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Scribe America ED > Day 5: Labs > Flashcards

Day 5: Labs Flashcards

1
Q

What gets tested in the CBC and what does it mean?

A
  1. WBC: high (leukocytosis): infection
  2. Hemoglobin/Hematocrit (H&H): Hgb/Hct: low: anemia
  3. Platelets: Plt : low (Thrombocytopenia) : prone to bleeding
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2
Q

CBC with Differential adds:

A
  1. Bands (band cells): high (bandemia) : serious infection
  2. Segs (segmented neutrophils): high (left shift): acute infection
  3. Lymphs (lymphocytes): high: viral infection
  4. Monos (monocytes): high: bacterial infection
  5. Eos (eosinophils): high: parasitic infection
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3
Q

What does the BMP include?

A

Na, K, BUN, Creat, Gluc, (HCO3, Cl)

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4
Q

BMP: Na

A

High (hypernatremia) : dehydration
Low (hyponatremia): dehydration

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5
Q

BMP: K

A

High (hyperkalemia): poor kidney function
Low (hypokalemia): prone to arrhythmias

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6
Q

BMP: BUN

A

high: renal insufficiency or failure

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7
Q

BMP: Creat

A

high: renal insufficiency or failure

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8
Q

What does the CMP include

A

BMP, T Prot/Alb, T bili, AST (SGOT), ALT (SPGT), Alk Phos

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9
Q

CMP: T prot/Alb

A

Total Protein/Albumin: low : poor nutrition

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10
Q

CMP: T bili

A

Total bilirubin: high: jaundice/liver failure

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11
Q

CMP: AST (SGOT)

A

Asparatate Transaminase: high: liver damage

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12
Q

CMP: ALT (SGPT)

A

Alanine Transaminase: High :liver damage

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13
Q

CMP: Alk Phos

A

Alkaline Phosphatase: high : liver damage

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14
Q

WHat does the cardiac enzyme panel include

A

Trop, CK, CK-MB, CK-RI

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15
Q

Cardiac Enzyme: Trop

A

Troponin: high: specific to heart damage

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16
Q

Cardiac Enzyme: CK

A

creatinine kinase: high: heart damage or Rhabdomyolosis

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17
Q

D-dimer test for and significance:

A

Tests for PE, if high you must order either CTA chest (check creatine first) or VQ scan to rule out PE

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18
Q

What are the respiratory labs?

A

BNP, ABG, VBG

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19
Q

Describe BNP:

A

B-type natriuretic peptide; high: CHF

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20
Q

Describe ABG:

A

Arterial blood gas; low pH: acidosis
High/Low HCO3: metabolic problem
High/Low pCO2: respiratory problem
Low pO2: hypoxia

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21
Q

Describe VBG:

A

venous blood gas; low pH: acidosis
High pH: alkalosis

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22
Q

The cardiac order set:

A

CBC, BMP, CK (CK-MB), Troponin, EKG, CXR

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23
Q

For whom will the cardiac order set be given?

A

Any adult complaining of chest pain

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24
Q

What are the ENT labs?

A

Strep, Monospot, Influenza A/B

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25
What are the pancreatic enzymes?
Lipase (Lip): high: specific to pancreatitis Amylase (Amy): high : possible pancreatitis
26
What are the inflammation labs?
CRP (c-reactive protein): high: active inflammation ESR or Sed Rate (erythrocyte sedimentation rate) : high: active inflammation
27
What are the OB/GYN labs?
HCG, Serum HCG Qual, HCG Quant
28
HCG tests for:
Positive: pregnant, Negative: not pregnant
29
Serum HCG qual tests for:
positive: preg, negative: not preg
30
Serum HCG quant tests for:
how long they have been pregnant If it gets higher, further along if it gets lower or unchanged: failed pregnancy
31
What are the pelvic exam labs?
Wet prep, GC, CT, Genital Cx
32
Pelvic: Wet Prep:
Many clue cells: Bacterial Vaginosis (BV) Many trichomonas : STC Many yeast: Vaginal Yeast Infection
33
Pelvic: GC
Gonococcus: Pos: Gonorrhea (STD)
34
Pelvic: CT
Chlamydia Trachomatis: Pos: Chlamydia (STD)
35
Pelvic: Genital Cx
Genital Culture: positive growth: pending results, ED will call pt if Cx is pos
36
Urine dip tests for:
Leuks, Nit, Gluc, Blo
37
Urine: Leuks
Leukocytes: pos: likely UTI
38
Urine: Nit
Nitrite: pos: UTI
39
Urine: Gluc
Glucose: pos: High blood sugar DM
40
Urine: Blo
Blood: pos: kidney stone vs. UTI
41
3 Efficiency Labs:
D-dim, Trop, Creat
42
Creatinine:
\>1.4: cannot give CT with dye
43
Trop:
Troponin: if high: Acute MI: give ASA, NTG, B blocker, heparin
44
D-dim
D-Dimer: high: must order CTA chest or VQ scan depending on creat
45
Micro UA tests:
WBC, RBC, Bacteria in urine ( all show for UTI) and epithelial cells in sample means contaminated
46
Medication Levels: Dilantin, INR, Tegretol
Dilantin: low (subtheraputic): at risk for sz INR (coumadin level): Low: at risk for clots; high: at risk for bleed Tegretol: low: at risk for sz
47
Steps to obtain lab results:
1. lab order placed by MD 2. nurse draws blood 3. tubes placed in plastic bags and delivered to lab 4. lab tech runs samples 5. lab results visible in meditech
48
Steps to obtain imagine results:
1. imagining order placed by MD 2. transport tech takes pt to XR, CT, or US 3. study is performed 4. films are loaded into PACS and available to view 5. MD reviews and interprets the film (preliminary vs. final read)
49
Types of XR:
CXR, AAS/KUB, all others
50
XR: CXR:
potential findings: PNA, PTX, widened mediastinum (dissection), pleural effusion, CHF
51
XR: AAS/KUB:
potential findings: Free air (rupture), SBO, constipation, large kidney stones
52
XR: all others:
Potential findings: fx, dislocation, joint effusion
53
Types of CT scans:
CT w/o, CTA, CT w/, CT A/P w/PO
54
CT: CT w/o
"dry CT", w/o contrast: potential findings: 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: PNA, PTX, Pleural effusion, rib fx CT Abd/Pel: kidney stones, pyelonephritis
55
CT: CTA, CT w/
CT Angiogram, CT w/IV contrast: potential findings: CTA Chest: PE, Aortic Dissection CTA Head: hemorrhagic CVA, Ischemic CVA CTA Neck: carotid dissection, carotid occlusion
56
CT: CT A/P w/ PO
CT Abd/Pel w/PO contrast: potential findings: Appy, SBO, Diverticulitis, Ischemic Gut
57
Types of Ultrasounds
US Doppler LE, US RUQ, US OB/Transvag/Pelvis, US Scrotum
58
US: US Doppler LE:
potential findings: DVT
59
US: US RUQ
Potential findings: Cholelithiasis (gallstones), Cholecystitis, bile sludge, gallbladder wall thickening, bile duct obstruction
60
US: US OB/Transvag/Pelvis
Potential findings: IUP, Ectopic pregnancy, ovarian cyst, ovarian torsion
61
US: US Scrotum
potential findings: testicular torsion, testicular mass
62
What are the orthopedic procedures?
Splint application, joint reduction (for dislocation), Athrocentesis (needle aspiration)
63
What are the skin procedures?
Laceration repair (stitches), I&D (1% lidocaine)
64
Other procedures:
LP, Bedside ultrasound, Conscious sedation (procedural sedation or moderate sedation)
65
Critical Care Procedures:
Endotracheal intubation (for respiratory failure) Central Line Placement (for fluid resuscitation or IV access) Chest tube placement (for PTX or hemothorax) Cardioversion (for A-fib) (defibrillation)
66
What are the low acuity procedure? (8)
Splint/Sling application laceration repair I&D Foreign body removal Cerumen disimpaction Rectal disimpaction Nail trephination (for subungual hematoma) Epistaxis management (cautery or packing)
67
Complaint to procedure: Joint injury
splint application
68
Complaint to procedure: Laceration
laceration repair
69
Complaint to procedure: Abscess
I&D
70
Complaint to procedure: Joint effusion
Arthrocentesis
71
Complaint to procedure: Dislocation
Joint reduction
72
Complaint to procedure: Headache/Fever
Lumbar Puncture
73
Complaint to procedure: Joint reduction
procedural sedation
74
Complaint to procedure: Respiratory failure
CRITICAL CARE; intubation
75
Complaint to procedure: Sepsis
CRITICAL CARE; central line placement
76
Complaint to procedure: PTX
CRITICAL CARE; chest tube
77
Complaint to procedure: Abnormal heart rhythm
CRITICAL CARE; cardioversion
78
Complaint to procedure: Cardiac Arrest
CRITICAL CARE; CPR
79
Complaint to procedure: COPD/CHF exacerbation
CRITICAL CARE; CPAP/BiPAP
80
Is the Doc doing the PE or a procedure?
Remember: actions during the PE are meant to gain info, procedures are meant to FIX problems
81
EKG rules for scribe:
- track closely when it is performed - after it is printed, ask Doc for EKG interpretation and be ready to write!
82
NSR
normal sinus rhythm, Normal RR 60-100
83
SB
sinus bradicardia (NRR \<60)
84
ST
sinus tachycardia (NRR \< 100)
85
A fib
atrial fibrillation
86
A flutter
atrial flutter
87
Paced
pacemaker is functioning
88
SVT
supraventricular tachycardia
89
PVC
premature ventricular contraction
90
PAC
premature atrial contraction
91
LAD
left axis deviation
92
RAD
right axis deviation
93
LAFB
left anterior fascicular block
94
LBBB
left bundle branch block
95
RBBB
right bundle branch block
96
1 degree AVB
first degree AV block (2 & 3 degree)
97
LVH
left ventricular hypertrophy
98
PRWP
poor R wave progression
99
ST up
acute ST elevation
100
ST down
acute ST depression
101
NSST changes
non-specific ST/T changes
102
5 reasons that a pt would be reevaluated:
1. discharge 2. admitted 3. abnormal vitals 4. PE finding 5. deterimine if a particular treatment was effective
103
Three reasons a Doc would get a consult:
1. ED doc needs to admit pt to hospital 2. ED doc needs specialist advise regarding treatment, follow up, or the disease 3. ED doc calls pt's PCP to inform them their pt was in ED

Scribe America ED (13 decks)

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