Lab Values and Drugs

Question 1

PH

Answer 1

7.35-7.45

Question 2

PCO2

Answer 2

35-45

Question 3

PO2

Answer 3

On ECMO -> 200

Question 4

Lactate

Answer 4

0.5-2

Question 5

NaHCO3

Answer 5

22-28

Question 6

Base deficit

Answer 6

+/- 4

Question 7

Hgb/HCT

Answer 7

12-15 (women) & 13-17 (men)
On ECMO (Adult >7, peds >10)

Question 8

Sodium

Answer 8

135-145

Question 9

Potassium

Answer 9

3.6-5.1

Question 10

Serum calcium

Answer 10

8.9-10.7

Question 11

Ionized Calcium

Answer 11

1.16-1.32

Question 12

Ionized magnesium

Answer 12

0.46-0.64

Question 13

PT

Answer 13

12.3-14.8 s

Question 14

PTT

Answer 14

25-36
On ECMO - 60-80 seconds

Question 15

AntiXa (AKA unfractionated Heparin)

Answer 15

On ECMO - 0.3-0.7
If bleeding 0.2-0.5

Question 16

ATIII activity (<30 days, >30 days)

Answer 16

< 30 days (44-76 %)
> 30 days (80-120 %)

ATIII bonds itself with heparin to work as an anticoagulant, heparin does not work by itself

Question 17

Cultures

Answer 17

You want negative cultures! Blood, urine, respiratory

Question 18

Plasma Hgb

Answer 18

<12

Question 19

Fibrinogen

Answer 19

200-400

Question 20

INR

Answer 20

<2 (on ECMO< 4.9)

Question 21

Troponin

Answer 21

0-0.4

Question 22

CK

Answer 22

40-350

Question 23

CK mb

Answer 23

0-5

Question 24

ALT

Answer 24

0-40

Question 25

AST

Answer 25

0-95

Question 26

Relationship of test to ECMO
Head ultrasound
1) is this done on all ECMO patient
2) when is this test done
3) what does the result show
4) why is this important to patients on ECMO

Answer 26

1) neonates and infants
2) done pre cannulation and then qd for first three days, then every other day
3) intracranial hemorrhage, blood in ventricles
4) it’s a contradiction for ECMO. If it’s a grade 1-2 then they will keep an eye on it, if it’s a grade or larger either will DC ECMO or not put patient on ECMO

Question 27

Relationship of test to ECMO
Chest X-ray
1) is this done on all ECMO patients
2) when is this test done
3) what does this test tell us
4) importance of test

Answer 27

1) yes
2) after cannulation/ daily-PRN
3) cannula placement
4) misplaced cannulas can cause decreased flows, chugging, recirculation (VV), high negative pressures, high positive pressures

Question 28

Relationship of test to ECMO
Cardiac ECHO
1) when is this test done
2) is this done on all ECMO patients
3) what do we learn from this test
4) are the results usually normal or abnormal

Answer 28

1) adults- during weaning (PRN to confirm cannula placement)
Neonates - pre-ECMO and (PRN to confirm cannula placement)
2) yes
3) cardiac function, pulmonary artery pressures
4) usually abnormal for VA and normal for VV

Question 29

Relationship of test to ECMO
CT scan
1) when is it done
2) what do we learn from this test
3) how does this affect the care of our patient
4) do all patients have this test

Answer 29

1) change in patient status
2) check for head bleed, abdominal function (with contrast)
3) can give immediate answers. Sometimes is not tolerated well by patient. If results are poor, then a conversation may happen to discontinue ECMO
4) No, would only need done for a specific change in patient status

Question 30

Relationship of test to ECMO
Fluoroscopy
1) when is this used
2) what does this tell the practitioner
3) what patients are most likely to have this done

Answer 30

1) to place a double-lumen cannula safely
2) cannula placement
3) VV ECMO

Question 31

Relationship of test to ECMO
Cardiac Cath
1) when is this done
2) can patients on ECMO go to the Cath lab
3) describe the information that might come from this test

Answer 31

1) if patient has had a STEMI, any patient on ECPR, create a balloon septostomy in neonates
2) yes
3) check for coronary blockage