Why Lab Values May Warrant a 911 Transport

Why Lab Values May Warrant a 911 Transport

 

If you haven’t yet, you will transport a patient for lab values that are too low or too high during your EMS career.  While it seems insignificant and often the patient does not have a physical complaint, lab values can
be very serious. Laboratory services are a vital part of the patient assessment and diagnosis process.  Values often indicate trends and issues before symptoms occur.  They are also used to monitor ongoing conditions. One lab value that is high or low can cause a cascading effect to other values.  If you are curious about common lab values, check out this “cheat sheet”: http://www.medicalestudy.com/critical-lab-values-cheat-sheet/

I tried to take a look at some of our numbers but this category is very difficult.  From October through January, there were 29 cases that specifically listed high or low blood values other than glucose readings as a complaint.  All were transported and at least five were transported ALS.  17 out of the 29 cases had a primary impression of “no complaint.”

Here are a couple of the lab values that were listed and why they will require transport.  There are numerous causes and treatments for each so this is not all inclusive.  This link has a short summary of various lab values including some causes and clinical signs: https://lms.rn.com/getpdf.php/1754.pdf

  • High Sodium/Hypernatremia can lead to CNS issues including confusion, muscle twitching, seizures, coma and death.  Major symptoms include thirst.  Values >145 mEq/L are considered high.  Hypernatremia can be caused by severe vomiting and diarrhea, burn injuries, impaired thirst mechanism or limited access to water.  Treatment included replacing intravascular volume and free water (not typically 0.9% NS).
  • High Potassium/Hyperkalemia is when the serum level is >5.5mEq/L.  It is often without symptoms until cardiac toxicity occurs.  EKG changes can be noted with levels >6.5.  Causes include renal issues, decreased potassium excretion or cell lysis (burns, trauma). Treatment for severely high levels includes lowering the potassium with calcium, albuterol, sodium bicarb, insulin with dextrose, dialysis and correcting the cause.
  • High Ammonia levels can be caused by numerous liver disorders including cirrhosis and GI bleeding.  Signs and symptoms can include confusion, slurred speech, behavior issues and tremors. Supportive care is given to these patients and correctable issues fixed.  They may also be given medications that help to digest protein.
  • High Blood Urea Nitrogen (BUN) are often greater than 20mg/dL.  They usually indicate impaired kidney functions which could be due to acute or chronic diseases. It could also be high due to elevated protein breakdown from a high protein diet or GI bleeding.  This test is usually run with a Creatinine and reported as a ratio.  Symptoms can include foamy urine, itchy skin, N/V and HTN. Avoiding medications that stress the kidney, dialysis and fluids can help lower a BUN.
  • Low Hematocrit (Hct) and Hemoglobin (Hgb) are signs of anemia.  Hct is the percent of blood containing red blood cells and Hgb is the protein in red blood cells that carries oxygen.  There are numerous causes from cancer to conditions that cause the body to produce fewer RBC’s or destroy them.  Blood loss is another cause.  Signs and symptoms include pallor, SOB, tachycardia, weakness, bleeding and fatigue.  Correcting the cause and blood transfusions will treat severe patients and iron or vitamins may help with less severe causes.
  • Medications have therapeutic ranges.  Some are very narrow and can cause serious side effects if too high or low.  Coumadin is a good example.  If the level is too high, serious bleeding can occur.

The human body is a well tuned machine—for some people it may be a little less tuned :)— but it doesn’t take much for things to get out of sorts and start causing issues.  Understanding that lab values we don’t normally know or deal with can be just as serious as a low/high blood glucose or low oxygen saturation might make that next BLS case a little more palatable.

Other references included: https://www.merckmanuals.com/professional