Data Assessment Flashcards
Your patient presents with:
PO2 72
PCO2 44
O2 sat 87%
Is this normal, ventilatory failure, or hypoxia?
Hypoxia
Your patient presents with:
PO2 67
PCO2 59
O2 sat 88%
Is this normal, ventilatory failure, or hypoxia?
Ventilatory failure
Your patient presents with:
PO2 57
PCO2 43
O2 sat 83%
Is this normal, ventilatory failure, or hypoxia?
Hypoxia
Your patient presents with:
PO2 89
PCO2 40
O2 sat 95%
Is this normal, ventilatory failure, or hypoxia?
Normal ABG
What is occurring in Phase I?
Inspiration
- ETCO2 = 0 (baseline)
What is occurring in phase II?
- Start of expiration & starting to clear dead space
What is occurring in phase III?
- Alveolar gas is exchanged
What is occurring in phase IV?
Start of inhalation
What part of the graph is showing up on our monitors?
- D = max ETCO2 = maximum sample of alveolar gas
If C - D is not flat what does that tell the practitioner ?
- V/Q mismatch
- C-D is alveolar gas exchange & is flat in a healthy patient
Alpha angle is normally 100-110 degrees what disease process would cause a widened angle?
- Disease process with a hard time pushing out CO2 = COPD, asthma
Beta angle is normally 90 degrees, what disease process would cause a widen angle?
- Rebreathing = mixture of O2 & CO2
What does this waveform represent?
Normal spontaneously breathing patient
What does this waveform represent?
Normal ventilated patient
What does this waveform represent?
- Rebreathing
- Soda Lyme needing changed
- Insufflation
- Inspiratory & expiratory valve failure
What does this waveform represent?
- Curare Cleft
- Diaphragm movement
- check twitches
- if no twitches — see what the surgeon is doing
What does this waveform represent?
- Esophageal intubation
- Obstructed sampling line
- How do you tell the difference? - blow into the sampling line
What does this waveform represent?
- Cardiogenic oscillations
- Paralyzed patient coming back = rhythmic increase & decrease of intrathoracic pressure
What does this waveform represent?
- Return of spontaneous respirations - asychronized with the vent
What does this waveform represent?
- Shark fin = loss of alpha angle = hallmark sign
- Prolonged expiration
- COPD
- Bronchospasm
- Partial mucous plug
- Upper airway obstruction (FBO)
What does this waveform represent?
- Cuff leak
- Over or under sampling
- Hyperventilation
- Increase dead space = V/Q mismatch
= look at ETCO2 & PCO2 to determine if this is the case
What does this waveform represent?
- Leak in sampling line
- ET diluted - the positive pressure from the vent pushes more CO2 into the line
What do these waveforms represent?
- Both could be faulty inspiratory flutter valve
What does this trend capnogram represent?
- Acute event
- Disconnect from the machine = extubation, circuit popped off
- Total obstruction
- Mucous plug
- Sampling line
What does this trend capnogram represent?
- Cuff leak
- Partial disconnect
- Partial mucous plug
- Cardiac arrest
- Bleeding out
- Passive PE
- Obstruction of major blood vessel - retractor/clamp/sponge
What does this trend capnogram represent ?
- Fixed a kink
- Small embolism with recovery
- Small bronchospasm with recovery
What does this trend capnogram represent ?
- Hypoventilation
- Hyperthermia (anything that increases metabolism)
- Tourniquet release
- CO2 insufflation
What are the normal parameters for pH, HCO3, & PCO2?
- pH 7.35 - 7.45
- HCO3 22 - 27
- pCO2 35 - 45
What is this ABG a sign of:
pH = 7.48
HCO3 = 38
PaCO2 = 53
- Metabolic alkalosis, partially compensated
What is this ABG a sign of:
pH = 7.37
HCO3 = 36
PaCO2 = 65
- Respiratory acidosis, compensated
What is this ABG a sign of:
pH = 7.32
HCO3 = 32
PaCO2 = 65
- Respiratory acidosis, partially compensated
What is this ABG a sign of:
pH = 7.69
HCO3 = 35
PaCO2 = 50
- Metabolic alkalosis, partially compensated
What is the relationship between FiO2 and PaO2?
- P divided by F = P/F ratio
- normal PaO2/FiO2 ratio = 400 - 500 mmHg (~55 - 65 kPa)
- PaO2 should = FiO2 x 500
Ex: PaO2 = 90 on 40% oxygen (FiO2 = 0.40)
90/ 0.40 = 225
(RA = 21% = 0.21; add 4% for every liter increase)
What is base excess or base deficit ?
- Refers to the amount of base in the blood, or the amount of acid required to restore a liter of blood to it’s normal pH at a PaCO2 of 40
- A positive number is called a base excess & indicates metabolic alkalosis
- A negative number is called a base deficit & indicates metabolic acidosis
- Does not take into account respiratory = cannot use as a diagnosis
What is a normal base excess/ deficit?
-2 to +2
What are causes of abnormally negative BE (< -2)
- Excretion or neutralization of HCO3 - in buffering =
- Excess lactic acid - anaerobic metabolism or hypoxia
- Diabetic ketoacidosis = high levels of keto acids
- Sepsis, septic shock, or chronic hypoxia
- Loss of HCO3 from the body
- Diuretics, diarrhea, renal failure
- Failure to regenerate HCO3 by the kidneys = preventing excretion of acids & reabsorption & production of HCO3
- Renal tubular acidosis
- Ingestion of poisons such as methanol, ethylene glycol, or excessive aspirin
What are causes of abnormally positive BE (> +2)
- Usually represents Metabolic alkalosis
- Increased generation or administration of HCO3
- consequent on excessive loss of hydrogen &/or chloride ions
- Vomiting
- Renal overproduction of HCO3 seen in Cushings disease
- Crohn’s disease - messes w/ Cl ions and causes Hypokalemia
What is an Anion gap
- Useful in determining whether a base deficit is caused by addition of acid or loss of bicarbonate
- Base deficit w/ elevated anion gap indicates addition of acid (ketoacidosis)
- Base deficit w/ normal anion gap indicates loss of bicarbonate (diarrhea) - the anion gap is maintained b/c HCO3 is exchanged for chloride during excretion
The law of electrochemical neutrality in the blood requires?
- All positive ions equal to all negative ions in the blood
- In the blood cations (+) are always greater than anions (-)
- The anion gap measures the gap between + and - ions
How do you calculate the Anion gap?
AG (w/o K+) = [Na+] - ([Cl-] + [HCO3-])
AG (w/ K+) = ([Na+] + [K+]) - ([Cl-] + [HCO3-])
What is a normal Anion gap?
10 - 20 mEq/L
(FYI: In practice 3- 10 is normal, & > 10 is almost exclusively the result of increased unmeasured anions derived from metabolic acids- thus metabolic acidosis is the most common cause of a raised anion gap)
Anion gap > 30 mmol/L is usually caused by ?
- Organic acidosis
- KULT acronym
- Keto acidosis
- Uremia
- Lactic acidosis
- Toxins: ethanol, aspirin, Toluene (solvent)
Anion gap < 20 mmol/L indicates what:?
- Rarely indicates a significant acidosis & is most often 2nd to changes in:
- Protein
- Phosphates
- Or change equivalents
What are the 2 electrolytes important in cell function?
- Calcium & Potassium
What does Potassium do for cell function?
- Maintain resting membrane potential
What does Calcium do for cell function?
- Maintain threshold potential
If a potassium imbalance is left undiagnosed & untreated (hypo or hyper) what could happen?
- Significant morbidity & mortality
- Both are medical emergencies and require prompt intervention
Where is majority of K+ excreted GI or renal?
- Major route = excretion in urine
- Minor route = excreted via the GI
Renal regulation of K+ depends on what hormone?
- Aldosterone
- Rising concentration of K+ stimulates aldosterone synthesis & release
= Reduces K+ by increasing renal excretion
What is the most common cause of Hypokalemia (< 3.5)**
- Diuretic therapy:
Thiazides & Loop diuretics
What are 9 other causes of Hypokalemia (< 3.5) other than diuretics?
- Severe/chronic diarrhea/vomiting
- Metabolic alkalosis (K+ moves into the cell)
- Conn’s syndrome (increased aldosterone)
- Tx of DKA (d/t increased loss of K+ in urine)
- Inadequate K+ intake
- Laxative abuse
- Licorice abuse (increases aldosterone levels)
- Beta blocker (K+ moves into cell)
- Insulin overdose (K+ moves into cell)
Symptoms of Mild Hypokalemia (> 3.0)
- Usually asymptomatic
Symptoms of Moderate Hypokalemia (2.6 - 3.0)
- Fatigue associated w/ muscular weakness (including cardiac)
- Constipation d/t impaired muscle tone of the GI tract
- Characteristic ECG changes
- increased PR interval
- increased p wave
- flat or inverted T wave
- QT prolongation
- U wave
- ST depression
- Hyporeflexia
Symptoms of Severe Hypokalemia (< 2.5 mmol/L)
- Flaccid paralysis (can’t contract)
- Respiratory failure
- Cardiac arrhythmias/ arrest (tachyarrhythmias)
What is the most common cause of Hyperkalemia (> 5.0)? **
- Chronic kidney disease (reduced urinary excretion of K+)
What are other causes for hyperkalemia (> 5.0mmol/L) besides CKD?
- Metabolic acidosis/ DKA (movement of K+ out of cell)
- Severe tissue damage: rhabdomyolysis, trauma, major surgery (K+ leak out of damaged cell)
- Cytotoxic drug therapy for hematological malignancy
- Addison’s disease (reduced aldosterone)
- Excessive K+ replacement therapy
- Some drugs:
- ACEi,
- Spironolactone
Symptoms of Hyperkalemia
May be absent or relatively non-specific
- Muscle weakness/ fatigue
- Diarrhea/abdominal pain
- Cardiac palpitations
- Characteristic ECG changes:
- Peaked T wave
- Flat P wave
- PR prolongation
- prolonged P wave
- Widened QRS & morphology changes
At what K+ level does the risk of potentially fatal ventricular arrhythmias & cardiac arrest present ?
- As K+ rises above 6.5 mmol/L
- present as slow arrhythmias: sinus brady, AV blocks, Junctional/escape beats
What is the most dominant cation in the extracellular fluid?
- Sodium, major contributor of the osmolality of the extracellular fluid
What is the main function of Na+
- Regulating water balance & maintaining BP
How are normal limits of Na+ controlled?
- Thirst response
- Normal renal & GI function
- Appropriate release of AVP (vasopressin)
- Appropriate release of aldosterone
- Intact renin-angiotensin pathway
“Think Brain”
9 Causes of Hyponatremia (< 135)
- Heart failure
- Cirrhosis
- Hyperglycemia - DKA
- Acute & chronic kidney disease
- Syndrome of inappropriate antidiuretic hormone (ADH)
- Chronic vomiting/diarrhea
- Addison’s disease (adrenal insufficiency)
- Diuretic therapy
- Fluid replacement therapy
What are symptoms of mild hyponatremia (130- 135 mmol/L)
- Usually asymptomatic
What are symptoms of moderate hyponatremia (125- 130 mmol/L)?
- Anorexia
- Nausea/vomiting
- Abdominal cramps
What are symptoms of severe hyponatremia (< 125 mmol/L)?
- All other symptoms of moderate plus:
- Agitation
- Confusion
- Hallucinations
What are symptoms of the most severe hyponatremia (< 115 mmol/L)?
- Seizures
- Coma
- Death
What are 8 causes of hypernatremia ( > 145mmol/L)?
- CKD
- Inadequate water intake (common in elderly)
- Failure of the thrust response d/t unconsciousness/head injury
- Conn’s disease (primary aldosteronism)
- Cushing’s disease
- Diabetes insipidus
- Over-vigorous Na replacement therapy
8 Lithium therapy
What are symptoms of mild hypernatremia (145 - 150 mmol/L)?
- Usually asymptomatic
What are symptoms of moderate hypernatremia (150 - 159 mmol/L)?
- Anorexia
- Muscle weakness
- Nausea vomiting
“Think GI”
What are symptoms of severe hypernatremia ( > 160)?
Due to dehydration of brain cells:
- Lethargy
- Irritability
- Altered LOC
- Coma
- Acute onset of severe hypernatremia is potentially fatal
What is the normal range for Chloride?
98 - 107 mEq/L
Why is Chloride important?
- Determines water movement between extracellular & intracellular compartments =
- regulation of blood volume & blood pressure
- Maintains the electrochemical neutrality of plasma (70% of anions in the AG, HCO3 30%)
- Essential in the digestion/absorption of food & control of GI bacterial growth
- Essential for the effective transport of CO2 from tissue to lungs & the maintenance of normal blood pH
Causes of hypochloremia & hyperchloremia
- Cl- closely parallels Na+ in both health & disease, the causes of hypochloremia are identical to hyponatremia
- Anorexia, N/V, ABD cramps
- Agitation, Confusion, Hallucinations
- Seizures, Coma, Death
- Hyperchloremia = Hypernatremia
- Anorexia, N/V, muscle weakness
- Lethargy
- Irritability
- Altered LOC
- Coma
Ionized calcium normal range?
- 4.6 - 5.3 mg/dL
FYI: 1.3 - 2.1 mEq/L
Importance of iCa+
- Bone mineralization
- Cellular processes
- Contractility of the heart & skeletal muscle
- Neuromuscular transmission
- Hormone secretion enzymatic reactions: blood coagulation
When do you see hypocalcemia?
- Never a singular finding
- May occur in the context of co-existing acidosis, hypothermia & dilution
What are 6 causes of hypocalcemia ?
- Hypothyroidism (reduced PTH d/t disease/damage of the parathyroid)
- Vit D deficiency (reduced production, diet deficiency, or malabsorption)
- CKD
- Chronic Liver disease
- Critical illness:
- Sepsis
- AKI
- Acute pancreatitis
- Rhabdomyolysis
- Severe burns
- Massive red blood cell transfusion
- Major surgery = saggy BP — need amp of Ca
What are symptoms of moderate hypocalcemia?
Related neural signaling/neuromuscular transmission
- Muscle twitching
- Carpopedal spasm = + Trousseau’s sign
- Paresthesia (tingling & numbness)
What are symptoms of severe hypocalcemia?
- Tetany with laryngeal spasm & breathing difficulty
- Convulsions, seizures/fits
- Cardiac arrhythmia with characteristic ECG changes:
- QT prolongation (secondary to lengthened ST segment)
- Rare but can lead to Torsades, VT or complete heart block
What are the 3 most common causes of hypercalcemia? *
- Primary hyperparathyroidism (excessive uncontrolled secretion of PTH)
- Malignant disease: especially lung, breast, & esophagus cancer
- Drugs: thiazide diuretics, lithium, excessive antacids & Vit. D
What are 4 rare causes of hypercalcemia ?
- Tuberculosis
- Sarcoidosis
- Hyperthyroidism
- Inherited hypercalcemia
What are the symptoms of Moderate hypercalcemia?
(Mild = asymptomatic)
- Abdominal pain
- Nausea
- Muscle weakness
- Constipation
- Thirst & polyuria
- Tiredness, fatigue, depression
- Palpitations/ ECG changes:
- Short QT interval
- Renal (calcium) stones
What are the symptoms of severe hypercalcemia?
- Convulsions
- Coma
What is a cause for chronic/long standing hypercalcemia?
- Irreversible chronic kidney disease
What is the importance of a lactate level?
- increase in lactate levels are an early sensitive indicator of imbalance between tissue oxygen demand & supply
- marker of tissue hypoperfusion in patients with circulatory shock
- Prognostic indicator for patient outcome
- An index of adequacy of resuscitation after shock
- A marker for monitoring resuscitation therapies
What is a normal lactate range ?
9 - 14 mg/dL (unstressed)
- Can go as high as 18 if stressed
Lactic acidosis is the most common cause of ?
- Metabolic acidosis
- Characterized by persistent hyperlactatemia (usually > 45 mg/dL) in association with reduced blood pH (< 7.35)
The development of lactic acidosis depends on :
- The magnitude of hyperlactatemia
- The buffering capacity of the body
- The co-existence of other conditions that produce tachypnea & alkalosis (liver disease, sepsis)
7 causes of Type A Lactic Acidosis
“Hypoxia” = inadequate tissue oxygenations
- Shock from blood loss/sepsis
- Myocardial infarction/ cardiac arrest
- Congestive heart failure
- Pulmonary edema
- Severe anemia
- Severe hypoxemia
- Carbon monoxide poisoning
What are 9 causes of Type B Lactic acidosis
“Metabolic”
- Liver disease
- Kidney disease
- DKA
- Leukemia
- HIV
- Sepsis & meningitis
- Congenital lactic acidosis: forms of muscular dystrophy
- Drugs & toxins
- Strenuous exercise
13 Drugs that are associated with Type B Lactic acidosis
- Biguanides (Metformin)
- Ethanol
- Methanol
- Antiretroviral drugs
- Cyanide
- Theophylline
- Cocaine
- Simvastatin
- Salicylates
- Paracetamol (acetaminophen)
- Lactulose
- Propylene glycol
- Epinephrine & norepinephrine
What is a normal Creatinine level?
- Men: 0.6 -1
(Women usually run a little lower but do not need to know those values for the exam) - the value is a used to assess kidney dysfunction - the marker is based on the constancy of endogenous creatinine production & the observation that creatinine is cleared from the blood to urine almost entirely by glomerular filtration
What reflects the rate at which blood is filtered in the kidneys?
- Glomerular filtration rate (GFR)
- Kidney disease/dysfunction is associated with reduction in GFR
11 Causes of high Creatinine
- Acute tubular necrosis
- Dehydration
- Diabetic nephropathy
- Glomerulonephritis
- Kidney failure
- Muscular dystrophy (beginning stages)
- Preeclampsia
- Pyelonephritis
- Reduced kidney blood flow (shock, congestive heart failure)
- Rhabdomyolysis
- Urinary- tract obstruction
2 causes for low creatinine
- Muscular dystrophy (late stage)
2. Myasthenia gravis
What is the principle distinction between CKD & AKI?
- The speed of progression “the decline in GFR”
- AKI: rapid progression over a period of hrs & days
- potentially reversible
- CKD: slow progression over a period of months, years, & even decades
- irreversible
- Medical intervention can slow progression
When is kidney replacement therapy required?
(Either dialysis or transplantation)
- Required for survival when creatinine exceeds 6.8 mg/dL & may be as high as 11.3 mg/dL (6-10 x’s baseline)
What GFR is abnormal at any age?
- Less than 75 mL/min/1.73m2
- GFR decreases as we age and that is normal but 70+ yo should remain at a GFR of 75 mL/min
Cardiac troponin markers
- Normally only barely detectable or undetectable in blood
- are sensitive & specific blood markers of Myocardial NECROSIS
- An aid in the diagnosis of MI & in the risk stratification of patient with acute coronary syndromes (ACS) w/ respect to their relative risk of mortality
Criteria to satisfy a diagnosis of acute, evolving or recent MI?
- Must rise above the 99th percentile
& at least one of the following:- Symptoms of c Adrian ischemia
- ECG changes consistent w/ new ischemia
- Imaging evidence of new loss of viable myocardium
- Identification of an intracoronary thrombus by angiography or at autopsy
How should troponins be measured?
- First detectable 4- 8 hrs after the onset of chest pain
- Peak 12- 48 hrs -
- Plasma cTNI & CTnT levels remain elevated several days after a severe MI
- Serial meausurements are necessary
- at presentation
- & again 3- 6 hrs later
- 6-12 hr to definitively exclude a diagnosis of MI if clinical doubt remains
How can you exclude an MI with troponins?
- A diagnosis of MI can usually be excluded if troponin remains negative over a period of 6-12 hrs after onset of symptoms
- MI is also excluded if an abnormal results remains unchanged (< 20%) during the hours after onset of symptoms
Should you delay reperfusion treatment for troponin test results?
- Presentation w/ typical ischemic chest pain & ST-segment elevation is a diagnosis of MI
- Reperfusion tx of this patient should not be delayed by troponin testing
When does a troponin have the greatest diagnostic value?
- In the absence of unequivocal ECG evidence of MI = NSTEMI
12 Causes other than MI that can increase troponin levels
- Heart failure
- Tachyarrhythmia
- Cardiomyopathy
- Myocarditis pericarditis
- Renal failure (ESRD)
- Blunt chest trauma
- Pulmonary embolism
- Sepsis/septic shock
- Aortic valve disease
- Cerebrovascular accident (stroke)
- Cardiotoxic drugs
- Extreme exertion (marathon running)
What are natriuretic peptides (BNP - NT-proBNP)
- Derived from heart muscle cells & are present in blood at very low concentrations in healthy individuals
- Increased concentrations are associated with many cardiac & some non-cardiac diseases
Why do we use BNP or NT-proBNP?
- Aids in the diagnosis of heart failure
- Both test have equal diagnostic value
- The physiological trigger for synthesis of proBNP within cardiac myocytes & release of BNP & NT-proBNP to the circulation is cardiac-wall stress
- induced by increased pressure/volume
- “Grades Heart failure”
What are 4 BNP effects in the body?
- Multiplicity hormonal effects that contribute to cardiovascular hemostasis, including regulation of blood volume & blood pressure
- BNP promotes increased Na & water loss in urine (natriuresis & diuresis) & induces vasodilation*
(May or may not be good since pt is in heart failure) trying to off load stress/ fluid from the heart - Inhibitory effect on the renin-aldosterone axis
- Protects the heart from fibrosis & hypertrophy
What is the half life of BNP?
- 20 minutes
- Eliminated via renal & non-renal routes
What is the range for BNP?
- For the exam know that BNP increases with age and women have higher levels
- (Ex: male 65-74 yr. Avg BNP 23 (w/ a range of 7-58) - Female 65-74 yr. Avg BNP 37 (w/ a range of 19- 111)
- Acute heart failure rule out = < 100 BNP
- Acute heart failure rule in = > 500 BNP (age is not a factor)
- if between 100- 500 — get an ECHO for diagnosis (gold standard)
What is the heart failure grading score based on the NYHA class and Mean BNP?
- Class I = asymptomatic = BNP 244, (+/- 286)
- Class II = mild = BNP 389 (+/- 374)
- Class III = moderate = BNP 640 (+/- 447)
- Class IV = severe = BNP 817 (+/- 435)
What is does an increased D-dimer relate to?
- An increased blood concentration of D-dimer provides evidence of ON-GOING fibrinolysis = fibrin clot formation
- normally undetectable or only at low levels unless your body is forming & breaking down significant blood clots
- Used for thrombotic conditions:
- Deep vein thrombosis
- Pulmonary embolism
What are D-dimers?
- Fibrin (ogen) degradation product (small protein fragment present in the blood) that provides a marker of ongoing fibrinolysis (blood clot degraded by fibrinolysis) & thereby coagulation activation
What are 12 causes of an increased D-dimer other than VTE?
- Arterial thrombotic diseases: MI, a-fib, CVA, limb ischemia
- DIC
- Sickle cell crisis
- Aortic dissecting aneurysm
- HF
- Severe infection/sepsis/SIRS; severe inflammation
- Surgery/trauma
- Cancer
- Cirrhosis
- AKI/ESRD
- Normal pregnancy & preeclampsia & eclampsia
- Use of Thrombolytic drugs
What is the sensitivity and specificity for VTE with a D-dimer?
- High sensitivity for VTE (90-98%)
- But limited by its low specificity for VTE (<50%)
- Negative test result rules out the likelihood of the disease
- But a positive test does not tell the practitioner “specifically” if the patient has a VTE (may be a PE, DIC, sepsis, cancer etc)
What is the gold standard for diagnosis of DVT? PE?
- DVT: Ultrasound scan of the legs
- PE: Chest CT
- The D-dimer is used to tell the practitioner if theses expensive test need to be ran
- If the D-dimer is low = pre-test = Wells score - VTE can be ruled out
What is the current universal reference for D-dimer assays?
- Assays vary greatly & there is no universal standard/ reference interval or diagnostic cut-off value for exclusion of VTE
What is the Wells Score used for?
Point system to determine the clinical probability of DVT or PE
- if the patient presents with low probability = get a D-dimer - if low DVT/PE is ruled out; - if high get imaging - if the patient presents with high probability = get imaging
Wells Score for DVT?
2 or more = high probability
1 or less = low probability
+ 1 point for :
- Active cancer
- Paralysis or recent cast immobilization
- Bed rest > 3 days or surgery < 4 weeks ago
- Pain on palpation of deep veins
- Swelling of entire leg
- Calf swelling > 3 cm difference in affected limb
- Pitting edema in affected limb
- Dilated superficial veins in affected limb
- Previously documented DVT
- Alternative diagnosis at least as likely as DVT = -2
Wells Score for PE?
More than 4 points = high probability
4 or less = low probability
\+ 1.5 - Previous PE or DVT - Heart rate > 100 bpm - Recent surgery or immobilization \+ 3 - Clinical signs of DVT (leg swelling pain) - Alternative diagnosis less likely than PE \+1 - Hemoptysis - Cancer
What is a CRP
- C-reactive protein
- a non-specific blood marker of organic disease from increased production of large protein polypeptide chains that are synthesized in hepatocytes
What is a normal CRP? And what increases a CRP level?
- Normal = < 5.0 mg/L
- Increased (> 10) = innate immune response to infection & major tissue injury/ insult
6 Causes associated with increased CRP
“Immune problems”
1. Bacterial/ Viral/ Fungal infection; sepsis
(Bacteria = higher rise than viral)
2. Arthritis
3. Inflammatory autoimmune: arthritis, vasculitis
4. Autoimmune: Crohn’s, SLE, sclerosis, UC, Polymyalgia rheumatica
5. Disease process: MI, acute pancreatitis, cancer
6. Injury: trauma, burns, fractures, surgery
What is an ESR?
“Sed rate”
- Measures how quickly erythrocytes settle at the bottom of a test tube that contains an anti coagulated blood sample after 1 hour (minimum)
- Normally RBC settle relatively slowly
What does a faster than normal ESR mean?
- Inflammation in the body:
- arthritis, vasculitis or inflammatory bowel disease
- Chronic condition or immune disorder
- monitor SLE or RA
- Infection or injury
What may cause a slow ESR?
- Sickle cell disease
- CHF
- Kidney disease
What are the Erythrocyte sedimentation rates (ESR) by age group?
Adults (< 50 yrs)
- Men < 15 mm/hr - Women < 20 mm/hr
Adults (> 50yrs)
- Men >/= 20 mm/hr - Women >/= 30 mm/hr
> 100 = active disease but not what disease
What are 4 importance of liver function tests?
- Screen for liver infections: hepatitis
- Monitor progression of disease & how well tx is working
- viral or alcoholic hepatitis
- Measure the severity of a disease
- particularly scarring of the liver = cirrhosis
- Monitor possible side effects of medications
= “screening + monitoring + grading”
Alanine transminase (ALT)
- Normal = 7 to 55 U/L
- A liver enzyme that helps convert proteins into energy for the liver cells
- Increased in liver damage
Aspartame transaminase (AST)
- Normal = 8 to 48 U/L
- A liver enzyme that helps metabolize amino acids
- Increased in liver damage, disease or muscle damage
Alkaline phosphatase (ALP)
- Normal = 40 to 129 U/L
- An enzyme (in liver & bone) that breaks down proteins
- Increases in liver damage, disease or certain bone diseases
Albumin & total protein
- Albumin = 3.5 to 5.0 g/dL
- Total protein = 6.3 to 7.9 g/dL
- Liver proteins that help fight infections & perform other functions
- When the liver is damaged levels DECREASE
Bilirubin
- Normal = 0.1 to 1.2 mg/dL
- Produced during the normal breakdown of RBCs
- Bilirubin passes through the liver & is excreted in stool
- Elevated levels of bilirubin = liver damage or certain types of anemia
Gamma- glutamyltransferase (GGT)
- Normal = 8 to 61 U/L
- An enzyme in the blood
- Increased in liver or bile duct damage
Prothrombin time (PT)
- Normal = 9.4 to 12.5 seconds
- The time it takes your blood to clot
- Increased in liver damage or anticoagulation therapy
