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ISCE BOOST Menti: 6274 8940 Data Interpretation Devon WardWhat questions do you already have about data interpretation?Our Series and Rough Timeline Menti: 6274 8940 W/B 20 Nov – Introduction and CBDs W/B 27 Nov – SBAR and Important Conditions th W/B 4 Dec – Pharmacology (how to explain and which ones?) W/B 11 Dec – Paeds ------- st W/B 1 Jan – O+G W/B 15 Jan – Data interpretation (ABGs, FBC, LFTs, TFTs) th W/B 26 Feb – Neuro W/B 11 Mar – Psych W/B 25 Mar – Imaging (CXR, CT head, MSK) th W/B 8 Apr – Common and Important PresentationsCBD Review Menti: 6274 8940 We heard you! CBDs are difficult to know if you’ve picked the right topic and if you’ve got the right content Email us and we can review your topic and/or CBD document! Email: wardde1@cardiff.ac.ukOverview Menti: 6274 8940 Today, we will look at: • How to interpret ABGs, FBCs, LFTs, U+Es and TFTs • How to present this in an ISCE station • Example stations Any questions put them in the chat and we’ll get to them as we can!Data Interpretation in an ISCE Menti: 6274 8940 Link this to your Read out Pt details primary DDx Read out whether Summarise Read out type of test each test is high or everything you’ve low using normal read in technical language terms Seek help from a Read out date senior Menti: 6274 8940 Data Interpretation in an ISCE Read out Pt details Link this to your primary DDx Read out type of test Read out whether each test Summarise everything you’ve read Read out date or low using normal language in technical terms Seek help from a senior This supports my These are the full The haemoglobin is most likely diagnosis blood count results for low at 89 and the of B12 deficiency. Pt name, and I would mean cell volume is This represents a double-check the date high at 105 with a macrocytic of birth with them. low B12 at 140. As I am still unsure of The date on the form Everything else is anaemia. the main differential diagnosis, I would like is XX/XX/XXXX within normal range. to consult my senior with these blood test results using an SBAR approachFBCSFull Blood Count Menti: 6274 8940 The most important parts of the FBC to understand are the Hb, WBC andPlt It includes: Hb, WBC, Plt, RBC, Hct, MCV, MCH You may also be asked to interpret a differential white cell count, which includes: Neut, Lymph, Mono, Eosin, Baso You’re often given CRP or iron studies alongside these resultsFull Blood Count Menti: 6274 8940 Low = Anaemia • Iron deficiency High = Polycythaemia Hb • CKD [Rare] • Aplastic anaemia • Dehydration • Haemorrhage • Polycythaemia vera High = Leucocytosis Low = Leucocytopaenia WBC • Aplastic anaemia • Infection • Leukaemia • Autoimmune conditions • Leukaemia Low = Thrombocytopaenia High = Thrombocytosis • ITP • RA, IBD Plt • CKD • Infection • Aplastic anaemia • DIC • COPDFull Blood Count - Hb Menti: 6274 8940 Low Hb Low MCV Microcytic anaemia Low Hb High MCV Macrocytic anaemia Low Hb Low WBC Low Plt Aplastic anaemia, leukaemia Normal High Hb WBC Low Plt Polycythaemia veraFull Blood Count - WBC Menti: 6274 8940 Infection High WBC High CRP Aplastic anaemia, Low WBC Low Hb Low Plt acute leukaemia Chronic myeloid High WBC Low lymph High neut leukaemia High Chronic lymphocytic High WBC lymph Low neut leukaemia, lymphomaFull Blood Count - Plt Menti: 6274 8940 Normal Low Plt Normal Hb WBC ITP Normal Low Plt Low Hb WBC DICFBC Interpretation Menti: 6274 8940 These are full blood count results for Mr Pt Name.I will double check the date of birth with my patient. Mr Pt Name DOB: 17/01/1985 There is low haemoglobin at 110 and low mean cell Hb 110 (130-180) volume of 76, with normal white cell counts and platelets. WCC 5.8 (3.6-11.0) Plt 160 (140-400) MCV 76 (80-100) This represents a microcytic anaemia, which points towards my primary differential diagnosis of...FBC Interpretation Menti: 6274 8940 These are full blood count results for Miss Pt Name.I will double check the date of birth with my patient. Miss Pt Name DOB: 17/01/2001 There is a high WCC at 13.2 and a raised CRP 110, with Hb 150 (130-180) normal Hb and Plt. WCC 13.2 (3.6-11.0) Plt 260 (140-400) CRP 110 (<3) This leucocytosis and raised inflammatory markers indicate an ongoing infection which is consistent with my primary DDx...FBC Interpretation Menti: 6274 8940 These are full blood count results for Mr Pt Name.I will double check the date of birth with my patient. Mr Pt Name DOB: 17/01/1965 There is low Hb at 105, high white cells at 25.3 and high platelets at 520. Hb 105 (130-180) WCC 25.3 (3.6-11.0) Plt 520 (140-400) This represents an anaemia alongside a very high leukocytosis and thrombocytosis.This points towards my most likely diagnosis of...U+EUrea and Electrolytes Menti: 6274 8940 Most important bits are the sodium, potassium, urea and creatinine (all of it??) Includes: Na, K, Urea, Creatinine, eGFR Broadly, we’re trying to identify any life-threatening electrolyte imbalances and any AKIUrea and Electrolytes Menti: 6274 8940 Low = hyponatraemia High = hypernatraemia • SIADH • Dehydration Na • HF • Diabetes insipidus • AKI • Hyperaldosteronism • Adrenal insufficiency • Hypercorticolism High = hyperkalaemia Low = hypokalaemia • LIFE THREATENING K • D+V • CKD • Hyperaldosteronism • Adrenal insufficiency • DKA • RhabdomyolysisUrea and Electrolytes Menti: 6274 8940 High = Hyperuraemia • Dehydration Urea • AKI, CKD • HF • GI bleeding High • Infection Creatinine • AKI, CKD • Dehydration • Rhabdomyolysis (CK better) Low • AKI, CKD eGFR • Diabetes • PCKD • ObstructionU+E – Urea and Creatinine Menti: 6274 8940 High Ur High Cr AKI, CKD Super high Ur High Cr Dehydration High Ur High Cr Low Ca High K CKD High Ur High Cr Low Na High K AKIU+E – Sodium and Potassium Menti: 6274 8940 High Na Low K Conn’s, Cushing’s Low Na High K Addison’s High K High CK Rhabdomyolysis Low Na Low K High Ur High Cr Severe vomitingU+E Interpretation Menti: 6274 8940 These are urea and electrolyte results for Mrs Pt Name.I will double check the date of birth with my patient. Mrs Pt Name DOB: 17/01/1967 There is a high potassium at 5.5, and urea is raised at 9.3 Na 136 (135-146) and creatinine is raised at 125. K 5.5 (3.5-5.3) Urea 9.3 (2.5-7.8) Cr 125 (45-100) This represents an acute kidney injury with hyperkalaemia, which points towards my primary differential diagnosis of...U+E Interpretation Menti: 6274 8940 These are urea and electrolyte results for Mx Pt Name.I will double check the date of birth with my patient. Mx Pt Name DOB: 17/01/1982 There is slightly raised Na at 148, raised urea at 10.2 and Na 148 (135-146) slightly raised creatinine at 103. K 4.6 (3.5-5.3) Urea 10.2 (2.5-7.8) Cr 103 (45-100) A rise in urea proportionately greater than the rise in creatinine alongside a mild hypernatraemia points towards dehydration which supports my likely diagnosis of...U+E Interpretation Menti: 6274 8940 These are urea and electrolyte results for Mr Pt Name.I will double check the date of birth with my patient. Mr Pt Name DOB: 17/01/1996 The sodium is low at 130, the potassium is high at 5.4 Na 130 (135-146) and the urea is raised at 8.1. K 5.6 (3.5-5.3) Urea 8.1 (2.5-7.8) Cr 100 (45-100) The combination of hyponatraemia and hyperkalaemia with slightly raised urea are likely due to adrenal insufficiency, or Addison’s disease.LFTSLiver Function T ests Menti: 6274 8940 Most important bits are the ALT and AST Includes: ALT, AST, ALP, bilirubin, GGT and albumin Fairly rare to come up Broadly looking for if there’s evidence of liver failure or biliary obstructionLFT – AST and ALT Menti: 6274 8940 High ALT High AST Hepatocellular injury High ALT Higher Alcoholic liver disease ASTLFT – ALP and GGT Menti: 6274 8940 High ALP High GGT Cholestasis High ALP Normal Paget’s dz GGT Normal ALP High GGT Alcohol excessLFT – Bilirubin Menti: 6274 8940 Pre-hepatic High Normal Normal Normal unconjugated ALT AST ALP (haemolysis) High Normal High ALT High AST Hepatic unconjugated ALP High Normal Normal conjugated ALT AST High ALP CholestasisLFT Interpretation Menti: 6274 8940 These are liver function test results for Mr Pt Name.I will double check the date of birth with my patient. Mr Pt Name DOB: 17/01/1965 The ALP is raised at 156 and the GGT is raised at 76.The ALT 35 (<40) bilirubin is slightly raised at 21 but the other liver AST 42 (1-45) enzymes are within normal range. ALP 156 (30-130) GGT 76 (<50) Bili 21 (<21) Alb 37 (35-50) The combination of raised ALP and GGT is a cholestatic picture and is consistent with my primary diagnosis of...LFT Interpretation Menti: 6274 8940 These are liver function test results for Miss Pt Name.I will double check the date of birth with my patient. Miss Pt Name DOB: 17/01/1995 The ALT is raised at 80 and AST is raised at 6, and the ALT 80 (<40) bilirubin is raised at 68.The ALP, GGT and albumin are AST 60 (1-45) normal. ALP 67 (30-130) GGT 45 (<50) Bili 68 (<21) The markedly raised ALT and raised AST with Alb 45 (35-50) bilirubinaemia is consistent with hepatocellular injury which is consistent with my primary differential of...LFT Interpretation Menti: 6274 8940 These are liver function test results for Mrs Pt Name.I will double check the date of birth with my patient. Mrs Pt Name DOB: 17/01/1955 ALT 12 (<40) The ALP is raised at 183 but all other LFTs are within AST 25 (1-45) normal ranges. ALP 183 (30-130) GGT 45 (<50) Bili 15 (<21) Alb 42 (35-50) An isolated raise in ALP without a rise in GGT points towards high bone turnover such as in Paget’s disease...TFTSTFT s Menti: 6274 8940 High TSH Low T4 Hypothyroidism Low TSH High T4 Hyperthyroidism Normal Non-compliance High TSH T4ABGSArterial Blood Gases Menti: 6274 8940 Make sure you know how to do the skill! A lot of people struggle with this, so find an explanation and method that works for you Not as scary as it seems???ABGs Menti: 6274 8940 Answer! pH CO2 HCO3 O2 CO2 is acidic If resp, then T1 or T2 Acidosis or If CO2 is high, this will change RF akalosis? pH should be if chronic and If neither, it’s acidic be normal if normal or acute fully compensated Does the pH If met, check it match the matches pH CO2? If yes -> resp (low if high pH, If no -> met high if low pH)ABGs Menti: 6274 8940 Normal Resp acidosis Low pH High CO2 HCO3 Low O2 Low pH Low CO2 High Normal Met acidosis HCO3 O2 Normal Normal High pH Low CO2 Resp alkalosis HCO3 O2 High Normal High pH High CO2 HCO3 O2 Met alkalosisABGs Menti: 6274 8940 Respiratory Respiratory Metabolic Metabolic acidosis alkalosis acidosis alkalosis Hypoventilation – Hyperventilation – Sepsis Vomiting opioids, NMD asthma, anxiety COPD DKA Diuretics Obstruction – foreign AKI Hyperaldosteronism, body, tumour, hypercortisolism apnoea, scoliosis) PoisoningABG Interpretation Menti: 6274 8940 These are ABG results for Mrs Pt Name.I will double check the date of birth with my patient. Mrs Pt Name DOB: 17/01/2001 The pH is high at 7.51, the CO2 is reduced at 4.1 and the pH 7.51 (7.35-7.45) O2 and HCO3 are within normal ranges. pCO2 4.1 (4.6-6.4) pO2 12.3 (11.0-14.4) HCO3 24 (22-26) This is consistent with a respiratory alkalosis with no metabolic compensation, indicating an acute course. This supports my likely diagnosis of...ABG Interpretation Menti: 6274 8940 These are ABG results for Mr Pt Name.I will double check the date of birth with my patient. Mr Pt Name DOB: 17/01/2004 The pH is low at 7.29, as are the CO2 at 3.7 and the pH 7.29 (7.35-7.45) HCO3 at 17.The O2 is within normal ranges. pCO2 3.7 (4.6-6.4) pO2 11.2 (11.0-14.4) HCO3 17 (22-26) This represents a metabolic acidosis with partial respiratory compensation.This is consistent with my primary differential of...ABG Interpretation Menti: 6274 8940 These are ABG results for Miss Pt Name.I will double check the date of birth with my patient. Miss Pt Name DOB: 17/01/1955 The pH is low at 7.31, and the CO2 is high at 8.2.The O2 pH 7.31 (7.35-7.45) is low at 8.9 and the HCO3 is high at 28. pCO2 8.2 (4.6-6.4) pO2 8.9 (11.0-14.4) HCO3 28 (22-26) This represents a respiratory acidosis, in particular type II respiratory failure, with partial metabolic compensation, indicating it is chronic in nature.This supports my most likely differential of...QUESTIONS Menti: 6274 8940