#lab result

[karanjoshi0950]

Blood Test: How To Understand Lab Results - Caringy Yours

Are you trying to read your blood test report? But you didn't understand it. Here, we bring you a guide on how to understand blood test lab results.

[backupprotectingnnj]

Understanding The Duty Of Proctors In CCIE Lab Certificate

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[mysecretrevelations]

No more typhoid infection in my bloodstream! So happy!!!😂

IgM - negative IgG - negative

[cranquis]

Cranquis Mail: Who is the messenger?

Paramedic student fan here, with a request for your two-cents;

Went to an after hours surgery (AHS) (comparable, I guess to an urgent care clinic?) on a week-night about 2100 for a 65ish YO male who had 3 day history of generalised unwellness and mild chest discomfort. Went in to AHS as not any better and now a bit SOB. (We were called for a transfer through to the ED)

Patient had normal obs, asymptomatic after 2.5mg IV morphine and anti emetic, and a NSR on 12-lead. However the Troponin-T came back at (roughly, I forget exactly now) 6500ng/L (normal value 0-34ng/L, apparently) so indicative of ACS/Infarct etc.

Now, what surprised me is that no one had told the patient what was going on - I asked on the trip over the usual cardiac-focused history (Have you ever had a heart attack before, any problems with your heart, general Hx) and he was pretty much clueless. I asked him "So what is your understanding of what's happening?" and the impression was pretty much a vacant look.

My question is, is it appropriate or encouraged for paramedics to be the one to tell this patient about what is happening?

(I felt it was at the least the responsibility of the doc at the AHS to tell them the results of the blood test well before we arrived)

In this case I didn't tell the patient what was happening because I didn't really feel comfortable doing so, but mentioned it to the receiving nurse at ED who talked to him about it. Next time I would (personally) give the patient as much information as I was able about their own healthcare/progress and as far as I felt confident to talk about (for example I wouldn't be talking to him about which coronary artery might be blocked or how many (if any) stents he'd need, as I don't know enough about that side of things to educate a pt on). I also gave him an aspirin (300mg PO per our standard procedure) as AHS hadn't done so, and figured the risks of giving it were outweighed by its potential advantages if he was/is infarcting or post-infarct.

Wow. WOW.

So this AHS has the capacity to do cardiac enzyme labs (which means that they have certainly dealt with initial workups for heart attacks before), and yet they (1) don't give this patient w/ classic heart attack symptoms some aspirin (either before or after the lab results came back) or (2) don't explain the lab results and reason for ER transfer to the patient? That's bad juju, my friend.

As for whether it is "encouraged" for paramedics to be the one who tells the patient about a major status update: well, as an Urgent Care doc, I wouldn't want a paramedic to do that with my patient during a transfer to the ER -- because it would be the responsibility of MYSELF (the ordering provider) or at least my nursing staff to update the patient on study results which have come in before the patient left my care. If the patient was already moved to the ER when the result came in, I'd be sure the ER doc had the result to then pass along to the patient.

Of course, sometimes things get "lost in the shuffle" of an emergent case, so hopefully this was just a rare mistake on that AHS doctor's part -- but if this is the pattern for handling life-changing lab results, it is gonna come back to bite them sooner or later (maybe not with THIS patient, since you [wisely, IMO] updated the patient on his status and [hopefully?] acted within your protocols and level of training to administer aspirin). A lax approach to fulfilling established standards of care (aspirin, updating on lab results, etc) in critical medical situations indicates that there are other issues and weaknesses in that doctor's/AHS's practice, and eventually a patient will suffer from it.

[cranquis]

Hemoglobin A1c = 16.8%

The highest "glycated hemoglobin" result I've ever seen, indicating rampantly uncontrolled diabetes. (For comparison, well-controlled diabetics have a level under 7%).