Bleed It or Not
This CBC value is primarily used to assess the oxygen-carrying capacity of the blood and can be critically important when evaluating a patient with suspected hemorrhage.
What is hemoglobin?
This CMP value is the body's primary extracellular cation and significant abnormalities can cause dangerous neurologic and cardiac complications.
What is sodium?
A trauma patient has prolonged PT and PTT, low fibrinogen, thrombocytopenia, and is bleeding from multiple IV sites. This life-threatening condition involves widespread activation of the coagulation system followed by consumption of clotting factors and platelets.
What is disseminated intravascular coagulation (DIC)?
This electrolyte abnormality can cause dangerous cardiac dysrhythmias and is especially concerning when the level rises above 6.0 mEq/L.
What is hyperkalemia?
Your patient’s ABG reads: pH 7.21, PaCO₂ 58, HCO₃⁻ 23. Someone on the crew says, “Looks like metabolic acidosis.” They are wrong. This is the primary problem.
What is respiratory acidosis?
A patient's hemoglobin drops from 14 g/dL to 9 g/dL after receiving several liters of crystalloid. This process can contribute to the decrease even without additional bleeding.
What is hemodilution?
A patient with renal failure has a potassium of 6.8 mEq/L. During transport, this electrolyte abnormality is particularly dangerous because it can cause this life-threatening complication.
What is cardiac dysrhythmia?
A critically ill patient develops unexpected bleeding, prolonged PT/PTT, thrombocytopenia, and low fibrinogen after a massive trauma. This blood product may be particularly important for replacing multiple clotting factors.
What is fresh frozen plasma (FFP)?
A patient has a sodium level of 118 mEq/L and is becoming confused with a new-onset seizure. This electrolyte abnormality is most directly responsible for the patient's neurologic emergency.
What is severe hyponatremia?
You're 10 minutes into transport. The patient suddenly becomes more somnolent. The ABG shows pH 7.10, PaCO₂ 72, HCO₃⁻ 22. The ventilator is running, but the patient is not being adequately ventilated. This is the problem you need to identify.
What is acute respiratory acidosis from inadequate ventilation?
A platelet count below this general threshold should raise significant concern for bleeding risk, particularly when invasive procedures may be necessary during transport.
What is 50,000/µL?
A patient in septic shock has a creatinine that has increased from 0.9 to 2.4 mg/dL. This trend suggests worsening function of this organ.
What are the kidneys?
A patient taking warfarin has an elevated value on this coagulation test, which is commonly used to monitor the medication's anticoagulant effect.
What is INR?
A patient with renal failure has a potassium of 7.1 mEq/L and peaked T waves on the monitor. This immediate treatment is indicated to stabilize the cardiac membrane before definitive treatment lowers the potassium.
What is IV calcium?
A patient with suspected toxic alcohol ingestion has a high anion gap metabolic acidosis and an elevated osmolar gap. This potentially lethal category of poisoning should immediately be considered
What is toxic alcohol poisoning (methanol or ethylene glycol)?
A critically ill patient has a WBC of 2,000/µL. Rather than reassuring the transport team, this finding in a septic patient can indicate this.
What is severe infection/sepsis with leukopenia?
A critically ill patient has a glucose of 38 mg/dL. During transport, this CMP abnormality requires immediate attention because prolonged hypoglycemia can result in this major complication.
What is neurologic injury/altered mental status?
A patient taking warfarin arrives for transport with an INR of 7.5 and active GI bleeding. This laboratory abnormality indicates a significantly increased risk of bleeding due to excessive anticoagulation.
What is a supratherapeutic INR?
A diabetic patient has glucose 580 mg/dL, bicarbonate 9 mEq/L, and an elevated anion gap. During transport, the team should recognize this potentially life-threatening metabolic emergency.
What is diabetic ketoacidosis (DKA)?
A patient presents after taking a large amount of Tylenol. This antidote should be considered to prevent or limit potentially severe liver injury.
What is N-acetylcysteine (NAC)?
A critically ill patient has a platelet count of 38,000/µL, hemoglobin of 7.1 g/dL, and is actively bleeding. Before transporting this patient, the team should be especially concerned about this CBC abnormality because it significantly increases bleeding risk.
What is severe thrombocytopenia?
This CMP abnormality in a critically ill patient can result from prolonged vomiting or gastric suction and may contribute to weakness, dysrhythmias, and altered mental status.
What is hypochloremia?
A critically ill patient is receiving an unfractionated heparin infusion. This laboratory test is commonly used to monitor the anticoagulant effect and guide dosing.
What is the aPTT (activated partial thromboplastin time)?
A patient in septic shock has a lactate of 8.5 mmol/L, hypotension despite fluids, and worsening mental status. This lab value is a marker of this dangerous physiologic state
What is tissue hypoperfusion/shock?
Na⁺ 140
Cl⁻ 100
HCO₃⁻ 12
Glucose 110
Calculate the anion gap and identify the acid-base problem.
What is an anion gap of 28, indicating a high-anion-gap metabolic acidosis?