labs and imaging Flashcards
What is the ED course?
it is instrumental in ruling or confirming the DDx that is generated from hx and PE. consists of lab & imaging results, procedures, medications given, consultations, reevaluations
describe a complete blood count (CBC) w/ differential
A measure of the number of red blood cells, white blood cells (WBC), and platelets (Plt), hematocrit (Hct), hemoglobin (Hgb) including the different types of white blood cells such as neutrophils (segs), lymphocytes (lymphs), monocytes (monos), and eosinophils (Eos)
what CBC results suggest anemia
low Hct and low Hgb
what CBC results suggest an infection
high WBC, high bands, and high differential cells (segs, lymphs, monos, eos)
describe basic metabolic panel (BMP)
it provides important information about the chemical and metabolic balance of the blood; main takeaway look at electrolyte imbalances, kidney problems, diabetic-related problems. includes Na, K, BUN, Creat, Gluc, HCO3, Cl
what BMP results suggest dehydration
low or high Na, high Cl
what BMP results suggest kidney problems
high BUN (blood urea nitrogen), high Creat, high K
what BMP results suggest diabetic-related problems
high or low Gluc
what is a comprehensive metabolic panel (CMP)
everything from the BMP plus liver function enzymes
wALT wALKs fAST to Bili!
liver function tests to watch out for. high levels of these point towards liver damage
what is the cardiac order set
*Trop, *EKG, CXR, CBC, BMP
these orders will placed for almost every adult pt who c/o chest pain
what does a high D-Dimer test suggest
D-dimer is a protein excreted by blood clots, therefore high D-dimer levels suggest a PE. a positive D-dimer does not necessarily mean a PE, but means a CTA chest needs to be ordered. a negative D-dimer means a PE can be excluded from the ddx
what do high levels of BNP (B-type natriuretic peptide) (B-nancy) suggest
congestive heart failure
what kind of problems do BNP, ABG, and VBG labs investigate
DKA and other respiratory problems
what do low readings of ABG and VBG labs suggest
blood acidosis, potentially from diabetic ketoacidosis
what is INR
international normalized ratio, measures the time it takes for blood to clot, especially while taking coumadin. pt who take coumadin should have INR btwn 2.0-3.0
what pancreatic enzymes help diagnose pancreatitis
lipase (lip)(strong correlation to pancreatitis) and amylase (amy)(possible pancreatitis)
describe the types of diabetes testing
serum ketone levels (high = DKA) and finger-stick blood glucose (Accu-Check or FSBG) (high = hyperglycemia, low = hypoglycemia)
what does a positive qualitative (urine/serum) HCG test mean
pregnant
what does a high quantitative HCG level mean
further along in pregnancy
why is it important for pregnant women to get a blood screen/blood type test? (T+S/ABO Rh)
to determine if the BT of the mother and baby are compatible. if Rh negative, then mother will need rhogam shot if pregnant
what is sepsis
an infection of the blood or that has spread to the blood
what tests are ordered if a pt is suspected to be septic
CBC w/ diff (signs of infection), lactate (cell death in the body or sepsis), blood cx
t/f: blood cultures results typically come back on the same day as they are ordered
false, they never come back the same day
how should you document if a culture was ordered in the chart
“___ culture was ordered, awaiting the results”
what should you look for when ordering and reading a urinalysis
sign os UTIs, DM, and kidney stones; WBC, RBC, bacteria, epithelial cells
what should you look for when testing the CSF? how is it collected?
lumbar puncture, looking for SAH (subarachnoid hemorrhage) and meningitis
The provider is performing a lumbar puncture. This means they wants to rule out 1 of 2 concerning conditions in the ED. The CSF analysis can be used to diagnose (select all that apply)
- hyperglycemia, meningitis, UTI, SAH, ischemic stroke
meningitis and SAH
what is an x-ray and what is it used to diagnose
produces images of the structures inside your body, especially bones. diagnoses bone fractures, infections, swallowed items, digestive tract problems
what are some potential things that can be diagnosed by a chest x-ray
PNA, PTX, widened mediastinum (dissection), pleural effusion, CHF
what can an acute abdominal series/kidneys ureters bladder (AAS/KUB) x ray diagnose
free air (rupture), SBO, constipation, large kidney stones
what can be seen on all other x-rays
fractures, dislocation, joint effusion
what are some pros and cons of x-rays
pros: simple, quick, easy to interpret, shows some soft tissue, especially beneficial for bones!
cons: radiation, not good for pregnant pts, cannot see other tissues or BV
what is a CT scan and what is it used to diagnose
a series of x-rays to create cross-sections of the inside of the body, including bones, BV, and soft tissues. injuries from trauma, bone fractures, vascular disease, infections
what are the 3 types of CTs
CT w/out contrast, CT w/ contrast, and CT abd/pelvis w/ PO contrast
what is the difference between IV contrast and PO contrast
IV contrast is injected through the veins and travels to the arteries and by the time it returns to the veins it is very diluted, good for see arteries. PO contrast is taken orally therefore it is good for observing the GI tract, but it takes a while to travel
what do you need to do before performing a CTA
CTAs are bad for the kidneys, so always check creatine levels. high creat = poor kidney fxn
what are the pros and cons of CT scans
pro: very detailed (especially w soft tissue), IV contrast shows circulatory system (clots, blockages, aneurysms), PO contrast shows GI tract
cons: TONS of radiation, IV contrast could harm kidney function, PO contrast studies take forever
what is an ultrasound/sonogram? what is it used to diagnose?
produce images of organs and show parts of the body in motion (e.g. heart beating or blood flowing through blood vessels). used to diagnose gallbladder disease, genital/prostate issues, blood flow problems, monitoring pregnancy
what are some pros and cons of an US
pros: no radiation, takes videos to investigate flow and movement
cons: takes longer to get results (time for videos, time to interpret), only see superficial structures
NSR
normal sinus rhythm
BBB
bundle branch block
LAD
left axis deviation
if the clinician says “normal EKG at 80”, what would the scribe write
NSR at a rate of 80 bpm, no acute ST/T changes
if the clinician says “sinus at 72” what would the scribe write
NSR at a rate of 72 bpm
if the clinicians says “sinus at 114” what would the scribe write
sinus tachycardia at a rate of 114 bpm
if the clinician says “sinus at 56” what would the scribe write
sinus bradycardia at a rate of 56 bpm
dr says: sinus brady, scribe writes:
sinus bradycardia
dr says: sinus tachy, scribe writes:
sinus tachycardia
dr says: left/right bundle; scribe writes:
L/RBBB
dr says: nothing acute; scribe writes:
no acute ST/T changes
dr says: non specific changes; scribe writes:
nonspecific ST/T changes
dr says: lead one, lead two, or lead three; scribe writes:
Lead I, Lead II or Lead III
what is critical care
care provided to any pt that is at serious risk for deterioration that may lead to permanent bodily harm or death
what steps should you take if a clinician asks you to document critical care
- how many minutes of critical care time were provided?
- ensure you have thorough documentation
when do re-evaluations occur
when the clinicians want to 1. determine if pt’s status has changed, 2. to discuss discharge instructions or admission, 3. re-check abnormal vital signs re-checked, 4. determine if a particular treatment was effective
what information needs to be included when documenting a consult
timestamp, name of provider being consulted, specialty of this provider, what was discussed
