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Scribe America ED > Day 5: Labs > Flashcards

Day 5: Labs Flashcards

1
Q

What gets tested in the CBC and what does it mean?

A
  1. WBC: high (leukocytosis): infection
  2. Hemoglobin/Hematocrit (H&H): Hgb/Hct: low: anemia
  3. Platelets: Plt : low (Thrombocytopenia) : prone to bleeding
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2
Q

CBC with Differential adds:

A
  1. Bands (band cells): high (bandemia) : serious infection
  2. Segs (segmented neutrophils): high (left shift): acute infection
  3. Lymphs (lymphocytes): high: viral infection
  4. Monos (monocytes): high: bacterial infection
  5. Eos (eosinophils): high: parasitic infection
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3
Q

What does the BMP include?

A

Na, K, BUN, Creat, Gluc, (HCO3, Cl)

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4
Q

BMP: Na

A

High (hypernatremia) : dehydration
Low (hyponatremia): dehydration

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5
Q

BMP: K

A

High (hyperkalemia): poor kidney function
Low (hypokalemia): prone to arrhythmias

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6
Q

BMP: BUN

A

high: renal insufficiency or failure

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7
Q

BMP: Creat

A

high: renal insufficiency or failure

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8
Q

What does the CMP include

A

BMP, T Prot/Alb, T bili, AST (SGOT), ALT (SPGT), Alk Phos

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9
Q

CMP: T prot/Alb

A

Total Protein/Albumin: low : poor nutrition

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10
Q

CMP: T bili

A

Total bilirubin: high: jaundice/liver failure

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11
Q

CMP: AST (SGOT)

A

Asparatate Transaminase: high: liver damage

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12
Q

CMP: ALT (SGPT)

A

Alanine Transaminase: High :liver damage

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13
Q

CMP: Alk Phos

A

Alkaline Phosphatase: high : liver damage

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14
Q

WHat does the cardiac enzyme panel include

A

Trop, CK, CK-MB, CK-RI

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15
Q

Cardiac Enzyme: Trop

A

Troponin: high: specific to heart damage

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16
Q

Cardiac Enzyme: CK

A

creatinine kinase: high: heart damage or Rhabdomyolosis

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17
Q

D-dimer test for and significance:

A

Tests for PE, if high you must order either CTA chest (check creatine first) or VQ scan to rule out PE

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18
Q

What are the respiratory labs?

A

BNP, ABG, VBG

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19
Q

Describe BNP:

A

B-type natriuretic peptide; high: CHF

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20
Q

Describe ABG:

A

Arterial blood gas; low pH: acidosis
High/Low HCO3: metabolic problem
High/Low pCO2: respiratory problem
Low pO2: hypoxia

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21
Q

Describe VBG:

A

venous blood gas; low pH: acidosis
High pH: alkalosis

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22
Q

The cardiac order set:

A

CBC, BMP, CK (CK-MB), Troponin, EKG, CXR

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23
Q

For whom will the cardiac order set be given?

A

Any adult complaining of chest pain

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24
Q

What are the ENT labs?

A

Strep, Monospot, Influenza A/B

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25
Q

What are the pancreatic enzymes?

A

Lipase (Lip): high: specific to pancreatitis
Amylase (Amy): high : possible pancreatitis

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26
Q

What are the inflammation labs?

A

CRP (c-reactive protein): high: active inflammation
ESR or Sed Rate (erythrocyte sedimentation rate) : high: active inflammation

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27
Q

What are the OB/GYN labs?

A

HCG, Serum HCG Qual, HCG Quant

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28
Q

HCG tests for:

A

Positive: pregnant, Negative: not pregnant

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29
Q

Serum HCG qual tests for:

A

positive: preg, negative: not preg

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30
Q

Serum HCG quant tests for:

A

how long they have been pregnant
If it gets higher, further along
if it gets lower or unchanged: failed pregnancy

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31
Q

What are the pelvic exam labs?

A

Wet prep, GC, CT, Genital Cx

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32
Q

Pelvic: Wet Prep:

A

Many clue cells: Bacterial Vaginosis (BV)
Many trichomonas : STC
Many yeast: Vaginal Yeast Infection

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33
Q

Pelvic: GC

A

Gonococcus: Pos: Gonorrhea (STD)

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34
Q

Pelvic: CT

A

Chlamydia Trachomatis: Pos: Chlamydia (STD)

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35
Q

Pelvic: Genital Cx

A

Genital Culture: positive growth: pending results, ED will call pt if Cx is pos

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36
Q

Urine dip tests for:

A

Leuks, Nit, Gluc, Blo

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37
Q

Urine: Leuks

A

Leukocytes: pos: likely UTI

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38
Q

Urine: Nit

A

Nitrite: pos: UTI

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39
Q

Urine: Gluc

A

Glucose: pos: High blood sugar DM

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40
Q

Urine: Blo

A

Blood: pos: kidney stone vs. UTI

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41
Q

3 Efficiency Labs:

A

D-dim, Trop, Creat

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42
Q

Creatinine:

A

>1.4: cannot give CT with dye

43
Q

Trop:

A

Troponin: if high: Acute MI: give ASA, NTG, B blocker, heparin

44
Q

D-dim

A

D-Dimer: high: must order CTA chest or VQ scan depending on creat

45
Q

Micro UA tests:

A

WBC, RBC, Bacteria in urine ( all show for UTI) and epithelial cells in sample means contaminated

46
Q

Medication Levels: Dilantin, INR, Tegretol

A

Dilantin: low (subtheraputic): at risk for sz
INR (coumadin level): Low: at risk for clots; high: at risk for bleed
Tegretol: low: at risk for sz

47
Q

Steps to obtain lab results:

A
  1. lab order placed by MD
  2. nurse draws blood
  3. tubes placed in plastic bags and delivered to lab
  4. lab tech runs samples
  5. lab results visible in meditech
48
Q

Steps to obtain imagine results:

A
  1. imagining order placed by MD
  2. transport tech takes pt to XR, CT, or US
  3. study is performed
  4. films are loaded into PACS and available to view
  5. MD reviews and interprets the film (preliminary vs. final read)
49
Q

Types of XR:

A

CXR, AAS/KUB, all others

50
Q

XR: CXR:

A

potential findings: PNA, PTX, widened mediastinum (dissection), pleural effusion, CHF

51
Q

XR: AAS/KUB:

A

potential findings: Free air (rupture), SBO, constipation, large kidney stones

52
Q

XR: all others:

A

Potential findings: fx, dislocation, joint effusion

53
Q

Types of CT scans:

A

CT w/o, CTA, CT w/, CT A/P w/PO

54
Q

CT: CT w/o

A

“dry CT”, w/o 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: PNA, PTX, Pleural effusion, rib fx
CT Abd/Pel: kidney stones, pyelonephritis

55
Q

CT: CTA, CT w/

A

CT Angiogram, CT w/IV contrast:
potential findings:
CTA Chest: PE, Aortic Dissection
CTA Head: hemorrhagic CVA, Ischemic CVA
CTA Neck: carotid dissection, carotid occlusion

56
Q

CT: CT A/P w/ PO

A

CT Abd/Pel w/PO contrast:
potential findings:
Appy, SBO, Diverticulitis, Ischemic Gut

57
Q

Types of Ultrasounds

A

US Doppler LE, US RUQ, US OB/Transvag/Pelvis, US Scrotum

58
Q

US: US Doppler LE:

A

potential findings: DVT

59
Q

US: US RUQ

A

Potential findings: Cholelithiasis (gallstones), Cholecystitis, bile sludge, gallbladder wall thickening, bile duct obstruction

60
Q

US: US OB/Transvag/Pelvis

A

Potential findings: IUP, Ectopic pregnancy, ovarian cyst, ovarian torsion

61
Q

US: US Scrotum

A

potential findings: testicular torsion, testicular mass

62
Q

What are the orthopedic procedures?

A

Splint application, joint reduction (for dislocation), Athrocentesis (needle aspiration)

63
Q

What are the skin procedures?

A

Laceration repair (stitches), I&D (1% lidocaine)

64
Q

Other procedures:

A

LP, Bedside ultrasound, Conscious sedation (procedural sedation or moderate sedation)

65
Q

Critical Care Procedures:

A

Endotracheal intubation (for respiratory failure)
Central Line Placement (for fluid resuscitation or IV access)
Chest tube placement (for PTX or hemothorax)
Cardioversion (for A-fib) (defibrillation)

66
Q

What are the low acuity procedure? (8)

A

Splint/Sling application
laceration repair
I&D
Foreign body removal
Cerumen disimpaction
Rectal disimpaction
Nail trephination (for subungual hematoma)
Epistaxis management (cautery or packing)

67
Q

Complaint to procedure: Joint injury

A

splint application

68
Q

Complaint to procedure: Laceration

A

laceration repair

69
Q

Complaint to procedure: Abscess

A

I&D

70
Q

Complaint to procedure: Joint effusion

A

Arthrocentesis

71
Q

Complaint to procedure: Dislocation

A

Joint reduction

72
Q

Complaint to procedure: Headache/Fever

A

Lumbar Puncture

73
Q

Complaint to procedure: Joint reduction

A

procedural sedation

74
Q

Complaint to procedure: Respiratory failure

A

CRITICAL CARE; intubation

75
Q

Complaint to procedure: Sepsis

A

CRITICAL CARE; central line placement

76
Q

Complaint to procedure: PTX

A

CRITICAL CARE; chest tube

77
Q

Complaint to procedure: Abnormal heart rhythm

A

CRITICAL CARE; cardioversion

78
Q

Complaint to procedure: Cardiac Arrest

A

CRITICAL CARE; CPR

79
Q

Complaint to procedure: COPD/CHF exacerbation

A

CRITICAL CARE; CPAP/BiPAP

80
Q

Is the Doc doing the PE or a procedure?

A

Remember: actions during the PE are meant to gain info, procedures are meant to FIX problems

81
Q

EKG rules for scribe:

A
  • track closely when it is performed
  • after it is printed, ask Doc for EKG interpretation and be ready to write!
82
Q

NSR

A

normal sinus rhythm, Normal RR 60-100

83
Q

SB

A

sinus bradicardia (NRR <60)

84
Q

ST

A

sinus tachycardia (NRR < 100)

85
Q

A fib

A

atrial fibrillation

86
Q

A flutter

A

atrial flutter

87
Q

Paced

A

pacemaker is functioning

88
Q

SVT

A

supraventricular tachycardia

89
Q

PVC

A

premature ventricular contraction

90
Q

PAC

A

premature atrial contraction

91
Q

LAD

A

left axis deviation

92
Q

RAD

A

right axis deviation

93
Q

LAFB

A

left anterior fascicular block

94
Q

LBBB

A

left bundle branch block

95
Q

RBBB

A

right bundle branch block

96
Q

1 degree AVB

A

first degree AV block (2 & 3 degree)

97
Q

LVH

A

left ventricular hypertrophy

98
Q

PRWP

A

poor R wave progression

99
Q

ST up

A

acute ST elevation

100
Q

ST down

A

acute ST depression

101
Q

NSST changes

A

non-specific ST/T changes

102
Q

5 reasons that a pt would be reevaluated:

A
  1. discharge
  2. admitted
  3. abnormal vitals
  4. PE finding
  5. deterimine if a particular treatment was effective
103
Q

Three reasons a Doc would get a consult:

A
  1. ED doc needs to admit pt to hospital
  2. ED doc needs specialist advise regarding treatment, follow up, or the disease
  3. ED doc calls pt’s PCP to inform them their pt was in ED

Scribe America ED (13 decks)

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