Page 178 - Registrar Orientation Manual 2016

Reference:
Effective date:
2015
Expiry date:
2018
Page:
4 of 28
Title: Laboratory Testing Guidelines (DRAFT)
Type:
Clinical Guideline
Version:
01
Authorising initials:
Triage Bloods in the Emergency Department
The following tests will be requested (if clinically indicated) by the triage nurses for patients referred to inpatient teams:
General Medicine
 CBC, Creatinine, Urea, Na, K, Glucose, (but not lipids).
 LFTs, Calcium and Phosphate will also be requested if indicated or the diagnosis is unclear. Overdose
 CBC, Creatinine, Urea, Na, K, LFTs, Glucose, Paracetamol level, Ethanol level (if intoxication suspected), bHCG (if pregnancy possible).
Cardiology
 CBC, Creatinine, Urea, Na, K, Trop T, Glucose. Abdominal pain
 CBC, Creatinine, Urea, Na, K, LFTs, Lipase. Trauma
 As for abdominal pain plus Ethanol level. PV bleed
 CBC, Glucose, bHCG, Group and Save.
Specific additional tests (listed alpabetically) that will be ordered in ED include:
bHCG in all women of child bearing age where pregnancy is possible and it is clinically relevant to quantify with a serum bHCG
Blood Gases and Blood Cultures will be performed if indicated (see page 7 and 17 for details).
BNP if new heart failure is suspected and a quantitative result will affect management.
CK if rhabdomyolysis is suspected.
Coagulation studies will only be done for specific indications such as patients on anticoagulants, significant liver disease and if a suspected coagulopathy in unwell patient.
CRP will only be done for assessment of occult infective and inflammatory conditions. The CRP is not a de facto measurement of “unwellness” and will not be done on routine conditions or infections. See the costs and indications on page 9 for more details.
D-dimer will only be done in patients with low to intermediate probability VTE (DVT/PE).
Ethanol levels will be checked if suspected intoxication or in undifferentiated overdose, abnormal
behaviour or decreased LOC.
TFTs will only be done if suspected thyroid disease (TSH only first). Troponin T will only be be done if cardiac ischaemia suspected.
Urate if gout is suspected and cannot be diagnosed by joint aspirate, remembering that if the urate is not elevated it does not rule out gout and if elevated does not rule it in.