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Paramedic Lab Values

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by

Travis Struss

on 22 December 2011

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Transcript of Paramedic Lab Values

Heparin/Lovenox
ptt (Partial thromboplastin time)
For pt's on heparin drip
Typically for prophylaxis DVT & short term anticoagulant
recheck every 4 hours
Antidote is Protamine sulfate
PTT=22-34
PT=11-13
INR=0.8-1.2

2-3 times if on med
PT (prothrombin time) & INR (International normalized ratio) for coumadin/warfarin type anticoagulants
Deal with long term anticoagulation (afib, valve issues)
Antidote is Vitamin K
Uncompensated respiratory Acidosis
PH
PaCO2
HCO3
Uncompensated Respiratory Alkalosis
PH
PaCO2
HCO3
Uncompensated Metabolic Acidosis
PH
PaCO2
HCO3
Uncompensated Metabolic Alkalosis
PH
PaCO2
HCO3
Metabolic =Elevator
Respiratory=See Saw



.
PH
CO2
PH
CO2
PH
HCO3
ph
HCO3
ABG Interpretation
PH
CO2
HCO3
O2
Anion Gap
A 7.35-7.45 B
35-45
22-26
80-100
Na & K
HCO3 & CL
3-11
Body decreases PaCO2 1-1.5 for every 1 mEq/L decrease in HCO3
Every 10 mmHg change in CO2, PH change .08 in opposite direction
Every 10Meq change in bicarb, PH change .15 in same direction
Buffering (Acid Excrete)
Lungs
Co2 is acid-increases/decreases
with respirations
Kidneys (SLOW...days)
Excrete HCO3 (base)
increase/decrease
Excrete/reabsorb based on PH
Co2 increased, reabsorb
Trauma, CNS depression
Obesity, Abnormal lungs
Aspiration, pulmonary edema
embolism, airway obstruction
Anxiety, head trauma, salicylates,
fever, pain, pregnancy, embolism,
cardiac failure, altitude, asthma,
hepatic failure, sepsis, hyperventilation
Ketoacidosis (diabetic, malnutrition,alcoholism)
Lactic Acidosis, coma, toxins (carbon monoxide
Ethylene glycol, methanol, hydrogen sulfide, etc)
Renal failure
diuretics, fluid shifts, GI losses, burns, hypovolemia,
drugs, N/V/D, Sodium Bicarb admin.
How to read ABG's
Check PH
<7.35 suspect acidosis
>7.45 suspect alkalosis
Check PaCO2
<35 suspect alkalosis
>45 suspect Acidosis
If moves opposite of PH, suspect respiratory in nature
If moves in same direction, suspect metabolic in nature
Check HCO3
<22 suspect acidosis
>26 suspect alkalosis
If same as PH, metabolic
If opposite PH, respiratory
Check PaO2
60-79% is mild hypoxemia
40-59% is moderate hypoxemia
<40% is severe hypoxemia
Complete blood count(CBC)-broad screning to check for variety of conditions including anemia and infection
White Blood cells (WBC)-immune system and indicate infections or diseases of immune system
4,500-10,000
High-acute infection, TB, Mono, Viran pneumonioa, cirrhosis, burns, tissue necrosis
Low-Malaria, Measles, Rubella, Hepatitis, Viral infections, Sickle cell, Stress

Red Blood Cells (RBC)-Used to carry oxygen & Nutrients to cells
Male 4.2-6
Female 3.6-5
Low
-bleeding, Anemia, bone marrow
suprression
High
-Polycythemia, altitude, dehydration

Hemoglobin (Hg or Hgb)-iron containing Oxygen transport protein on RBC
Male 14-18
Female 12-16
Low
-Anemia, Hemorrhage, Hemodilution, renal Failure
High
-COPD, CHF, Burns, Polycythemia, Dehydration, Altitude

False Sp02 readings
Carbonmonoxide
Sulfer Monoxide
Cyanide
Nitrous Oxide
Sulfide
Hydrogen Sulfide

Hematocrit (Hct)-Percentage of RBC in blood
Male 40-50%
Female 36-46%
Low
-Anemia, Hemodilution, Acute blood loss, Cirrhosis, renal Failure, Pregnancy
High
-Hypovolemia, dehydration, Diabetic Acidosis, Burns, Poycythemia

Blood
Giving 3 cc/kg of packed red cells will raise the hemoglobin by 1 gm/dl
1 unit of PRBC is approximately 300cc

Giving 10 cc/kg of packed red cells will raise the hematocrit by 10 points (vol%) or hemoglobin by about 3 gm/dl

Logical Math
Rule of Three's
RBCx3=HgB
HgBx3=Hct

5-15-45

Platelets-Coagulation
150,000-400,000
Low
-Cancer, Anemias, DIC, renal disease
High
-Pulmonary Embolism,Iron deficiency, TB, Polycythemia, Acute Blood loss (peaks in 10 days)

or sequent calculus for classical linear logic
Coagulation Tests
D-Dimer
Test for clot
Normal is <500 mcg/l
Deep Vein Thrombosis
Disseminated Intravascular Coagulation (DIC)
Pulmonary Embolism

False Positives-trauma, pregnancy, Liver Disease, inflamation, Recent surgery,
Blood Urea Nitrogen (BUN)
metabolic byproduct of breakdown of blood, muscle and protein
evaluates renal function and hydration
Normal 8-20 mg/dL
Low
-Overhydrated, malnutrition, liver failure, Pregnancy, Hepatic insufficiency
High-
Dehydration, renal failure, CHF, Shock, Sepsis, GI Bleed, Gout, MI
B-type Natriuretic peptide (BNP)
Measures hormone produced when cardiac atria stretched
<100 =low likelihood of failure
100-400 =indeterminate
>400 =high likelihood of heart failure
Creatinine (Cr)
Wasteproduct of protein metabolism found in urine
Aids in diagnosis of renal dysfunction
0.6-1.4
Low
-Muscle atrophy, low muscle mass, pregnancy, eclapsia
High
-renal failure, nephritis, dehydration, muscle disease, diabetic acidosis, starvation, shock, leukemia
BUN/Creatinine ratio
Evaluates renal function
normal is 10:1 or less
Elevated indicates failure
Renal tests
Cardiac biomarkers
Creatine phosphokinase (CPK)
Enzyme in skeletal muscles (CK-MM), Brain (CK-BB), Cardiac (CPK-MB)
Normal 5-35 mcg/ml
increased 90% in MI
False positives Trauma, muscle fatigue, physical exertion, previous surgery, seizures
rises 4-6 hours after MI
Peak 24 hours
Normal 3-4 days post

Troponin I
Cardiac troponin contractile proteins of myofibril
More specific for MI than CPK-MB
elevates 2-6 hours after MI
Peak 12-16 hours
elevated 5-10 days
Normal <0.2 mcg/ml

Myoglobin
Released after muscle injury
normal 9-12 mcg/ml
increase 2-6 hours after injury
peak 8-12 hours

Lab analysis and ABG interpretation
Amylase/Lipase
Amylase 44-128 U/L
Lipase 0-160 U/L
Pancreatic enzymes
Liver Enzymes

AST: Aspartate Aminotransferase
10-40 U/L
ALT: Alanine Aminotransferase
7-56 U/L
ALP: Alkaline Phosphatase
45-150 U/L
(Enzyme related to bile ducts)
Bilirubin: Measures Jaundice
0-0.3mg/Dl
Albumin: Main protein created by the liver
3.5-5.5g/dl
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