Labs in Trauma - Dr. Colucciello

COre Concepts

• 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.

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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