Labs and diagnostics

[chbare]

Just wanted to get a feel for how well educated people feel regarding lab tests and diagnostic studies. Did you get exposed to this in school and what was the extent of your education regarding diagnostics? Is this even important to the practice of pre hospital medicine?

Take care,

chbare.

[Ridryder 911]

You brought up a very good point,, even Dr. Bledsoe addressed one time. He was discussing how one Paramedic was blasting a new RN on not recognizing an AMI on a XII lead, and the discussion somehow lead to the patients creatinine and BUN level, which the nurse noted and asked if the patient was in ARF. Noting the Paramedic had that "deer looking in the headlight look".. he then realized how ignorant, most EMS providers were of laboratory values. This is why their is a dedicated section on the Critical Care Paramedic book on some basic understandings of laboratory tests, and values..

R/r 911

[AZCEP]

For a great many lab values, I can't tell you what a "normal" would be, unless the range is printed along with it.

When I went through school, lab values were limited to pH, PCO2, PO2, and maybe potassium. Everything else was eliminated. We talked about what the various conditions would do to the body's chemistry, but we never discussed how or why it was important.

With the focus that I've placed on the pathophysiology, hopefully, my students will have a better understanding. Even if they know what the effects of highs and lows will cause/indicate.

[Just Plain Ruff]

I agree, normal values must be there to determine how out of whack the labs etc are. But every paramedic should have a basic understanding of lab values in order to help guide(not determine but guide) patient care.

I'm not saying we need to be able to interpret what the minutia(sic) results are like mcvh and other parts of the cbc is but the H&H, CBC(main values), CMP or Chem 22 and basic metabolic panels. We also should understand the pt, ptt and INR if we are to be giving clotbusters or blood thinners.

If you are a paramedic in the ER then you better be able to at least interpret the most used labs in the ER.

Interpretations of the Urinalysis is important also.

So to further the discussion - What labs should be basic knowledge of a paramedic/emt? Here's my list

cbc

cmp or chem 22

Basic metabolic panel or Chem7

CK/MB

PT/PTT with INR

Urinalysis

Lytes maybe

alcohol

that's a short list.

[AZCEP]

I'd add an ABG, Tox screen, BNP, and D-dimer

While understanding what the values mean, we should not forget understanding the limitations of each test. Especially the Tox screen.

[Just Plain Ruff]

Azcep, that is true also. We have to remember that test are used in the aid for diagnosis. They are a tool juust like the defibrillator and iv's are tools of our trades.

We have to understand the overall picture and presentation of the patient before we can make any sort of diagnosis of a patient.

And the fact that we cannot diagnose is critical here too. All we can do is gather the facts, try to fix the most urgent lifethreatening problems and get them to definitive treatment. That is what we do. To diagnose based on lab tests can be a dangerous slippery slope.

[becksdad]

This is actually something that had some importance at least once that I recall. We got a call for transfer from an ALF to ER for abnormal lab values. We all hate nursing home calls right? For various reasons. Little dehydrated? Can they take liquid PO? How about rehydrating before you call an emergency service?

Well, this REALLY nice lady, who was totally asymptomatic, was getting a ride to the hospital because her Digoxin levels were high. We had NO IDEA what an acceptable range was for Dig levels, and the lab reports we got did not indicate such. It just seemed like we were taking a perfectly normal, asymptomatic patient, with no complaint, V/s WNL, monitored normal sinus rhythm, to the hospital for what??

When we arrived at the ER and turned over paperwork, we found out that her Dig levels were SKY-HIGH! I mean astronomically high. I forget what they were, I even forget the acceptable range (shame on me). But this time, the nursing home Doc was right-on, and we made bad ASSumptions (to use Dust's analogy).

So lab values are sometimes important in the field. Do I still know squat about labs, diagnostics, and their implications? Nope. But remembering this call, and viewing this topic will sure make me look at this closer. Thanks, that's why I came to this website and joined.

[chbare]

I really appreciate the posts thus far. I hope I did confuse anybody on this topic. I would never expect anybody to remember all of the exact values, but having a broad understanding of what basic labs tell us about the patient and the underlying pathology will help us better understand how to treat the patient and even communicate and help the patient/family understand their condition. In addition, it helps to know a little about diagnostic studies. For example; You are going to transport a patient with a subdural bleed to the trauma center from a smaller hospital. You receive report and the doc tells you that there is a 4cm midline shift on the head CT. Understanding what this means allows you to relate this to your patients condition.

Take care,

chbare.

[buckeyedoc]

We covered basic lab values in medic school. We learned the ranges and treatments, but that was about it. It wasn't until I started working in the ER and married a nurse, that I worried about specific lab values. Now I am more aware of lab values and the impact they have on the patient's outcome. It's amazing how complacent medics are when they get patients with Na and K levels that are outside of the normal limits. They don't put 2 and 2 together. I admit that I don't know all lab values and still have to look some of them up.

[ffmedic9588]

I believe medics should be proficient at ABG's should know the cardiac enzymes as well we should be able to interrupt xrays to a degree.