labs and imaging Flashcards by Renee Torre

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

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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)

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what CBC results suggest anemia

low Hct and low Hgb

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what CBC results suggest an infection

high WBC, high bands, and high differential cells (segs, lymphs, monos, eos)

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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

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what BMP results suggest dehydration

low or high Na, high Cl

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what BMP results suggest kidney problems

high BUN (blood urea nitrogen), high Creat, high K

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what BMP results suggest diabetic-related problems

high or low Gluc

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what is a comprehensive metabolic panel (CMP)

everything from the BMP plus liver function enzymes

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wALT wALKs fAST to Bili!

liver function tests to watch out for. high levels of these point towards liver damage

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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

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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

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what do high levels of BNP (B-type natriuretic peptide) (B-nancy) suggest

congestive heart failure

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what kind of problems do BNP, ABG, and VBG labs investigate

DKA and other respiratory problems

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what do low readings of ABG and VBG labs suggest

blood acidosis, potentially from diabetic ketoacidosis

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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

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what pancreatic enzymes help diagnose pancreatitis

lipase (lip)(strong correlation to pancreatitis) and amylase (amy)(possible pancreatitis)

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describe the types of diabetes testing

serum ketone levels (high = DKA) and finger-stick blood glucose (Accu-Check or FSBG) (high = hyperglycemia, low = hypoglycemia)

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what does a positive qualitative (urine/serum) HCG test mean

pregnant

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what does a high quantitative HCG level mean

further along in pregnancy

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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

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what is sepsis

an infection of the blood or that has spread to the blood

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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

1. how many minutes of critical care time were provided? 2. 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