mod_ DxLabs

  • [3] Labs: __ __
    • Ordered, pending at this time, including: [1]
      • CBC, 
      • BMP, 
      • LFTs/lipase, 
      • UA, 
      • Urine Cx
      • lactate
      • Blood Cx
        • [01] x2
        • __
      • CK, 
      • EtOH level, 
      • Ingestion labs (acetaminophen, ASA), 
      • Troponin, 
      • Delta troponin, 
      • BNP, 
      • HIV, 
      • Influenza, 
      • Urine toxicological screen, 
      • CRP,
      • ESR,
      • __
    • [2] Reviewed and interpreted/correlated to clinical scenario to inform diagnosis and plan by me.  
      • No significant labratory abnormalities contributory to patient’s presentation.
      • Non-emergent abnormalities __ which I informed the patient about and advised for prompt outpatient follow up for outpatient care.  
      • [1] Specifically: 
      • [01] [1] CBC:
        • __
        • [01] No significant unexpected anemia, No significant leukocytosis, No thrombocytopenia.
        • Hg
          • anemia,
            • transfusion indicated given
              • symptomatic
              • < 7 Hg (6-8 range from restrictive transfusion strategy)
              • active significant bleeding
            • transfusion not indicated (considered)
            • peri-baseline,
            • significantly lower than baseline
            • unknown baseline,
            • suspected iron deficiency contributory, will advise/rx Ferrous sulfate 325mg daily w/ vit C.
        • wbc’s
          • luekocytosis
            • suspect demarginalization given lack of infectious findings on hx/exam,
            • suggestive of infectious process, 
            • concerning for malignancy, advised to for follow up
          • leukopenic
            • neutropenic 
              • ((ANC < 500))
        • platelets:
          • thrombocytopenic 
            • ((platelets < 150k))
            • transfusion not indicated
              • given suspected consumptive process 
              • ((ITP, TTP, HIT))
          • transfusion indicated given
            • <10 k (regardless that pt is asymptomatic)
            • <20k and and planned CVP or pt febrile
            • <50k and planned LP or neurosurgical procedure
        • pancytopeniac
          • likely 2/2 chemo
          • likely 2/2 HIV
          • likely 2/2 hep C
          • unclear etiology, will initiate eval w/ completion of eval and monitoring/treatment to be continef as outpatientafter ED
      • [01] [2] BMP:
        • No significant pathologic electrolyte derangements.
        • AKI, 
          • [::- 50% increase from baseline -::]
          • BUN/Cr >20 suggestive of prerenal process, 
            • will administer IVF
            • and recheck
        • CKD, 
          • grossly unchanged from prior, 
        • Hyperkalemia, 
        • Anion gap 
          • ((> 12))
        • acidotic suggested by low bicarb, 
        • __
      • [2] LFTs/lipase:
        • [01] No laboratory evidence of hepato-biliary pathology.
        • Transaminitis without elevated bilirubin, suggestive of hepatic pathology
        • Elevated direct bilirubin suggestive of biliary pathology
        • Elevated indirect bilirubin suggestive of increased rbc breakdown
        • __
      • [2] UA:
        • [01] Not consistent with urinary tract infection.   
        • Urine Cx sent with follow mechanism in place
        • Equivocal for infection
          • Empirically treated.
          • UCx sent with f/u mechanism in place
          • __
        • __
      • [2] Cardiac Labs:
        • [01] [2] Troponin: 
          • undetectable
          • [01] <99th percentile
          • >99th percentile but under cut off for positive
          • positive
          •  __
        • [2] Delta troponin
          • pending, pt under care of other service at time of delta troponin, 
          • undetectable, 
          • <99th percentile, 
          • >99th percentile but under cut off for positive, 
          • positive, 
          •  __
        • [2] BNP:
          • [::- please note that greater than 500 suggests CHF, under suggests not CHF -::]
          • not suggestive of CHF exacerbation
          • suggestive of CHF exacerbation
          • non-diagnostic
          • __
      • [2] HIV:
        • negative,
        • positive, 
          • [01] I discussed this finding with patient in sensitive private manner, educated on treatment options, offered resources, answered all questions, advised to have partner evaluated and advised to refrain from any of the common modes of transmission. 
        • Prior to test sent, pt was informed that we advise for testing for HIV. Pt did not opt out. 
      • [2] Influenza
        • negative
        • __
      • [2] CK: 
        • significantly elevated, requires trending,  [::- usually for >500-1000k -::]
        • mildly elevated, not anticipated to rise given negated precipitant, 
        • not high enough to suggest concern for pathology, 
        • __
      • [2] Ingestion labs: 
        • [01] acetaminophen
          • [01] non-detectable, 
        • [01] ASA:
          • [01] non-detectable,
        • [01] etoh
          • [01] non-detectable, 
          • positive __
          • __
      • [2] Urine toxicological screen:
        • [01] negative
        • postive for __
        • __
      • [2] Markers of inflammation
        • CRP [::- suggestive of more acute inflammation -::]
          • wnl
          • elevated
          • __
        • ESR [::- suggestive of more chronic inflammation -::]
          • wnl
          • elevated
          • __
      • __

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