Respiratory Therapy Cave

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Critical Lab Values and Hemodynamics

Indicators for calling patient’s Dr: (Sepsis Screen = Temp>100.3 or < 96.8, HR>80, RR >20, SBP <90)
Respiratory Change in Change in LOC Change in Staff Worry Chest Pain Fluid status Temp Labs
Status Change HR (mental status) BP
8 or >28 >130 <40 <90 >170 Not look right I>O >100.4 or WBC > 12,000
or Lethargic or New < 96.8 or < 4,000
SOB changed by Confused Changed by Nausea/ Wet lungs
20% from Unresponsive 20% from vomiting Recurring Critical Critical >25,000
O2 Sat: decreased baseline Agitated baseline Diaphoretic UOP: >106 <2,500
from baseline <50cc/ <91
Rhythm Undetectable What’s wrong? 4hours
Respiratorytherapycave.blogspot.com 09/07/2009

Lab tests & possible reasons for abnormal results:
(Critical values in parenthesis.)
1. CK: >200 (>351-2000 critical) = Muscle damage (nonspecific)
2. CKMB: >2.5-3.0 (>5.5) = Heart muscle damage
3. Troponin: >0.1 (>0.4) = Heart muscle damage (most specific)
4. ALK: >136 = Liver or bone damage
5. ALP: >150 = Liver or bone damage
6. AST: >37 (>200 critical) = Liver tissue damage (nonspecific)
7. ALT: >65 = Liver tissue damage (Specific for Hepatitis)
8. Biliruben: >1.0 = Liver cell damage (best indicator of liver function)
9. Albumin: >5.0 = Dehydration (best indicator of liver function)
<3.5 (<1.5) = Liver disease, shock, malnutrition
10. Gamma-Gt: >51 = CHF, liver damage
11. BNP: >100 = CHF (300=mild, 600=mod, 900 severe)
OK = 125-450, <75 YO = 125, >75 YO = 450
12. Glucose: >120 (>350) = Diabetes (>150 = insulin protocol)
<90 (<40)= Liver failure if not on Insulen (sepsis?)
13. GFR: <60 (<29 critical) <15=Kidney failure
14. BUN: >18 (>45 critical) = Kidney problems, CHF, shock, stress
MI, dehydration, GI bleed
<07 = Severe liver disease, malnutrition, over-hydrated
15. Creatinin: >1.7 (3.0 critical) = Kidney probs, dehydration, CHF, shock
16. Sodium: >145 (>160 critical) = Dehydration
<136 (<120) Kidney disease, over-hydrated (edema), not
eating well, CHF, effects of Lasix, diarrhea, vomiting
sweating. (<126=critical, confusion, lethargy, seizures)
17. Potassium: >5.1 (>6 critical) Kidney failure, massive tissue trauma,
(post op), metabolic acidosis (diabetes), dehydration.
<3.5 (<2.8) = Not enough in diet, gastro-intestinal disorder,
vomiting. Due to Insulen, Lasix, dig, steroids?
18. Magnesium: >2.4(>2.7) = Kidney failure, dehydration, diabetic acidosis
<1.3 (<1.0 critical) Malnourished (low intake), elderly,
alcoholism, long-term diuretic use, diarrhea.
19. Chloride: >107 = Dehydration, met acidosis, hypoventilation (alkalosis)
<98) = When Sodium low
20. Calcium: >10.1 (>13) = Bone breaks, prolonged bed rest, etc.
<8.5 (<6) = Bone disease, malnutrition, alcoholism
21. PTT/ PT: >33/ >12.7(>60/>40) = transfusion, therapeutic, DIC.
PTT is one of the best measures of liver function.
<24/<10 = Impaired clotting ability
22. INR: >1.2 (>6) = Acute bleed, DIC or therapeutic.
23. Fibrinogen: >450 = Risk for heart disease (checked often)
<160 (<70) = Acute bleed, liver disease, malnutrition, DIC
24. D-Dimer: >500 = DVT, PE, DIC, acute bleed, surgery, trauma
25. Platelets: <80,000 = bleeding problems, Heparin, DIC alcoholic,
leukemia (Vitamin K increases clotting)
26. Phosphorus: >4.1 (>8) = Liver disease, Kidney failure, bone mets.
<3.0 (<1.1) = Diabetic Keto-acidosis
27. Uric Acid: >7.0 = Acidosis, alcoholism, diabetes, Kidney failure
28. Folic Acid: <2.0 = Malnutrition
29. Lactic Acid: >19.8 = Hypoxia, O2 deprivation, shock, CHF, tissue death
Increases when organs failing/dying (sepsis?)
30. LDH: >136 (>350 critical) = Nonspecific Tissue damage or death
31. Osmology >300 = Dehydration
32. Hematocrit: >47 = Dehydration
33. Keytones: Positive test = Diabetes, starvation, vomiting, increased
metabolism (fever, severe illness).
34. Neutrophils: >48-73% = increased levels of bacterial infection (acute)
a. Segs >60 if new infection
b. Bands >2% = worsening infection
35. Eisinophils: >2% with allergic reaction (associated with asthma).
36. Lymphocytes: >18-48% = may indicate viral infection (mono, measles, pox)
37. Basophils: >2% = allergic reaction
Hemodynamic Monitoring & Normal Values:
1. BP: Systolic = 90-140; Diastolic 60-90
a. As BP increases CO & CI usually decrease
b. As BP decreases CO and CI usually increase
2. Pulse Pressure = Systolic – Diastolic = 40 mmHg
>40 indicates decreased Stroke Volume (SV)
3. SV = CO/HR = 60 – 130 ml/beat = volume ejected per beat
4. CO = HR(SV) = 4.8 LPM (More reliable than MAP)
5. CI = CO/BSA = 2.5 LPMm2 or simply CO/2
a. Decreased with shock, dehydration, cardiac fail, PE.
b. Increased with hypoxia, low BP.
c. More reliable measurement than CO.
6. Ejection Fraction (EF): % of blood volume pushed out of heart per beat.
a. Normal = 65 – 75%
b. Reduced with ventricular damage
7. MAP = systolic + (Diastolic*2)/3 = 70 – 105
8. Preload: Blood that returns to ventricles at end diastolic, & refers to
stretch of myocardial fibers. Preload increases = heart function increase
a. PCWP: Measures left heart function.
1. Normal = 5 – 12 mmHg (same as PAP diastolic)
2. >18 = edema forming in lungs (if no signs CHF think ARDS)
3. >25 = edema in lungs from left heart failure (CHF)
4. >5 – 12 + edema = noncardiogenic edema (ARDS)
5. > 12 may also indicate Mitral valve stenosis
b. CVP: Measures right heart function and used to monitor systemic
venous drainage (fluid levels).
1. Normal = 2 – 6 mmHg
2. <5 = hypovolemia, fluid restriction, diuretics shock, hemorrhage,
vasodilators (Nipride, Morphine) blood thinners, peep, ippb
3. >7 = hypervolemia, fluid challenge, increased SNS tone (fight or
flight), shock, slow HR, decreased ejection fraction (CHF,
pump failure, Aortic valve failure, thick blood)
9. Afterload: Resistance heart must work against, or blood that returns
& fills the atria. All other values constant, has an inverse relationship
with CO, and is indirectly monitored by Blood Pressure.
a. SVR = (MAP – CVP)/CO
1. Normal = 900 – 1400 dynes or < 20 mmHg/L/min
2. Increased = HTN = vasoconstriction, increased SNS tone, cardiac
stimulants (EPI, alpha action drugs), thick blood, narrow valves.
3. Decreased by vasodilators, decreased WOH, adequate preload,
alpha blockers (Regitine, Dibenzylene), decreased SNS tone.
b. PVR = (meanPAP – PCWP)/CO
1. Normal = 150 – 250 dynes or <2.5 mmHg/L/min
2. Increased with hypoxia, pulmonary hypertensin, PE
c. PAP: Monitors blood moving into lungs, afterload of right ventricle.
1. Normal is 25/8 (mean = 14)
2. PAP diastolic can be used to estimate PCWP.
10. Cardiac Electrolytes:
--Potassium:
Increases and
decreases in this
result in majority
of cardiac
arrhythmias.
-- Magnesium:
Low Mg
associated with
low K. Results
in numbness,
tingling,
contractions,
cramps, seizures,
& cardiac
arrhythmias.