So I get a call from the lab..... - page 4
by mindlor 10,564 Views | 40 Comments
Your pt has a critical high potassium of 4.8.....seriously? Then in the same sentence....your other pt is set for dialysis....tell the dialysis nurse to stop.....their creatinine is 4.1 and dialysis may not be... Read More
- 1Nov 14, '12 by T-Bird78Quote from imintroubleYes, they have their protocol, but I think the rolling eyes are due to the lab tech telling the nurse what to do and critical values that are really in normal range. Call to inform the critical values, but don't tell the nurse or doctor what to do about it. It's like the radiology tech looking at the X-ray and saying it looks good--they take the x-rays, they're not trained to interpret them.I'm not sure why all the eye rolling over lab calling results. They have protocols just like us. I'll bet they hate to call the floor over a result that is trending down, just like we hate to call the MD for the same reason.
I've never had one to interpret results for me, but I don't think I'd ridicule them for it even if they did.
I wonder if the lab feels small when we make fun of them? I know I do, when I have to call a critical BUN and creatinine on a dialysis pt to a nephrologist. Then have him yell at me because "Don't you know they're on dialysis?"
We all just do what we have to do.
- 1Nov 14, '12 by psu_213Quote from DSkelton711I don't think I have ever gotten a call on a white count. I have seen pt's over 100 and not gotten a call--if it's that high, they have leukemia. Calling the doctor within a few minutes is not going to make much of a difference in the long term. Will they treat it? Yes. Do they need to know "ASAP?" Not at the expense of other more critical pts.Nobody called it critical, they were making a point about some orders. Your labs critical is 100? That seems excessive to me. If I'm hitting 40 someone better be letting someone know about it ASAP.
- 0Nov 14, '12 by blondy2061hQuote from psu_213Over 100,000 puts patients at risk for complications from being in a hyperosmolar state. For 100,000+ we usually leukopherese ASAP or minimally begin Hydrea.I don't think I have ever gotten a call on a white count. I have seen pt's over 100 and not gotten a call--if it's that high, they have leukemia. Calling the doctor within a few minutes is not going to make much of a difference in the long term. Will they treat it? Yes. Do they need to know "ASAP?" Not at the expense of other more critical pts.
- 0Nov 14, '12 by psu_213Quote from blondy2061hWell, there is generally something we do not do in the ER. A leukemia pt had a white count in the 120s...the attending said this was the highest count he's ever seen. Pt got admitted to a non monitored bed.Over 100,000 puts patients at risk for complications from being in a hyperosmolar state. For 100,000+ we usually leukopherese ASAP or minimally begin Hydrea.
- 1Nov 14, '12 by Good Morning, Gilit does depend on hospital policy, but most labs are required to call with critical lab values. I guess your critical potassium starts at 4.8? That's low, but every hospital uses slightly different lab values. Our lab calls with critical values, but will sometimes even call with any big changes. If Hgb dropped by 3 in a day, they'll call, and ask if they want us to result the value, and I'll say, "yes, they received fluid boluses, etc." or something to that effect.
I'm always looking for my lab values to pop up anyway, and even though it may seem like it's wasting our time, it's still nice that they call. An extra safety measure.
- 0Nov 15, '12 by wyogypsyI appreciate the calls as it is an extra check. I am secure enough that I don't get upset if they mention what they think I should do, after all - they may be speaking to someone new or someone without a lick of common sense and thankfully they did say something! I would rather have the calls than not have the calls.
- 0Nov 17, '12 by eatmysoxRNReminds me of the monitor tech who called me to tell me my patient was in VT and told me that I "probably needed to go check on them." Ummm... yeah? And I probably should take the crash cart as I run to the room. Geez I think some monitor techs don't realize I studied rhythms and drugs etc.