Course 5 Flashcards
(169 cards)
1
Q
Arterial Blood Gas
A
Blood taken from an artery
2
Q
Serum
A
The clear liquid separated from clotted blood. Serum is also another word for blood
3
Q
Coagulation
A
The change of blood from liquid to solid
4
Q
what does POC stand for ?
A
Point of care
5
Q
What are cultures?
A
The propagation of microorganisms or of living tissue cells in media conducive to their growth
6
Q
What is Critical care time ?
A
Any Pt. at serious risk for deterioration that may lead to permanent bodily harm or death
7
Q
Define Hemolyzed Samples
A
The blood cells have broken down due to the incorrect drawing and storing of Blood
8
Q
What does CBC mean?
A
Complete Blood Count
9
Q
What does WBC stand for?
A
White blood cells
10
Q
What does it mean when the blood contains high levels of WBC?
A
-This indicates that there is an infection. A key assoc DDx is Leukocytosis
11
Q
What does Hgb stand for
A
Hemoglobin
12
Q
When there are low amounts of hemoglobin in the blood what does this mean?
A
Anemia
13
Q
What does Hct stand for?
A
Hematocrit
14
Q
What does it means when there are low levels of hematocrit?
A
anemia
15
Q
If the doctor puts in a lab work order for H&H what does this mean?
A
Hemoglobin and Hematocrit
16
Q
What does Plt stand for?
A
Platelets
17
Q
What does it mean when the platelets count is low?
A
The Pt. is prone to bleeding and might have Thrombocytopenia.
18
Q
Which DDx has low platelets count is associated with?
A
Thrombocytopenia
19
Q
Which DDx has high white blood cellc count?
A
Leukocytosis
20
Q
The physician puts in a lab order for CBC. What does this lab order entail?
A
It entails find the count for:
- WBC
- Plts
- Hgb
- Hct
21
Q
What are band cells?
A
Immature Neutrophil
22
Q
What is another way of saying the Band cells are high?
A
Bandemia
23
Q
When the band cells are high what does this indicate?
A
A serious infection
24
Q
What does Seg stand for ?
A
Mature neutrophils also referred to as Segmented Neutrophils
25
When the levels of segmented neutrophils are high what does this indicate?
An acute infection
26
What does Monos stand for?
Monocytes
27
What does high leves of Monocytes indicate?
bacterial infection
28
What does Lymph stand for?
Lymphocytes
29
What type of infection high levels of Lymphocytes indicate?
Viral infection
30
What does Eos stand for?
Eosinophils
31
What type of infection does high levels of Eosinophils indicate?
Parasitic infection
32
The physician puts in an order for CBC with Differentials what does this mean?
```
The order is requesting to check the levels of:
-WBC
-Plts
-Hgb
-Hct
in addition to:
-Band cell
-Segs
-Lymphs = viral infection
-Monos = bacterial infection
-Eos =parasitic infection
```
33
What does BMP stand for?
Basic Metabolic Panel
34
What is the term for low sodium?
Hyponatremia
35
What is the term for high sodium?
Hypernatremia
36
What does it mean when the levels of sodium is too high or low?
Dehydration
37
What is the term for high potassium?
Hyperkalemia
38
What does hyperkalemia indicates?
Poor kidney function
39
What does the term for low potassium mean?
Hypokalemia
40
What does hypokalemia indicate?
May cause arrhythmias
41
Which labs can signify dehydration?
Chloride and Sodium
42
What does BUN stand for?
Blood Urea Nitrogen
43
What do high levels for blood urea nitrogen signify?
Renal insufficiency or failure
44
Where is Creatinine filtered out of the body?
Kidneys
| So if there are high levels in the blood then the kidneys aren't working properly
45
Which labs can signify renal failure or insufficiency?
Creatinine and Blood Urea Nitrogen
46
What does Gluc stand for?
Glucose
47
What is the term for high levels of glucose?
Hyperglycemia
48
What does hyperglycemia signify?
High blood sugar
49
What is the term for low glucose?
Hypoglycemia
50
What does hypoglycemia indicate?
Low blood sugar
51
What does HCO3- stand for?
Bicarbonate
52
What is the term for high HCO3?
Hypercarbia
53
What is the significance of hypercarbia?
Possible respiratory disease
54
What is the term for low HCO3?
Hypocarbia
55
What is the significance of hypocarbia?
Hyperventilation (Possible DKA)
56
What is the term for high chloride?
Hyperchloremia
57
What is the term for low chloride?
Hypochloremia
58
The physician puts in a BMP order. What does this order entail?
```
-BMP stands for Basic Metabolic Panel
It entails testing for :
-Na
-Cl-
-BUN
-K
-HCO3-
-Creat
-Gluc
```
59
What does LFT's stand for?
Liver Function Test
60
The LFT's is apart of which set of tests?
CMP
61
What are the 3 LFTs? What do they assess?
```
They all test for liver function
AST (SGOT)
--Aspartate Transaminase
ALT (SGPT)
--Alanine Transaminase
ALK Phos
--Alkaline Phosphatase
```
62
What does AST stand for?
Aspartate Transaminase
63
What does ALT stand for?
Alanine Transaminase
64
What does Alk Phos stand for?
Alkaline Phosphatase
65
What does CMP stand for?
Comprehensive Metabolic Panel
66
What does the CMP include?
The 3 LFT's and
T bili = Total Bilirubin
T Prot/Alb = Total protein/albumin
67
What does low T Prot/Alb signify?
Poor Nutrition
68
What does high T bili signify?
Jaundice/Liver failure
69
What are the labs in the CEP?
When these levels are high they indicate heart damage
Trop = Troponin
CK= Creatine Kinase
CK- MB = Creatine Kinase- Muscle Breakdown
CK-RI = Creatine Kinase Relative Index
Myo = Myoglobin
70
Define Rhabdomyolysis
s the breakdown of damaged skeletal muscle. Muscle breakdown causes the release of myoglobin into the bloodstream.
A symptom of high Creatine Kinase (CK)
71
What does a troponin diagnose? (be as specific as possible):
Non-STEMI Myocardial Infractions
72
What does a D-dimer detect?
Helps to detect clots in the body but does not specify the type of location
The amount of D-Dimer circulating in the body
73
What is D-Dimer ?
a protein secreted by clots of blood
74
If a D-dimer is possible what is the significance?
If the Physician orders a D-Dimer. She is considering PE as a DDx
75
If the D-dimer is positive what must we order to r/o a PE?
```
CTA chest (with IV contrast)
or a VQ scan
```
76
If the D-dimer is negative what can be excluded from the DDx?
PE
77
What lab is significant for CHF if it is elevated?
BNP
| B-type Natriuretic Peptide
78
What does the ABG (Arterial Blood Gas) check for?
Low pH = Acidosis
High/Low HCO3 = Metabolic problems
High/Low pCO2 (carbon dioxide) = Respiratory problems
Low pO2 = Hypoxia
79
What does the VBG (Venous Blood Gas) check for?
1) Low pH = Acidosis
| 2) High pH = Alkalosis
80
What is the cardiac order set?
```
CBC
BMP
Troponin
EKG
CXR
```
81
A lumbar puncture can diagnose:
Hemorrhagic Cerebrovascular Accident
----If the CSF red blood cells are >0 in tube 4 then its a brain bleed
Meningitis
---If the CSF white blood cells are >3 in tube 4 then it's possible meningitis
82
Supratherapeutic means:
Too much Coumadin
83
Subtherapeutic means:
Not enough Coumadin
84
We check INR because:
Is used to check the levels of Coumadin in the blood. Coumadin is a blood thinner giving to Pt. with Afib.
85
What does COAGS stand for?
Coagulation
86
What is a Normal INR
For Pt. that are not on Coumadin, they have an INR of 1.0
87
What does INR stand for?
International Normalized Ratio
88
If a provider says: I am going to check the enzymes in your pancreas… what will they order?
1) Lip = Lipsae is only found in the Pancreas
| 2) Amy= Amylase is found in both the pancreas and saliva
89
If a pt had a serum HCG quant that was 500 yesterday, but today it is 300… what do you think is happening?
A failed or ectopic pregnancy
90
Nitrites and Leukocyte Esterase are part of what order? What are their significance?
Urine Dip. They test for UTIs
91
Name 3 sepsis labs:
Blood Cx
Lactate
Complete Blood Count
92
Name the 3 abnormal vitals of septic patients:
-Febrile: temp greater than 100.5 degree F or 38.0 degrees Celsius
Tachycardic: HR greater than 100 bpm
Hypotensive : BP less than 90/60
93
A positive Rapid Step Test indicates?
Strep Throat
94
A positive Mononucleosis Test indicates?
Mononucleosis
95
A positive influenza A + B test indicates ?
"The Flu"
96
A positive Respiratory Syncytial Virus test (RSV) indicates?
Bronchiolitis
97
High levels of Lipase indicates Pancreatitis while high levels of Amylase indicates the possibility of Pancreatitis. Why?
Lipase is only found in the pancreas so high levels of this would indicate Pancreatitis. While Amylase is found in both the saliva and the pancreas so its hard to be confident that high levels of amylase mean pancreatitis
98
What does TSH stand for?
Thyroid Stimulating Hormone
99
What is the term for High levels of Thyroid Stimulating Hormone (TSH)? note: think carefully about this one.
Hypothyroidism
100
What is the term for low Thyroid Stimulating Hormone (TSH)? note: think carefully about this one.
Hyperthyroidism
101
Low levels of T3 (Triiodothronine) signify?
Hypothyroidism
102
Low levels of T4 (Thyroxine) signify?
Hypothyroidism
103
What are the inflammation labs?
CRP : C-Reactive Protein
| ESR or Sed Rate: Erythrocyte Sedimentation Rate
104
What does CRP stand for?
C-Reactive Protein
105
What does ESR or Sed Rate stand for?
Erythrocyte Sedimentation Rate
106
State the significance of a Positive and negative HCG ?
Positive HCG in Urine indicates pregnancy
| Negative HCG in urine indicates no pregnancy
107
What does T + S/ABORh mean?
Type and Screen/Blood Type
108
What does Rh negative of a T + S/ABORh indicates ?
Pt. needs RhoGam shot is pregnant
109
What is the purpose of the T + X ?
Gets blood ready for transfusion
110
What is the significance of a Wet Prep (Vaginal Wet Mount)?
Test for Bacterial Vaginosis (BV)
- Trichomoniasis (STD)
- Vaginal Yeast Infection
Wet Prep is done in the ED
111
What 3 labs are known as the rate limiting step?
D-Dimer
Troponin
Creatinine
112
What is the significance of Chlamydia Trachomatis?
It test for Chlamydia (STD)
| Not done in the ED
113
What is the significance of GC (Gonococcus)?
Test for Gonorrhea (STD)
| Not done in the ED
114
What does positive Gluc in the urine indicates?
High Blood Sugar and could mean the Pt. has DM
115
What does Gylcosuria mean?
Glucose in Urine
116
What is the significance of hematuria ?
Kidney stone Vs. UTI
117
If Epi (Epithelial cells) are found in the urine sample, what does the mean?
Contaminated sample
118
What does pyuria mean?
Pus in urine
119
If a Pt. is found to have sepsis, what lab test can you anticipate them ordering and why?
- CXR to r/o PNA
- UA to r/o UTI
- LP to r/o Meningitis
120
List the 4 types that is typically ordered.
- BCx (Blood Culture)---Sepsis
- UCx-- Urine Culture ---UTI
- Wound Cx--wound culture
- Stool Cx--Stool Culture
121
What lab checks for toxicity for Aspirin?
ASA
| Serum Acetysalicylic Acid
122
What lab checks for toxicity for Tylenol?
APAP
| Serum Acetaminophen
123
What would signify likely DKA?
Large amounts of Ketones in the blood (Ketones serum)
124
What lab checks for toxicity for alcohol intoxication?
EtOH
| Serum EtOH Alcohol
125
What lab checks for toxicity for Drug abuse?
Utox
| Urine Drug Screen
126
What is a Portable XR?
XR that are conducted at the Pt bedside. It is brought to the Pt.
127
List the critical care procedures.
```
Headache fever- Lumbar Puncture
Joint reduction -Procedural Sedation
Respiratory failure -Intubation
Sepsis- Central Line Placement
Pneumothorax- Chest Tube
Abnormal heart rhythm- Cardioversion
Cardiac Arrest-CPR
COPD/CHF Exacerbation CPAP/BiPAP
```
128
What does Low levels of INR mean ?
Subthrapeutic; risk of clots
129
What does high levels of coumadin indicate?
supratherapeutic risk for toxicity
130
What is the risk of having low levels of Digoxin?
risk for having Afib
131
What is the risk of having high levels of Digoxin?
risk for toxicity
132
List the four medications that can result in seizure at low levels?
-Tegretol
-Keppra
Depakote
-Neurontin
133
What can a CXR diagnose?
```
PNA
PTX
Widened Mediastinum (dissection)
Pleural effeusion
CHF
```
134
What can an AAS/KUB diagnose?
Free Air (Rupture)
SBO
Constipation
Large kidney stones
135
What does AAS/KUB stand for ?
Acute Abdominal Series/Kidney Ureters Bladder
136
All other X-rays can diagnose?
Fracture
Dislocation
Joint effusion
137
X-rays are great for evaluating what?
Bones in the body
138
What can a "dry CT" diagnose?
CT Head : Ischemic CVA or Hemorrhagic
CT Cervical-spine, Thoracic-spine, lumbar spine
CT Chest: PNA, PTX, Pleural Effusion, Rib fracture
CT A/P: Kidney Stones, Pyelonephritis
139
What does a Dry CT refer to?
CT w/o IV contrast
140
What can a CTA w/ IV contrast diagnose?
CTA chest: Pulmonary Embolism, Aortic Dissection
CTA Head: Hemorrhagic CVA. Ischemic CVA
CTA Neck: Carotid Dissection, Carotid Occlusion
141
CT A/P with PO contrast: (*This requires a 2 hour prep!*) this can diagnose what?
Appendicitis, SBO, Diverticulitis, Ischemic Gut
142
what is the catch with CT’s with IV contrast? There is a lab that needs to be done...why?
Contrast is hazardous to kidney but gives great images.
To ensure that the Pt. is able to do a CTA w/ Iv contrast we check their renal function using the Creatinine test from BMP
143
What does US Doopler LE diagnose?
Deep Venous Thrombosis (DVT)
144
What does US RUQ diagnose?
Cholelithiasis, Cholecystitis, Bile sludge, Gallbladder wall thickening, Bile duct obstruction
145
What does US Obstetrics/Transvaginal diagnose?
```
Intrauterine Pregnancy (IUP)
Ectopic Pregnancy
Ovarian Cyst. Ovarian Torsion
```
146
What does US Scrotum diagnose?
Testicular Torsion. Testicular mass
147
Ultrasounds are great for evaluating what?
Investigative the flow by providing real time images
148
What procedure would be conducted for a joint injury?
Splint Application
149
A dislocation would call for what kind of procedure?
Joint reduction
150
A joint effusion would call for what kind of procedure?
Arthrocentesis
151
What procedure would be done on a laceration and what information should we document about the laceration?
- Laceration repair would be conducted
| - --Key information to record: location, length and depth of the laceration. In addition to what caused the laceration
152
What procedure would be done on an abscess?
Incision & drainage
153
What procedure would be done on a meningitis or hemorrhage?
Lumbar puncture
| -require a sterile environment, betadine prep and local anesthesia with 1% Lido
154
Which Pt. would get bedside US?
Trauma, Suspected acute disease or Ultrasound-guided procedure
155
What preparations are required for a conscious sedation procedure?
Suction at bedside.
| Pt on cardiac monitor and continuous pulse oximetry.
156
Why would a pt. get an endotracheal intubation?
If the Pt. experience respiratory failure. Airway control
157
What preparation are need for a endotracheal intubation?
Suction at bedside.
| Consent precluded by clinical urgency
158
What preparation are needed for a Central Line Placement?
Sterile field, chlorhexidine prep, local anesthesia 1% lidocaine
159
Why would a Pt. need a central line placement?
For intravenous access for abx or fluid resuscitation
160
Where are the 3 major sites for central line placement?
Internal Jugular
Subclavian
Femoral
161
Would would need a chest tube placement?
Pt. with PTX or Hemothorax(blood in lungs)
162
Who would need a cardioversion?
Pt. with Atrial fib or abnormal rhythm
163
What is the difference between an electronic cardioversion and a pharmacologic cardioversion?
electronic cardioversion sends an electrical shock to the heart to adjust the abnormal rhythm
Pharmacologic cardioversion is giving a medication to fix the heart's abnormal rhythm
164
When would a physician order a 12 lead-EKG?
If a Pt. complains of chest pain, SOB or syncope
165
What are the two questions we should ask the provider about critical care time?
1) Does this Patient qualify for critical care?
| 2) How many mins of critical care time were provided?
166
What is the min amount of critical care time given?
30 mins
167
What are the reasons for re-evaluations?
1) discharged
2) Admitted
3) abnormal vital signs
4) physical exam finding
5) treatment was effective
168
What are the 3 reasons for consultations?
1) the Ed doctors needs to admit a pt. to the hospital
2) the ed doctor needs specialist advice regarding a particular disease, treatment or need for follow up
3) the ed doctor calls the patient's PCP to inform them their pt. was evaluated in the ED
169
What are the critical care procedures?
```
Intubation---respiratory failure
Central line placement--sepsis
chest tube- PTX
Cardioversion---abnormal heart rhythm
CPR--cardiac arrest
CPAP/BiPAP--COPD/CHF Exacerbation
```
