Course 5: Labs and Imaging Flashcards
Function of the ED course
- The ED course is instrumental in ruling out or confirming the DDx
- Contains the remaining objective workup after the physical exam
ED Course Contents
Lab and imaging results, Procedures, Medications given, Consultations, Reevaluations
Complete Blood Count (CBC) with Differentials
White Blood Cells (WBC), Hemoglobin (Hgb), Hematocrit (Hct), Platelets (Plt), Bands cells (Bands), Segmented neutrophils (Segs), Lymphocytes (Lymphs), Monocytes (Monos), Eosinophils (Eos)
White Blood Cells (WBC) Significance
High → Leukocytosis (infection)
Hemoglobin (Hgb) Significance
Low → Anemia
Hematocrit (Hct) Significance
Low → Anemia
Platelets (Plt) Significance
Low → Thrombocytopenia (prone to bleeding)
Bands Cells (Bands) Significance
High → Bandemia (infection)
Segmented Neutrophils (Segs), Lymphocytes (Lymphs), Monocytes (Monos), Eosinophils (Eos) Significance
High → Infection
Basic Metabolic Panel (BMP)
Sodium (Na), Potassium (K), Blood urea nitrogen (BUN), Creatinine (Creat), Glucose (Gluc), Bicarbonate (HCO3), Chloride (Cl)
Sodium (Na) Significance
High → Hypernatremia (dehydration)
Low → Hyponatremia (dehydration)
Potassium (K) Significance
High → Hyperkalemia (poor kidney function)
Low → Hypokalemia
Blood urea nitrogen (BUN) and Creatinine (Creat) Significance
High → Renal insufficiency or renal failure
Glucose (Gluc) Significance
High → Hyperglycemia
Low → Hypoglycemia
Bicarbonate (HCO3) Significance
High → Possible respiratory disease
Low → Hyperventilation
Chloride (Cl) Significance
High → Dehydration
Comprehensive Metabolic Panel (CMP)
Sodium (Na), Potassium (K), Blood urea nitrogen (BUN), Creatinine (Creat), Glucose (Gluc), Bicarbonate (HCO3), Chloride (Cl), Total protein (T Prot), Albumin (Alb), Total bilirubin (T Bili), Aspartate transaminase (AST or SGOT), Alanine transaminase (ALT or SGPT), Alkaline phosphatase (Alk Phos)
Total Protein (T Prot) Significance
Low → Hemorrhage, liver disease, kidney disease
Albumin (Alb) Significance
Low → Liver or kidney problem
Total Bilirubin (T Bili), Aspartate Transaminase (AST or SGOT), Alanine Transaminase (ALT or SGPT), Alkaline Phosphatase (Alk Phos) Significance
High → Liver damage
Cardiac Order Set
Troponin (Trop), EKG, CXR, CBC, BMP
D-Dimer Significance
High → Must rule out pulmonary embolism
Respiratory Labs
B-type natriuretic peptide (BNP), Arterial blood gas (ABG), Venous blood gas (VBG)
B-Type Natriuretic Peptide (BNP) Significance
High → Congestive heart failure
Arterial Blood Gas (ABG) Significance
Low pH → Acidosis
High/low HCO3 → Metabolic problem
High/low pCO2 → Respiratory problem
Low pO2 → Hypoxia
Venous Blood Gas (VBG) Significance
Low pH → Acidosis
High pH → Alkalosis
Coagulation Studies (Coags)
Prothrombin time (PT), International normalized ratio (INR)
Prothrombin Time (PT) Significance
High → Blood that clots too slowly
International Normalized Ratio (INR) Significance
> 3 → Too much Coumadin = Supratherapeutic
2-3 → Normal if on Coumadin = Therapeutic
< 2-3 → Too low = Subtherapeutic
1 → Normal if not on Coumadin
Pancreatic Enzymes
Lipase (Lip), Amylase (Amy)
Lipase (Lip) Significance
High → Pancreatitis
Amylase (Amy) Significance
High → Possible pancreatitis
Diabetes Testing
Serum ketones, Finger-stick blood glucose (Accu-Check or FSBG)
Serum Ketones Significance
High → Diabetic ketoacidosis (DKA)
Finger-stick blood glucose (Accu-Check or FSBG) Significance
High → High blood sugar (hyperglycemia)
Low → Low blood sugar (hypoglycemia)
Obstetrics
Urine βHCG (HCG), Serum βHCG qualitative (HCG), Serum βHCG quantitative (HCG Quant), Type and screen/blood type (T+S/ABO Rh), Type and cross (T+X)
Urine βHCG (HCG) Significance
Positive → Pregnant
Serum βHCG Qualitative (HCG) Significance
Positive → Pregnant
Serum βHCG Quantitative (HCG Quant) Significance
High → Further along in pregnancy
Type and Screen/Blood Type (T+S/ABO Rh) Significance
Blood type → In case blood transfusion needed
Rh negative → Will need Rhogam shot if pregnant
Type and Cross (T+X) Significance
Blood type → Gets blood ready for transfusion
Sepsis
Complete blood count (CBC) with differentials, Lactate or lactic acid, Blood cultures (Blood Cx)
Complete Blood Count (CBC) with Differentials Significance
High WBC → Leukocytosis (possible sepsis)
High bands → Bandemia (possible sepsis)
Lactate or Lactic Acid Significance
High → Sepsis or cell death in the body
Blood Cultures (Blood Cx) Significance
Positive growth → Sepsis
Cultures
Blood culture (BCx), Urine culture (UCx), Wound culture (WCx), Stool culture (SCx)
Blood Culture (BCx) Significance
Positive growth → Sepsis
Urine Culture (UCx) Significance
Positive growth → Urinary tract infection (UTI)
Wound Culture (WCx) and Stool Culture (SCx) Significance
Positive growth → Infection
Microscopic Urinalysis
White blood cells (WBC), Red blood cells (RBC), Bacteria, Epithelial cells (Epi)
White Blood Cells (WBC) Urine Significance
Many → Urinary tract infection (UTI)
Red Blood Cells (RBC) Urine Significance
Many → Possible urinary tract infection (UTI) or kidney stones
Bacteria Urine Significance
Many → Urinary tract infection (UTI)
Epithelial Cells (Epi) Urine Significance
Many → Contaminated specimen
ENT
Rapid Strep test, Mononucleosis, Influenza A+B, Respiratory syncytial virus (RSV), Covid-19 antigen
Rapit Strep Test Significance
Positive → Strep throat
Mononucleosis Significance
Positive → Mononucleosis
Influenza A+B Significance
Positive → Influenza
Respiratory Syncytial Virus (RSV) Significance
Positive → Respiratory syncytial virus (RSV)
Covid-19 Antigen Significance
Positive → Covid-19
Genital
Vaginal wet mount (wet prep), Gonococcus (GC), Chlamydia trachomatis (CT), Genital culture
Vaginal Wet Mount (Wet Prep) Significance
Positive clue cells → Bacterial vaginosis (BV)
Positive trichomonas → Trichomoniasis (STD)
Positive yeast → Vaginal yeast infection
Gonococcus (GC) Significance
Positive → Gonorrhea (STI)
Chlamydia Trachomatis (CT) Significance
Positive → Chlamydia (STI)
Genital Culture Significance
Positive growth → Infection
Cerebrospinal Fluid (CSF)
CSF glucose, CSF protein, CSF red blood cells (RBC), CSF white blood cells (WBC), CSF Gram stain
CSF Glucose Significance
Low → Possible bacterial meningitis
CSF Protein Significance
High → Possible meningitis
CSF Red Blood Cells (RBC) Significance
Greater than 4 in tube 4 → Subarachnoid hemorrhage
CSF White Blood Cells (WBC) Significance
Greater than 3 in tube 4 → Possible meningitis
CSF Gram Stain Significance
Positive bacteria → Meningitis
Types of Imaging Studies
X-ray, CT, Ultrasound/sonogram
X-Ray Description
Produce images of the structures inside of the body, especially bones
X-Ray Diagnostic Utility
Bone fractures, infections, swallowed items, digestive tract problems
CT Description
A series of x-rays to create a to create cross sections of the inside of the body, including bones, blood vessels, and soft tissues
CT Diagnostic Utility
Injuries from trauma, bone fractures, vascular disease, infections
Ultrasound/Sonogram Description
Produce images of organs and show parts of the body in motion e.g. heart beating or blood flowing through blood vessels
Chest X-Ray (CXR) Potential Findings
Pneumonia, pneumothorax, widened mediastinum (dissection), pleural effusion, congestive heart failure
Acute Abdominal Series (AAS)/Kidneys Ureters Bladder (KUB) Potential Findings
Free air (rupture), small bowel obstruction (SBO), constipation, large kidney stones
All Other X-Rays Potential Findings
Fracture, dislocation, joint effusion
CT without IV Contrast Potential Findings
CT head: Large hemorrhagic or ischemic CVA
CT C-spine/T-spine/L-spine: Cervical/thoracic/lumbar spine fracture or subluxation (partial dislocation)
CT chest: Pneumonia (PNA), pneumothorax (PTX), pleural effusion, rib fracture
CT abdomen/pelvis: Kidney stones, pyelonephritis
CT Angiogram (CTA)/CT with IV Contrast Potential Findings
CTA head: Hemorrhagic CVA, ischemic CVA
CTA neck: Carotid dissection, carotid occlusion
CTA chest: Pulmonary embolism, aortic dissection
CT Abdomen/Pelvis with PO Contrast Potential Findings
CT abdomen/pelvis: Appendicitis, small bowel obstruction (SBO), diverticulitis, ischemic gut
Ultrasound Doppler Lower Extremities Potential Findings
Deep vein thrombosis (DVT
Abdominal Ultrasound of RUQ Potential Findings
Cholelithiasis, cholecystitis, bile sludge, gallbladder wall thickening, bile duct obstruction
Ultrasound Obstetrics/Transvaginal Potential Findings
Intrauterine pregnancy (IUP), ectopic pregnancy, ovarian cyst, ovarian torsion
Ultrasound Scrotum Potential Findings
Testicular torsion, testicular mass
Clinician says “Normal EKG at 80 (bpm)”
Scribe documents “NSR at a rate of 80 bpm, no acute ST/T changes”
Clinician says “Sinus at 72”
Scribe documents “Normal sinus rhythm at a rate of 72 bpm”
Clinician says “Sinus at 114”
Scribe documents “Sinus tachycardia at a rate of 114 bpm”
Clinician says “Sinus at 56”
Scribe documents “Sinus bradycardia at a rate of 56 bpm”
Clinician says “Sinus brady”
Scribe documents “Sinus bradycardia”
Clinician says “Sinus tachy”
Scribe documents “Sinus tachycardia”
Clinician says “Left bundle”
Scribe documents “LBBB”
Clinician says “Right bundle”
Scribe documents “RBBB”
Clinician says “Left axis”
Scribe documents “LAD”
Clinician says “Nothing acute”
Scribe documents “No acute ST/T changes”
Clinician says “Non specific changes”
Scribe documents “Nonspecific ST/T changes”
Clinician says “Lead one, lead two, or lead three”
Scribe documents “Lead I, Lead II, or Lead III”
Critical Care Scribe Role
- Ask “How many minutes of critical care time were provided?”
- Ensure you have thorough documentation
Reevaluations occur when the clinician wants to…
- Determine whether the patient’s status is improving, unchanged, or worsening
- Discuss discharge instructions or admission
- Re-check abnormal vital signs
- Determine if a particular treatment was effective
Consults are completed if the provider needs to…
- Admit a patient to the hospital
- Gain a specialist’s advice
- Inform the patient’s PCP that they were evaluated in the ED
What to include when documenting a consult…
- Timestamp
- Name of provider being consulted
- Specialty of provider being consulted
- What was discussed
Disposition Options
- Discharged to home
- Discharged to nursing facility
- Admitted
- Transferred
- Left against medical advice (AMA)
- Expired
