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Emergency Testing

Emergency Medicine

labs to get in the w/u of sepsis CBC, chems (LFTs, bicarb, creatinine), PT/PTT, Lactate
an important marker of global tissue hypoxia lactate
additional labs to evaluate source of sepsis blood cultures, UA,urine C & S, CXR, discharge from lesions, sterile fluids if suspected
CSF tube 1 is used for what purpose appearance; cell count/diff
CSF tube 2 is used for what purpose glucose and protein
CSF tube 3 is used for what purpose gram stain and culture
CSF tube 4 is used for what purpose cell count with differential
what patients with cystitis should get a urine culture anyone who is not a healthy young female
pneumonia labs CBC; CXR; sputum gr stain/cx; Blood cx; Pulse ox, ABG; Urine for streptococcal and Legionella antigen; PCR assays; Serologies; Influenza rapid antigen
Septic arthritis: Joint fluid analysis Cell count/diff (WBC <200 normal; septic >50-60K); Diff: <25% PMN normal; >50% PMN infxs/inflam; Gr stain/cx; Crystals
What do you include in the work-up of a corneal abrasion Slit lamp exam with fluorescein, evert lids to rule out foreign body
What should be included in the workup for central retinal artery occlusion ESR for temporal arteritis
What should be done in the case of orbital cellulitis Emergent CT of the orbits and sinuses, ophthalmologic consultation and admission for cefuroxime IV
What is the preferred topical ocular anesthetic used when assessing a corneal abrasion Proparacaine
How will a corneal abrasion appear during fluorescein stain when using cobalt blue light on slit lamp It will fluoresce green
A hyphema should be dilated with __ to prevent pupillary movement from tearing damaged blood vessels Atropine 1%
A bright green streaming appearance to fluorescein instilled into the tear layer (Seidel test) is pathognomonic for what Penetrating trauma or ruptured globe
What is a normal range for IOP 10-20 mm Hg
What may be seen on funduscopic exam with giant cell arteritis? Flame hemorrhages
What labs should be ordered when giant cell arteritis is suspected Sed rate, c-reactive protein
Hyphema work-up Assume open globe; poss CT (if suspect blow out fx); poss US to r/o vitreous hemo or retinal detach; SPE (pts w/SCD)
MI labs troponin, CKMB
AAA imaging xray: calcified arch or paravert ST mass; u/s accurate for dx/measuring diameter; CT most sensitive for ruptured AAA
Imaging modality of choice for acute pancreatitis CT
Imaging modality of choice for aortic aneurysm CT
Imaging modality of choice for acute appy CT w/contrast: shows walls >2mm, abscess, free fluid, RLQ fat stranding, appendicolith
Imaging modality of choice for biliary obstruction u/s is definitive initial test for GS; u/s or HIDA for cholecystitis; xray/CT for porcelain; u/s or ERCP for choledocho
GI bleed labs CMP, CBC (H&H), type & cross, coags; BUN often elevated 2/2 GI blood breakdown; ECG; poss NG tube to distinguish upper/lower
GIB: angiography requires bleeding rates of: 0.5 - 2.0 mL/min
imaging TOC for upper GIB = endoscopy
GIB IVF resuscitation 3:1 rule - 3L crystalloid per 1L blood lost
GIB RFs EtOH, NSAIDs, steroids, anticoag meds
mesenteric ischemia TOC angio/CTA; abd xray/CT shows wall thickening / pneumatosis intestinalis
biliary labs ECG, CBC, lytes, LFTs, bili, amylase, lipase, UA, bHCG
appendicitis labs UA, CBC, bHCG
what radiographs should be obtained to assess for intestinal obstruction flat and upright abdominal, and upright chest
pancreatitis labs elev WBC, hypocalcemia; Sens/Sens: lipase > amylase (both high in acute)
Fever, all peds: ua/ucc; poss cxr
Fever (>38C), <28 days old Admit; ucc, blood cx, LP, poss cxr; IV amp/gent
Fever (>38C), 28 day - 3 mos ucc, blood cx, LP, poss cxr; Rocephin 50 mg/kg; dc if cxs neg; f/u in 24hr
Fever (>39C), 3 mos - 3 yo ucc, poss cxr, stool cx; close f/u
imaging TOC for pyloric stenosis u/s; spec, not always sensitive; 2nd line: upper GI series: shows string sign
imaging TOC for PE ECG, CXR (atalectasis, pl effusion, elev hemidiaphragm); gold std = pulmonary angiogram, but invasive (mort = 1-5%), so most 1st order V/Q scan
testing for suspected stroke glucose, EKG, lytes, CBC, coag
imaging tests for stroke CT: noncontrast detects hemo, ischemic visible after 6 hrs; MRI sensitive for posterior fossa or <6 hr; gold std: angio
meningitis testing CBC, coag, blood cx; CT (r/o mass lesion) before LP; empiric abx
CSF, viral meningitis opening pressure <200, WBC <1000 & <50% PMN, glucose >40, pro <200, neg Gr Stain / cx
CSF, bacterial meningitis opening pressure >300, WBC >1000 & >80% PMN, glu <40, pro >200, pos Gr Stain / Cx
seizure labs anticonvulsant levels; lytes, glu, tox screen, poss CK; poss LP
seizure tx 1stline: benzos (versed, ativan, valium), poss phenobarb; 2ndline: dilantin, depakote; Mg sulfate: eclampsia
status epilepticus tx pentobarb infusion (coma), isoflurane aesthesia
SAH testing CT 90% sensitive, esp within 12 hrs; LP 98%, esp >12 hrs, when xanthochromia present
AMI labs: troponin Troponin rises first & stays high 5 to 14 days, and is most sensitive/specific for MI
AMI labs: CK-MB CKMB rises within 4 hours and peaks at 24 hrs
CHF xray cardiomegaly, pulmo edema (plump vessels, interstitial / alveolar edema, Kerley B lines)
imaging for aortic dissection CXR: widened mediastinum, poss tracheal deviation to right, left hemothorax; CT contrast; TEE to ID type & valvular involvement; aortography is gold std but invasive
Created by: Abarnard