Diagnostics in the ED -- CA Flashcards
What four labs are considered to be “high frequency” in the ED?
BMP or CMP
CBC
UA
beta-hCG
What’s the difference between a Chem 7 and a Chem 8?
Calcium is included in a Chem 8
We would order this test for find out the current status of a person’s kidneys, electrolyte balance, acid/base balance, blood glucose, and calcium levels.
BMP
90% of cases of hypercalcemia are caused by these two things
Malignancy and hyperparathyroidism
What might a low carbon dioxide value cue you into?
Acidosis and possibly ketoacidosis
When we do we see low glucose?
Diabetic insulin overdose and sepsis
and yes we just learned hyperglycemia for sepsis. don’t ask me
Elevated BUN and Creatinine?
Renal failure
Elevated BUN but a normal creatinine?
Diureased
What does a CMP have that a BMP doesn’t?
Why would we order a CMP?
Albumin, ALP, AST, ALT, bilirubin and total protein
CMP also looks at liver function and nutritional status
What does low albumin indicate?
Malnutrition (possible liver disease or reaction to chemo)
What does increased alk phos likely indicate?
gallstones
What does increased AST, ALT likely indicate?
Hepatitis
What does increased total bilirubin likely indicate?
Cirrhosis, hepatitis
Low RBC, hemoglobin, and hematocrit – think about?
Blood loss vs. anemia or other blood dyscrasia
High RBC, hemoglobin, hematocrit, think about?
hemocentration due to dehydration vs polycythemia
Low platelets, think about?
acute infection, bleeding, DIC, HELLP syndrome, or preeclampsia during pregnancy
What does a differential white count do?
Breaks down the WBC count into types – neutrophils, lymphocytes, monocytes, eosinophils, and basophils
What type of white blood cell makes up the majority?
Neutrophils
followed by lymphocytes, monocytes, eosinophils, then basophils
High neutrophils, think about?
Acute bacterial infection
low neutrophils, think about?
severe widespread bacterial or viral infection – this is known as a left shift
High lymphocytes, think about?
Viral infection, such as mono, mumps, or measles
High eosinophils, think about?
Acute allergic reaction
Very high eosinophils, think about?
Parasitic infection
Urine glucose, think about?
Poorly controlled diabetes or possibly DKA
Positive nitrites and/or leukocyte esterase, think about?
UTI
UTI symptoms with negative nitrites and/or leukocyte esterase, think about?
Interstitial cystitis
What can serum beta-hCG do that urine beta-hCG can’t?
Allows for dating of pregnancy
What is the primary test used to screen for syphilis?
Rapid plasma reagin (RPR)
What do you do if a first screening test for syphilis is positive?
You do another blood test
What test do we do for gonorrhea?
Nucleic acid amplification test
Is a nucleic acid amplification test a blood or urine test?
Urine
Whats the problem with using urine tests for STD’s?
They will not detect a vaginal, cervical, anal, or pharyngeal infection.
What test do we do for chlamydia?
Nucleic acid amplification (NAA)
Is the genital herpes test a blood or urine test?
Blooooood
How many samples need to be collected for blood cultures?
two or three
Do we use blood from the same vein for blood cultures?
No! Need different veins
For what infections might we want to get blood cultures?
Meningitis, osteomyelitis, pneumonia, kidney infection, or sepsis
Lactate is a marker for cellular ________.
hypoxia
Once someone’s lactate is above _______ mmol/L the mortality rate increases form 7 percent to _____ percent.
4
27
This test result can help in assessment of a patient’s gas exchange, ventilatory control and acid-base balance
Arterial blood gas
What might cause metabolic acidosis?
DKA
What might cause metabolic alkalosis?
Vomiting
What might cause respiratory acidosis?
Hypoventilation due to pulmonary edema, pneumonia, chronic obstructive pulmonary disease, respiratory depression from drugs
What might cause respiratory alkalosis?
Hyperventilation, pulmonary embolism, anxiety, pain
Do we need to test urine to diagnose DKA?
No
What should be measured in order to monitor the response to DKA treatment?
capillary blood ketones
This test is used to evaluate a patient for the presence of thrombosis, pulmonary embolism, and clot
D-dimer
This is secreted in response to volume overload and results in myocardial stretch
BNP
Increased or persistent elevation in _______ despite treatment, suggests progression of disease or resistance to treatment.
*This is in reference to CHF
BNP
Cardiac _________ are proteins essential to cardiac muscle contraction
troponins
Troponin has replaced _______ as the biomarker of choice for detection of myocardial injury
CK-MB
Which value evaluates the extrinsic pathway of coagulation?
PT/INR
Is the intrinsic or extrinsic pathway responsible for most of the procoagulant activity within the body?
Extrinsic
What drug inhibits the production of vitamin K dependent factors produced in the liver?
Coumadin
What test is used to evaluate the intrinsic pathway of coagulation?
PTT
The effect of what drug is measured using the PTT test?
Heparin
What test will diagnose mononucleosis between 2 and 6 weeks after the onset of the illness?
Monospot
What are some causes of a false-positive monospot?
Toxoplasmosis, rubella, lymphoma, and certain malignancies
What is a cause of false negative “monospot” test?
Testing too early
What is a rapid diagnostic test that is widely used in clinics to assist in the diagnosis of bacterial pharyngitis caused by group A strep?
Rapid strep
Detects influenza A and B?
Influenza swab
The digestive enzyme _______ is secreted by the pancreas and salivary glands
Amylase
What is the main enzyme that breaks down fats?
Lipase
Is Amylase or Lipase more specific to the pancreas?
Lipase
According to Conley’s lecture, what are the two most common complaints in the ED?
- abdominal pain
2. chest pain
