Super Sleuth

[Ridryder 911]

With the outstanding history, and rash I highly suspect Lyme disease, Early progression although it is unusual to see such symptoms (joint) until a few weeks or even months later, description of rash (if possible from patient).

I would order a Lyme titer- to confirm dx.

Western Blot, Inmmuno- again confirm stage

Possible fluid from joint if needed after confirmation

CSF- if needed

Sounds like a aggressive early disseminated Stage II Lyme .. yet again, I may be wrong, I have been before...

R/r 911

[chbare]

Ridryder 911, you got it. He does have Lyme disease. When asked about his vacation he tells you that he went to Maryland in the early summer after allot of raining and spent a few days camping in the thick woods. This raises a red flag with regard to his history and how it relates to his complaints. I wanted to create a scenario that could be solved without the use of extensive tests but let every body have their tests to show that a good history and exam can provide critical information about our patient. This is especially true of BLS providers who may not have all of the cool toys or know all about labs, however, the lost art of history taking and the physical exam can still be their best friend. (This is true for all levels of providers)

Future medic 48_234, I understand that you may not know all about labs and do not feel bad about this. I try to present scenarios that require BLS and ALS techniques. I will give you some very basic lab info but highly recommend that you pick up a lab book for further reading. I really like Nursing Implications of Laboratory Tests. Pick up the latest edition you can find. In addition, formal education in A&P and biology is most helpful if you are able to take these courses.

I will briefly cover a few basic labs.

NA= Sodium. Sodium is a very important electrolyte (cation) when we talk about fluid movement and nervous system and muscle impulses. The normal range is 135-145 (plus or minus a few depending on the lab) Meq/L (miliequivelents per liter--> most electrolytes are measured in Meq/L) Sodium likes to live out side of the cell. At a very basic level sodium imbalances manifest with deficits in hydration and neurological changes.

K= Potassium. Potassium is a very important cation when we talk about nervous transmission and cardiac conduction. the normal range is 3.5-5 (+ or -). Potassium likes to live within the cell. At a very basic level potassium imbalances will manifest with cardiac conduction problems.

CL= Chloride is an anion (negative charge) and is important with fluid movement and sodium levels will roughly follow sodium because of the close relationship of sodium and chloride.

WBC- White blood cell count. This tells us about the immune system. Elevation (leukocytosis) may indicate infection, trauma/stress, or inflammation. Low WBC level may indicate immune suppression. the WBC is very non specific and a diff.. is needed to tell us which type of WBC is elevated. There are several types of WBC's. Remember, Never let monkeys eat bananas. N-neutrophils, L-lymphocytes, M-monocytes, E-eisoniphils, B-basophils. Normal WBC= 4.5-11.

Hbg- (Hemoglobin)is the measure of hemoglobin, the oxygen carrying substance within the red blood cells.

Hct- (Hematocrit) is the concentration of red blood cells in a sample of blood. Normal=37-47 may vary depending on gender.

Low Hbg & HCT may indicate anemia or acute blood loss. High H7H may indicate dehydration, asthma, or polycythemia.

A good general rule is the Hct should be around 3 times the Hbg.

Plt-Platelets- measure of the blood clotting pseudo cells called platelets.

Tryponin is a cardiac enzyme and high levels of tryponin may indicate MI or heart damage.

Myoglobin- is released by damaged muscle tissue and may indicate many problems.

PT/PTT/INR tell us how well the blood is clotting. Elevated levels may indicate a clotting problem or may be a result of medications (ASA, Heparin, Coumadin, and Plavix)

BUN and Creat- tell us about how the kidneys are working. Elevated BUN and Creatinine may indicate renal problems.

UDS= urine drug screen

UA= urinalysis-> multiple tests done on urine that tell us about the kidneys, hydration status, and presence of infection, among other things.

Tilts- a tilt test is done to check for ortho static changes such as dehydration. You should be able to google this one easily.

Sorry if I have spelling errors, the check is not working.

ESR

I hope this helps give you a tiny taste of basic labs.

EDIT: here is a link to more info on Lyme Disease

http://en.wikipedia.org/wiki/Lyme_disease

Take care,

chbare.

[future medic 48_234]

Thankyou for making it more clear for me to understand. I look forward to more of your scenarios.

[Ridryder 911]

As with any medical patient diagnosis.. hx., hx., hx...

Great scenario!

R/r 911