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ScribeAmerica ED Classroom Training > Course 5: Labs and Imaging > Flashcards

Course 5: Labs and Imaging Flashcards

1
Q

Function of the ED course

A
  1. The ED course is instrumental in ruling out or confirming the DDx
  2. Contains the remaining objective workup after the physical exam
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2
Q

ED Course Contents

A

Lab and imaging results, Procedures, Medications given, Consultations, Reevaluations

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3
Q

Complete Blood Count (CBC) with Differentials

A

White Blood Cells (WBC), Hemoglobin (Hgb), Hematocrit (Hct), Platelets (Plt), Bands cells (Bands), Segmented neutrophils (Segs), Lymphocytes (Lymphs), Monocytes (Monos), Eosinophils (Eos)

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4
Q

White Blood Cells (WBC) Significance

A

High → Leukocytosis (infection)

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5
Q

Hemoglobin (Hgb) Significance

A

Low → Anemia

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6
Q

Hematocrit (Hct) Significance

A

Low → Anemia

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7
Q

Platelets (Plt) Significance

A

Low → Thrombocytopenia (prone to bleeding)

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8
Q

Bands Cells (Bands) Significance

A

High → Bandemia (infection)

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9
Q

Segmented Neutrophils (Segs), Lymphocytes (Lymphs), Monocytes (Monos), Eosinophils (Eos) Significance

A

High → Infection

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10
Q

Basic Metabolic Panel (BMP)

A

Sodium (Na), Potassium (K), Blood urea nitrogen (BUN), Creatinine (Creat), Glucose (Gluc), Bicarbonate (HCO3), Chloride (Cl)

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11
Q

Sodium (Na) Significance

A

High → Hypernatremia (dehydration)

Low → Hyponatremia (dehydration)

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12
Q

Potassium (K) Significance

A

High → Hyperkalemia (poor kidney function)

Low → Hypokalemia

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13
Q

Blood urea nitrogen (BUN) and Creatinine (Creat) Significance

A

High → Renal insufficiency or renal failure

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14
Q

Glucose (Gluc) Significance

A

High → Hyperglycemia

Low → Hypoglycemia

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15
Q

Bicarbonate (HCO3) Significance

A

High → Possible respiratory disease

Low → Hyperventilation

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16
Q

Chloride (Cl) Significance

A

High → Dehydration

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17
Q

Comprehensive Metabolic Panel (CMP)

A

Sodium (Na), Potassium (K), Blood urea nitrogen (BUN), Creatinine (Creat), Glucose (Gluc), Bicarbonate (HCO3), Chloride (Cl), Total protein (T Prot), Albumin (Alb), Total bilirubin (T Bili), Aspartate transaminase (AST or SGOT), Alanine transaminase (ALT or SGPT), Alkaline phosphatase (Alk Phos)

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18
Q

Total Protein (T Prot) Significance

A

Low → Hemorrhage, liver disease, kidney disease

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19
Q

Albumin (Alb) Significance

A

Low → Liver or kidney problem

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20
Q

Total Bilirubin (T Bili), Aspartate Transaminase (AST or SGOT), Alanine Transaminase (ALT or SGPT), Alkaline Phosphatase (Alk Phos) Significance

A

High → Liver damage

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21
Q

Cardiac Order Set

A

Troponin (Trop), EKG, CXR, CBC, BMP

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22
Q

D-Dimer Significance

A

High → Must rule out pulmonary embolism

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23
Q

Respiratory Labs

A

B-type natriuretic peptide (BNP), Arterial blood gas (ABG), Venous blood gas (VBG)

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24
Q

B-Type Natriuretic Peptide (BNP) Significance

A

High → Congestive heart failure

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25
Q

Arterial Blood Gas (ABG) Significance

A

Low pH → Acidosis

High/low HCO3 → Metabolic problem

High/low pCO2 → Respiratory problem

Low pO2 → Hypoxia

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26
Q

Venous Blood Gas (VBG) Significance

A

Low pH → Acidosis

High pH → Alkalosis

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27
Q

Coagulation Studies (Coags)

A

Prothrombin time (PT), International normalized ratio (INR)

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28
Q

Prothrombin Time (PT) Significance

A

High → Blood that clots too slowly

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29
Q

International Normalized Ratio (INR) Significance

A

> 3 → Too much Coumadin = Supratherapeutic

2-3 → Normal if on Coumadin = Therapeutic

< 2-3 → Too low = Subtherapeutic

1 → Normal if not on Coumadin

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30
Q

Pancreatic Enzymes

A

Lipase (Lip), Amylase (Amy)

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31
Q

Lipase (Lip) Significance

A

High → Pancreatitis

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32
Q

Amylase (Amy) Significance

A

High → Possible pancreatitis

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33
Q

Diabetes Testing

A

Serum ketones, Finger-stick blood glucose (Accu-Check or FSBG)

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34
Q

Serum Ketones Significance

A

High → Diabetic ketoacidosis (DKA)

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35
Q

Finger-stick blood glucose (Accu-Check or FSBG) Significance

A

High → High blood sugar (hyperglycemia)

Low → Low blood sugar (hypoglycemia)

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36
Q

Obstetrics

A

Urine βHCG (HCG), Serum βHCG qualitative (HCG), Serum βHCG quantitative (HCG Quant), Type and screen/blood type (T+S/ABO Rh), Type and cross (T+X)

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37
Q

Urine βHCG (HCG) Significance

A

Positive → Pregnant

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38
Q

Serum βHCG Qualitative (HCG) Significance

A

Positive → Pregnant

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39
Q

Serum βHCG Quantitative (HCG Quant) Significance

A

High → Further along in pregnancy

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40
Q

Type and Screen/Blood Type (T+S/ABO Rh) Significance

A

Blood type → In case blood transfusion needed

Rh negative → Will need Rhogam shot if pregnant

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41
Q

Type and Cross (T+X) Significance

A

Blood type → Gets blood ready for transfusion

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42
Q

Sepsis

A

Complete blood count (CBC) with differentials, Lactate or lactic acid, Blood cultures (Blood Cx)

43
Q

Complete Blood Count (CBC) with Differentials Significance

A

High WBC → Leukocytosis (possible sepsis)

High bands → Bandemia (possible sepsis)

44
Q

Lactate or Lactic Acid Significance

A

High → Sepsis or cell death in the body

45
Q

Blood Cultures (Blood Cx) Significance

A

Positive growth → Sepsis

46
Q

Cultures

A

Blood culture (BCx), Urine culture (UCx), Wound culture (WCx), Stool culture (SCx)

47
Q

Blood Culture (BCx) Significance

A

Positive growth → Sepsis

48
Q

Urine Culture (UCx) Significance

A

Positive growth → Urinary tract infection (UTI)

49
Q

Wound Culture (WCx) and Stool Culture (SCx) Significance

A

Positive growth → Infection

50
Q

Microscopic Urinalysis

A

White blood cells (WBC), Red blood cells (RBC), Bacteria, Epithelial cells (Epi)

51
Q

White Blood Cells (WBC) Urine Significance

A

Many → Urinary tract infection (UTI)

52
Q

Red Blood Cells (RBC) Urine Significance

A

Many → Possible urinary tract infection (UTI) or kidney stones

53
Q

Bacteria Urine Significance

A

Many → Urinary tract infection (UTI)

54
Q

Epithelial Cells (Epi) Urine Significance

A

Many → Contaminated specimen

55
Q

ENT

A

Rapid Strep test, Mononucleosis, Influenza A+B, Respiratory syncytial virus (RSV), Covid-19 antigen

56
Q

Rapit Strep Test Significance

A

Positive → Strep throat

57
Q

Mononucleosis Significance

A

Positive → Mononucleosis

58
Q

Influenza A+B Significance

A

Positive → Influenza

59
Q

Respiratory Syncytial Virus (RSV) Significance

A

Positive → Respiratory syncytial virus (RSV)

60
Q

Covid-19 Antigen Significance

A

Positive → Covid-19

61
Q

Genital

A

Vaginal wet mount (wet prep), Gonococcus (GC), Chlamydia trachomatis (CT), Genital culture

62
Q

Vaginal Wet Mount (Wet Prep) Significance

A

Positive clue cells → Bacterial vaginosis (BV)

Positive trichomonas → Trichomoniasis (STD)

Positive yeast → Vaginal yeast infection

63
Q

Gonococcus (GC) Significance

A

Positive → Gonorrhea (STI)

64
Q

Chlamydia Trachomatis (CT) Significance

A

Positive → Chlamydia (STI)

65
Q

Genital Culture Significance

A

Positive growth → Infection

66
Q

Cerebrospinal Fluid (CSF)

A

CSF glucose, CSF protein, CSF red blood cells (RBC), CSF white blood cells (WBC), CSF Gram stain

67
Q

CSF Glucose Significance

A

Low → Possible bacterial meningitis

68
Q

CSF Protein Significance

A

High → Possible meningitis

69
Q

CSF Red Blood Cells (RBC) Significance

A

Greater than 4 in tube 4 → Subarachnoid hemorrhage

70
Q

CSF White Blood Cells (WBC) Significance

A

Greater than 3 in tube 4 → Possible meningitis

71
Q

CSF Gram Stain Significance

A

Positive bacteria → Meningitis

72
Q

Types of Imaging Studies

A

X-ray, CT, Ultrasound/sonogram

73
Q

X-Ray Description

A

Produce images of the structures inside of the body, especially bones

74
Q

X-Ray Diagnostic Utility

A

Bone fractures, infections, swallowed items, digestive tract problems

75
Q

CT Description

A

A series of x-rays to create a to create cross sections of the inside of the body, including bones, blood vessels, and soft tissues

76
Q

CT Diagnostic Utility

A

Injuries from trauma, bone fractures, vascular disease, infections

77
Q

Ultrasound/Sonogram Description

A

Produce images of organs and show parts of the body in motion e.g. heart beating or blood flowing through blood vessels

78
Q

Chest X-Ray (CXR) Potential Findings

A

Pneumonia, pneumothorax, widened mediastinum (dissection), pleural effusion, congestive heart failure

79
Q

Acute Abdominal Series (AAS)/Kidneys Ureters Bladder (KUB) Potential Findings

A

Free air (rupture), small bowel obstruction (SBO), constipation, large kidney stones

80
Q

All Other X-Rays Potential Findings

A

Fracture, dislocation, joint effusion

81
Q

CT without IV Contrast Potential Findings

A

CT head: Large hemorrhagic or ischemic CVA

CT C-spine/T-spine/L-spine: Cervical/thoracic/lumbar spine fracture or subluxation (partial dislocation)

CT chest: Pneumonia (PNA), pneumothorax (PTX), pleural effusion, rib fracture

CT abdomen/pelvis: Kidney stones, pyelonephritis

82
Q

CT Angiogram (CTA)/CT with IV Contrast Potential Findings

A

CTA head: Hemorrhagic CVA, ischemic CVA

CTA neck: Carotid dissection, carotid occlusion

CTA chest: Pulmonary embolism, aortic dissection

83
Q

CT Abdomen/Pelvis with PO Contrast Potential Findings

A

CT abdomen/pelvis: Appendicitis, small bowel obstruction (SBO), diverticulitis, ischemic gut

84
Q

Ultrasound Doppler Lower Extremities Potential Findings

A

Deep vein thrombosis (DVT

85
Q

Abdominal Ultrasound of RUQ Potential Findings

A

Cholelithiasis, cholecystitis, bile sludge, gallbladder wall thickening, bile duct obstruction

86
Q

Ultrasound Obstetrics/Transvaginal Potential Findings

A

Intrauterine pregnancy (IUP), ectopic pregnancy, ovarian cyst, ovarian torsion

87
Q

Ultrasound Scrotum Potential Findings

A

Testicular torsion, testicular mass

88
Q

Clinician says “Normal EKG at 80 (bpm)”

A

Scribe documents “NSR at a rate of 80 bpm, no acute ST/T changes”

89
Q

Clinician says “Sinus at 72”

A

Scribe documents “Normal sinus rhythm at a rate of 72 bpm”

90
Q

Clinician says “Sinus at 114”

A

Scribe documents “Sinus tachycardia at a rate of 114 bpm”

91
Q

Clinician says “Sinus at 56”

A

Scribe documents “Sinus bradycardia at a rate of 56 bpm”

92
Q

Clinician says “Sinus brady”

A

Scribe documents “Sinus bradycardia”

93
Q

Clinician says “Sinus tachy”

A

Scribe documents “Sinus tachycardia”

94
Q

Clinician says “Left bundle”

A

Scribe documents “LBBB”

95
Q

Clinician says “Right bundle”

A

Scribe documents “RBBB”

96
Q

Clinician says “Left axis”

A

Scribe documents “LAD”

97
Q

Clinician says “Nothing acute”

A

Scribe documents “No acute ST/T changes”

98
Q

Clinician says “Non specific changes”

A

Scribe documents “Nonspecific ST/T changes”

99
Q

Clinician says “Lead one, lead two, or lead three”

A

Scribe documents “Lead I, Lead II, or Lead III”

100
Q

Critical Care Scribe Role

A
  1. Ask “How many minutes of critical care time were provided?”
  2. Ensure you have thorough documentation
101
Q

Reevaluations occur when the clinician wants to…

A
  • Determine whether the patient’s status is improving, unchanged, or worsening
  • Discuss discharge instructions or admission
  • Re-check abnormal vital signs
  • Determine if a particular treatment was effective
102
Q

Consults are completed if the provider needs to…

A
  • Admit a patient to the hospital
  • Gain a specialist’s advice
  • Inform the patient’s PCP that they were evaluated in the ED
103
Q

What to include when documenting a consult…

A
  • Timestamp
  • Name of provider being consulted
  • Specialty of provider being consulted
  • What was discussed
104
Q

Disposition Options

A
  • Discharged to home
  • Discharged to nursing facility
  • Admitted
  • Transferred
  • Left against medical advice (AMA)
  • Expired

ScribeAmerica ED Classroom Training (5 decks)

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