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Labs in Trauma - Dr. Colucciello

8/7/2014

0 Comments

 

COre Concepts

Picture
  • Type and Cross and Lactate most important lab studies in trauma.
  • Use clinical decision rules to guide imaging in trauma.
  • Clinical judgment must always be used to supplement CDRs.
  • Use radiation reduction strategies to avoid unnecessary radiation in children.
  • Be thrifty in imaging children and expansive in imaging elderly.

Some Specifics

Type & Screen 
- cheaper and doesn't hold blood and doesn't do whole cross match
- Consider in severe mechanisms, blood loss, tachycardia, concern for intraabdominal injury

Type & Cross 
- holds blood
- Consider in coagulopathy & severe trauma; significant mechanism with known blood loss; base deficit < -6, lactate > 4, low Hgb; +FAST

Serial H/H 
- not routinely used 
- consider in pelvic fractures (q1hr)

CBC 
- WBC rarely useful; 
- Consider to use to look at platelets (head trauma, liver disease, long bone Fx); 

PT/INR 
- For liver disease or anticoagulated; 
- Get coags for severe head trauma

Lactate 
- Strongly associated with blood loss and mortality in the setting of trauma

Urinalysis
- adult patient not in shock - gross hematuria matters; 
- microscopic hematuria - in stable patients don't worry; 
- in adult patients with shock - get CT scan - marker for intraabdominal injury; 
- in pediatric population with microscopic hematuria - need CT scan - marker for intraabdominal injury - most commonly splenic injury

Special Trauma COnsiderations

Electrical injuries 
- CPK now and at 4 hrs 

Elderly 
- get PT/INR and lactate > 2 is concerning 

Pediatric 
- UA, LFT, lipase, Hgb

Spearing injuries
 - serial pancreatic enzymes 
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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • Fellowships at CMC
    • Ultrasound
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
  • PEOPLE
    • Program Leadership
    • Current Chiefs
    • PGY-3
    • PGY-2
    • PGY-1
    • Recent Grads >
      • Class of 2023
      • Class of 2022
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Incentive Shifts & Moonlighting >
      • AEC Incentive Shifts
      • STICU Moonlighting
      • MICU X moonlighting
      • Cardiac Rehab >
        • Pineville Cardiac Rehab
        • Union Cardiac Rehab
    • Schedules >
      • Block Schedule
      • ED Shift Schedule
      • Conference and Resident Lectures
      • Journal Club
      • CQR
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction
    • Off Service Rotators