Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Interpreting test results: Bloods, ECG, and chest X-raysLearning outcomes ▶Accurately interpret full blood count results and determine normal ranges for various markers. ▶Reading and interpreting x-rays in order to diagnose and manage patient conditions effectively. ▶Learn how to analyze ECG results and identify common abnormalities related to heart conditions. ▶Gain confidence and proficiency in applying these interpretation skills through case examples.Full Blood Count (FBC) Components, key disorders, case-based questionsFBC ▶Provides insight into the cellular components of blood (amount, size etc.) ▶ Red blood cells ▶ White blood cells ▶ PlateletsHaemoglobin (Hb) and MCV ▶Anaemia is indicated by a low Hb and is categorised based on causes and MCV: ▶ Microcytic anaemia - ↓Hb ↓MCV ▶ Macrocytic anaemia - ↓Hb ↑MCV ▶ Normocytic anaemia - ↓Hb MCV ▶ TIP: History (e.g. heavy menstrual bleeding, GI blood loss) - Look at Hb - Look at MCV to determine type of anaemia ▶ Further tests: Consider haematinics i.e. Iron stores, B12, and folate▶ Polycythaemia - ↑Hb + ↑ haematocrit ▶ Absolute - increase in the number of red cells ▶ Primary - myeloproliferative disease e.g. polycythaemia rubra vera ▶ Secondary - increased EPO e.g. COPD, smoking, malignancies, EPO abuse in athletes, endogenous steroids (cushings etc.) ▶ Relative - decrease in the amount of blood plasma e.g. low fluid intake, excess fluid loss such as in burnsReticulocytes ▶Immature red cells released by bone marrow into peripheral blood ▶Mature over 24 hrs ▶↑reticulocytes + anaemia = bone marrow trying to replace lost RBCs. Red cells lost by destruction e.g. haemolysis and bleeding ▶↓reticulocytes + anaemia = problem with the bone marrow not making enough cells due to nutritional deficiency or a bone marrow disorder e.g. aplastic anaemia ▶↑reticulocytes no anaemia = effective compensation of blood loss or haemolysis; increased O2 demandWhite cell countPlatelets ▶ Thrombocytosis (raised) ▶ Thrombocytopenia (low) ▶ Primary - essential ▶ Increased destruction - thrombocytosis or other immune (e.g. ITP, SLE, myeloproliferative drugs), non-immune (e.g. disorders DIC, HUS, hypersplenism) ▶ Secondary ▶ Decreased production - bone marrow failure, ▶ Inflammation, B12/folate deficiency, Infections, myelosuppression malignancy, postsplenectomy - reactive thrombocytosis, iron deficiencyRed flags Pancytopenia - anaemia, leukopenia, thrombocytopenia ▶ Non-haematological - severe infection, chemotherapy, liver disease and hypersplenism, bone marrow infiltration ▶ Haematological - Leukaemia, myelofibrosis, aplastic anaemia, lymphoma, myeloma Febrile neutropenia - fever + low neutrophils (<1.5) ▶ Really high infection risk ▶ Medical emergency requiring prompt management with broad spectrum Abx ▶ SEPSIS!Other important tests (not covered here) ▶ CRP - acute phase protein - increased in inflammation and infection (Normal: <5 mg/L) ▶ Urea and electrolytes ▶ LFTs ▶ Coagulation screen ▶ HaematinicsCase 1 78 year-old male presents with a 3 day history of cough, green sputum production, and SOB. Temp 38.3C, RR 32, HR 112, SpO2 92%, BP 102/75 Examination: right sided coarse crackles in the right lung base PMH: diabetes and CKD Interpret the following blood results and suggest a diagnosis, investigations, and management plan.Case 2 A 25 year old patient with Crohn’s disease presents with tiredness. Interpret the following blood tests and comment on abnormalities, suggest a likely diagnosis, and management.Would you request any further blood tests?Electrocardiogram (ECG) Components, structure of analysis, key disorders, case-based questionsWhat is an ECG? What are its components? ▶ ECGs are used to record electrical activity of the heart measured from different angles by placing electrodes on the patient ▶ 12 lead ECG has 10 electrodes and measures activity in 12 different directions/positionsV1, V2 Right ventricle V3, V4 septum V5, V6, Lead I L side of heart Lead II, III, Inferior aVF territory aVL L side of heart aVR R side of heart1.Rate ▶ Normal adult HR = 60-100 bpm ▶ Tachycardia >100 bpm ▶ Bradycardia <60 bpm ▶ If the rhythm appears regular ▶ count number of large squares between one R-R interval ▶ then divide 300 by this for HR ▶ If the rhythm is irregular ▶ calculate the number of QRS complexes on the rhythm strip (usually lead II) - e.g, on 10s strip ▶ multiple by 6 for HR in 1 60 secondsCalculate the HR2. Rhythm ▶ Is the rhythm regular? Is the distance between all P waves and QRS complexes equal and consistent? ▶ May be difficult to assess in bradycardia or tachycardia at times. ▶ Paper test! ▶ Mark out consecutive R-R intervals on a piece of paper and see if subsequent intervals are similar. ▶ Regularly irregular: Recurrent pattern of irregularity (e.g. AV blocks) ▶ Irregularly irregular: No pattern (e.g. AF)Atrial fibrillation (irregularly irregular)2nd degree heart block (regularly irregular)3. Cardiac axis ▶ Direction of overall electrical current. Normally between -30 and +90. ▶ Normal: aVR will have the most negative deflection ▶ If lead I and II +ve = normal cardiac axis ▶ Right axis deviation - deflection between +90 and +180 degrees ▶ Left axis deviation - deflection between -30 and -90 degrees4. P waves ▶ Represents atrial depolarisation ▶ are P waves present? are these followed by QRS complexes? do they look normal? ▶ if P waves absent - any atrial activity (e.g. saw tooth, flutter waves, fibrillating waves)5. PR interval ▶Start of the P wave to the start of the QRS complex ▶Normally 120-200ms (or 3-5 small squares) ▶Prolonged PR - AV delay, heart block ▶Shorter PR - P wave originates closer to AV node, accessory pathway (e.g. WPW)6. QRS complexes ▶Represents depolarization of the ventricles ▶width = <0.12s (3 small squares) ▶height ▶ small (<5mm in limb leads and <10mm in chest leads) ▶ tall (ventricular hypertrophy, tall slim people) ▶morphology = delta wave (WPW), broad QRS complexes (ventricular ectopics, BBB)Bundle branch blocks ▶ Look at QRS complexes in V1 and V6 ▶ WiLLiaM = left bundle branch block ▶ MaRRoW = right bundle branch block7. ST segment ▶ Isoelectric line ▶ abnormalities = ischaemia or infarction ▶ ST elevation (significant if >1mm or 1 small square) in 2 or more contiguous limb leads or >2mm in 2 or more chest leads (e.g. STEMI) ▶ ST depression >= 0.5mm in 2 or more contiguous leads = myocardial ischaemia e.g. NSTEMI8. T waves ▶Represents repolarization of ventricles ▶height = tall (>5mm in limb leads and >10mm in chest leads) vs flat ▶Tall T waves = hyperkalemia, hyperacute STEMI ▶T wave inversion = normal in aVR, V1-V3 and lead III) ▶New T wave inversion is usually abnormal8. T waves ▶Represents repolarization of ventricles ▶height = tall (>5mm in limb leads and >10mm in chest leads) vs flat ▶Tall T waves = hyperkalemia, hyperacute STEMI ▶T wave inversion = normal in aVR, V1-V3 and lead III) ▶New T wave inversion is usually abnormal9. U waves ▶>0.5mm deflection after T wave best seen in V2 and V3 ▶More pronounced in bradycardia ▶Causes: electrolyte abnormalities, hypothermia, digoxin/amiodaroneECG spot diagnosis 1ECG spot diagnosis 2 Chest X-rays (CXR) Structure of analysis, key findings, case-based questionsA: assessment, airways and air ▶ Assessment: identify the patient and match the scan, note quality of the image (including exposure, good inspiration, AP/PA) ▶ Airway: trachea, carina, bronchi and hilar structures ▶ Look for deviation (effusion? pneumothorax?), paratracheal masses, lymphadenopathy ▶ Hilar enlargement (sarcoidosis, malignancy)B: breathing and bones ▶ Breathing refers to lung fields ▶ Divide lungs into three zones (does not equate to lobes) ▶ Start from top (apex) to bases ▶ lung markings? (absence - pneumothorax?) ▶ Airspace shadowing? ▶ Consolidation? ▶ Pleura - inspect borders, fluid or blood can increase opacity ▶ Bones ▶ assess bones starting from clavicles downwards counting all ribs ▶ Fractures? Lytic lesions?C: cardiac silhouette ▶ Normal = heart occupies <50% of the width of the thorax (cardiothoracic ratio of 0.5) ▶ >50% = cardiomegaly - underlying cardiac disorder ▶ Inspect heart borders - RA makes up right heart border while the LV makes up the left heart border ▶ Increased consolidation can blur this outlineD: diaphragm ▶ Normally R higher than L due to gastric bubble ▶ Inspect the costophrenic angles - dome of each hemidiaphragm and later chest wall ▶ blunting = fluid or consolidation ▶ flattening = lung hyperinflation (e.g. COPD)E: equipment, soft tissues, great vessels ▶ Equipment refers to correct positioning of devices, wires, lines etc. e.g. NG tube in gastric bubble passing the middle of the carina, ET tube in the middle of trachea, pacemakers ▶ Soft tissue: changes in the soft tissue around the chest e.g. large haematoma ▶ Great vessels: superior and inferior vena cava, ascending and descending aorta, aortic arch, pulmonary artery ▶ Aortic knuckle reduced definition = aneurysm? ▶ mediastinal contours - lymphadenopathy? malignancy?Case based question 67 year old man with shortness of breath. O/E: hypoxic, tachypneic, tachycardic, reduced breath sounds + widespread coarse crackles Describe their chest X-ray and suggest a diagnosis.Useful learning/practice resources ▶ https://oxfordmedicaleducation.com/ecgs/ecg-examples/ ▶ Geeky Medics OSCE guides + stations ▶ https://www.radiologymasterclass.co.uk/quizzes/test-yourself-chest-x-ray- quiz-1 ▶ Life in the fast lane ECG and CXR cases ▶ https://www.australiancriticalcare.com/content/quizzesQUESTIONS?Feedback Please take a minute now before you leave to fill in a quick feedback form! https://app.medall.org/feedback/feedback- flow?keyword=dbe6d2235c6298113aea328d&organisation=ac cessibility-in-medicineThank you for coming! ▶ If you have any more questions, feel free to email me at s1908775@ed.ac.uk or email accessibilityinmedicine@gmail.com ▶Give our Facebook page a like for updates and opportunities, just search @AIMEdinburghSign up to the mailing list ▶ Sign up to the AIM mailing list to be the first to hear about tutorials, discounts, and opportunities! ▶https://forms.gle/q JNyeoFzA9B5urND7Thank you to our sponsors