip:
4 components, abnormal level (assoc dx), significance
Leuks (leukocyte esterase), positive, likely UTI
Nit (nitrite), positive, UTI
Gluc, positive (glycosuria), high blood sugar (DM)
Blo (blood), positive (hematuria), kidney stone v UTI (further analysis)
Done at bedside. If dip is abnormal, will get sent for UA and UCx
UA:
4 components
WBC
RBC
Back
Epi (epithelial cells)
UA:
4 components, abnormal level (assoc dx), significance
WBC, >6 (pyruia), UTI
RBC, >6 (hematuria), UTI v kidney stone
Bact, many, UTI
Epi (epithelial cells), many, contaminated sample
Sepsis Labs (3) with abnormal results
CBC, high WBC (leukocytosis) or high bands (bandemia), possible sepsis
Lactate (Lactic Acid), high, sepsis or cell death in the body
Blood Cx, pos growth, definitive sepsis
Sepsis Next Steps
Physician needs to know source of infection. Will order CXR (r/o PNA), UA (r/o UTI), LP (r/o meningitis). Box ordered to diagnose type of sepsis and what abx bact sensitive to.
BCx
Blood culture
pos growth, sepsis
UCx
pos growth, UTI
Wound Cx
results pending
Stool Cx
results pending
Toxicology Labs (4)
ASA (serum, acetylsalicylic acid), APAP (serum, acetaminophen), EtOH (serum ethanol, alcohol), UTox (urine drug screen)
ASA
ASA (serum, acetylsalicylic acid)
high, toxic ASA level
APAP
APAP (serum, acetaminophen)
high, toxic Tylenol level
EtOH
EtOH (serum ethanol, alcohol)
high, alcohol intoxication
UTox
UTox (urine drug screen)
pos for opiates, cannabinoids, cocaine, methamphetamines, PCP, drug abuse
Ketones
Serum Ketones, large, likely DKA
Accu-chek
Finger stick blood glucose (FSBG), less than 80mg/more than 110 mg, low or high blood sugar
Medication Levels: Dilantin
Serum phenytoin, low, sub therapeutic; at risk for sz
Medication Levels: INR
Coumadin level, low/high, sub therapeutic/at risk for clots, super therapeutic/risk for bleed
Medication Levels: Dig
Digoxin, low, sub therapeutic, at risk for Afib
Medication Levels: Tegretol
Serum carbamazepine, low, sub therapeutic/at risk for sz
Medication Levels: Keppra
Serum Keppra, low, sub therapeutic, at risk for sz
Medication Levels: Depakote
Serum valproic acid, low, sub therapeutic/at risk for sz
Medication Levels: Neurontin
serum gabapentin, low, sub therapeutic/at risk for sz
3 Labs for Efficiency
D-Dimer, Trop, Creat (Creatinine - from BMP)
rate timing steps
Carefully track and frequently check!
3 Labs for Efficiency and RESULTS
D-Dimer, high, must order CTA or VQ scan (but first Creat before CTA)
Trop, high, acute MI: give ASA, NTG, beta blocker, heparin
Creat, >1.4, assesses kidney function. Creatinine must be obtained prior to order CT with IV contrast due to IV contrast stressing kidneys. Any pt with >1.4 cannot receive IV contrast.
Hemolyzed Samples
If something is done incorrectly, the blood may hemolyze (blood cells have broken down which may skew results). Nurse must re-draw blood and send another sample. ALERT PHYS ASAP if results as hemolyzed.
CBC with Diff: What is it used to assess?
infection (WBC) or anemia (Hgb and Hct = H&H)
BMP: What is it used to assess?
electrolytes (Na + K), renal function (BUN + Creat), glucose
CMP: What is it used to assess?
BMP + LFTs (liver function)
Trop: What is it used to assess?
acute MI (if high)
uDip + UA: What is it used to assess?
UTI or blood (possible kidney stone)
BNP: What is it used to assess?
acute CHF (if high)
Coags (PT/INR/PTT): What is it used to assess?
risk for bleeding (if high)
ABG: What is it used to assess?
respiratory function (hypoxia?)
D-Dimer: What is it used to assess?
possible blood clot (if high, need Creat for CTA chest)
CXR: Potential Findings?
PNA, PTX, Dissection, Pleural effusion, CHF
AAS/KUB : Potential Findings?
acute abdominal series/ kidneys ureters bladder
Free air (rupture), SBO, constipation, large kidney stones
Xray v CT readings?
XR can be interpreted by ED physician.
CT and US must be interpreted separately by a specialized radiologist.
CT Scans
CT w/o
CT without IV Contrast
“Dry CT”
CTA, CT w/
CT Angiogram
CT with IV Contrast
CT A/P w/ PO
CT Abd/Pelvis with PO Contrast
CT w/o
CT without IV Contrast
“Dry CT”
CT Head: Large Hemorrhagic or ischemic CVA
CT C-Spine/ T-Spine/L-Spine: Cervical/ Thoracic/Lumbar spine fx or subluxation (partial dissolution)
CT Chest: PNA, PTX, Pleural effusion, rib fracture
CT Abd/Pel: Kidney Stones. Pyelonephritis.
CTA, CT w/
CT Angiogram
CT with IV Contrast
CTA Chest: PE, Aortic Dissection
CTA Head: Hemorrhagic CVA. Ischemic CVA
CTA Neck: Cartoid dissection. Carotid occlusion.
CT A/P w/ PO
CT Abd/Pelvis with PO Contrast
APPY, SBO, Diverticulitis, Ischemic Gut
US Doppler LE
DVT
US RUQ
Cholelithiasis, Cholecystitis, Bile sludge, Gallbladder wall thickening, Bile duct obstruction.
US OB/Transvag/Pelvis
Intrauterine Pregnancy (IUP), Ectopic pregnancy. Ovarian cyst, ovarian torsion.
US Scrotum
testicular torsion, testicular mass
How US Works
High freq sound waves to generate real-time images.
Investigate “flow” over time. Take longer to complete.
ED Procedures Documentation
“Discussed risks, benefits, alternatives. Consent obtained. Time-out performed.”
