Investigation Results Flashcards
High WCC
Infection, leukaemia, steroid use
Low WCC
Bone marrow cancer, viral infection
What do lymphocytes change with?
Viral infections
High eosinophils
Atopy, parasitic infections, vasculitis
High basophils
Infections, inflammatory disorders
High Hb
Lung disease, bone marrow disease
Low Hb
Anaemia
High platelets
Inflammation, infection, bleeding
Low platelets
Viral infection, autoimmune conditions
High MCV
B12 + folate deficiency Liver disease Hypothyroidism Pregnancy Alcohol excess
Low MCV
Anaemia, thalassemia
High urea
AKI, CKD, HF, GI bleed
High sodium
Dehydration
Low sodium/ chloride
D+V, sweating, CKD, Addisons
Too much water due to HF, cirrhosis
High potassium
Kidney disease, Addisons, infection, DM, NSAIDs, B blockers, ACE inhibitors, potassium sparing diuretics
Low potassium
D+V
High bicarbonate
Vomiting, lung disease, Cushing’s, metabolic alkalosis
Low bicarbonate
Addisons, diarrhoea, DKA, metabolic acidosis, kidney disease, aspirin OD
High TSH, normal T3 + T4
Subclinical hypothyroidism
High TSH, low T4 + T3
Hypothyroidism
Low TSH, normal T4 + T3
Subclinical hyperthyroidism
Low TSH, high T4 + T3
Hyperthyroidism
Low TSH, low T4 + T3
Non-thyroid illness
What is ALT + AST?
ALT = specific to liver AST = liver, heart, skeletal muscle, kidneys, pancreas
Very high ALT + AST
Drug induced hepatitis, viral hepatitis, liver ischaemia
Moderate increase in AST + ALT
Chronic/ alcoholic hepatitis, biliary obstruction
Mild increase in AST + ALT
Cirrhosis, fatty liver
ALT higher than AST
Acute liver damage eg hepatitis
AST higher than ALT
Damage due to alcohol
High AST
Haemolysis after MI
High total bilirubin
Blockage of hepatic system eg gallstones
High conjugated bilirubin
Blockage of bile ducts, hepatitis, cirrhosis
High unconjugated bilirubin
Haemolysis, sickle cell, pernicious anaemia
Where is ALP produced?
Biliary ducts, bone, small intestines, kidneys
Very high ALP
Cholestasis (gallstones, pancreatic carcinoma)
High ALP
Hepatitis, cirrhosis, infiltration (abscess, liver carcinoma)
High ALP with calcium + phosphate abnormal
Bone disease
Low albumin + low protein
Cirrhosis
Alcoholism
Chronic inflammation
Kidney disease
Low albumin + normal protein
Infection
Low + increased protein
Myeloma
High albumin
Dehydration
Prolonged PT, normal PTT
Liver disease, decreased Vit K, decreased factor VII
Normal PT, prolonged PTT
Decreased VIII, IX, XI, XII, vW disease
Prolonged PT + PTT
Decreased I, II, V or X, DIC
How to interpret blood gases
O2 - are they hypoxic
pH
Respiratory - PaCO2
Metabolic - HCO3-
What should PaO2 be?
10 below inspired O2
What does a low pH + high PCO2 mean?
Respiratory acidosis
Pneumonia, COPD, over sedation from drugs
High pH low PCO2
Respiratory alkalosis
Hyperventilation, emotional distress, severe infection
Low pH, low bicarbonate
Metabolic acidosis
Diabetes, shock, kidney failure
High pH, high bicarbonate
Metabolic alkalosis
Hypokalaemia, chronic vomiting, sodium bicarb OD
High creatine kinase
Muscle damage
High ESR
Infection, inflammation, anaemia, kidney failure
Low ESR
Polycythaemia, extreme leucocytosis
High lactate
Decreased O2, metformin, shock, infection
High amylase
Pancreatitis, cancer of pancreas or gallbladder, perforated ulcer, mumps, ectopic
X Ray presentation
Intro - identify patient, type of X ray Date + time taken RIP: rotation, inspiration, penetration Obvious abnormalities Systematic approach of anatomical structures
Lung x ray structures
Trachea Hilar structure Zones of lung Costophrenic angles + hemidiaphragms Heart size + contours Bones + soft tissue
Sepsis results
Temp <36 or >38 HR >90 RR >20 WCC <4 or >12 PaCO2 <4.3 Lactate >2
ECG interpretation: rhythm abnormalities
Supraventricular tachycardias:
AF = irregular without P waves
Atrial flutter = regular with sawtooth baseline
Atrial tachycardia = regular with abnormal P waves
VF = no discernible P waves/ QRS complexes
VT = broad complex tachycardia
ECG interpretation: perfusion abnormalities
Infarction: ST elevation, T wave inversion, pathological Q waves
STEMI: ST elevation
Ischaemia: ST depression, new wave T inversion
ECG interpretation: LV hypertrophy
R wave >5 big squares in V5/6, T wave inversion
ECG interpretation: RV hypertrophy
Dominant R wave in V1
T wave inversion in right chest leads
ECG interpretation: hypertrophic cardiomyopathy
LV hypertrophy signs + dramatic T wave inversion in lateral leads
ECG interpretation: hyperkalaemia
Low flat P waves, wide bizarre QRS, slurring into ST segment, tall tented T waves
ECG interpretation: hypokalaemia
Small flattened T waves, prolonged PR, depressed ST, prominent U wave
ECG interpretation: hyper/hypocalcaemia
Hyper: short QT
Hypo: prolonged QT
ECG interpretation: PE signs
Tachycardia
RV strain
T wave inversion in right chest lead
What does NEWS measure?
RR O2 Temp Systolic BP HR LOC
What to do with NEWS 1-4?
4-6 hr obs
Inform nurse
What to do with NEWS >5?
1 hrly obs
Inform medical team + urgent assessment
Clinical care in an environment with monitoring
What to do with NEWS >7?
Continuous monitoring
Immediately inform medical team + seen by reg, transfer to HDU/ ICU
