CRITICAL (PANIC) VALUES (Excluding Outreach Nursing Homes)

Transcription

1 Ammonia mcmol/l Amylase U/L AST (Aspartate Aminotransferase) 2000 U/L Bilirubin, Total & Neonatal 0-1 day mg/dl 2 days mg/dl 3-21 days mg/dl Bilirubin, Direct, Neonatal days 2 -- mg/dl BUN mg/dl Results will not be called to designated Royal Oak nephrologists Calcium, Total mg/dl Calcium, Ionized mg/dl Creatine Kinase-MB ng/ml Results on patients from 6-East (Royal Oak) will NOT be called to the physician or nursing unit Creatine Kinase-MB Index 2.2 Creatine Kinase 20, U/L Creatinine 0-16 years mg/dl Creatinine 17 years mg/dl Results will not be called to designated Royal Oak nephrologists Creatinine Grosse Pointe Only 6 -- mg/dl Glucose, FBS or Random 0 23 mos mg/dl IP, EC or POC: 24 months 16 yrs mg/dl OP/: 2 yrs 16 yrs mg/dl IP, EC or POC: =/> 17 years 500 mg/dl IP, EC or POC: =/> 17 years 50 mg/dl OP/: =/> 17 years 500 mg/dl OP/: =/> 17 years 40 mg/dl Glucose, CSF 0-24 months mg/dl >24 months mg/dl Lactic Acid mmol/l Magnesium 6 1 mg/dl with online version to verify that it is up-to-date before use. Page 1

2 continued Osmolality mosmol/kg ph, Venous Phosphorus -- 1 mg/dl Troponin I ng/ml Results on patients from 6-East (Royal Oak) will NOT be called to the physician or nursing unit Troponin I Farmington Hills 0.49 ng/ml Uric Acid mg/dl Uric Acid Rasburicase mg/dl Electrolytes: Sodium 0-1 day mmol/l 2 Days 17 years mmol/l 18 years mmol/l Potassium 0-1 day mmol/l 2 days 3 months mmol/l 4 months - Adult mmol/l Chloride mmol/l CO 2 Farmington Hills, Royal Oak, Troy mmol/l Grosse Pointe Only mmol/l Gases: Oxyhemoglobin (arterial specimen only) % PO 2 (arterial specimens only) mmhg PCO 2 (arterial & capillary specimens) mmhg ph Total CO 2 Farmington Hills, Royal Oak, Troy mmol/l Grosse Pointe Only mmol/l Hemoglobin 0-14 days g/dl >14 days 20 <6.5 g/dl Carboxyhemoglobin % Methemoglobin % Sulfhemoglobin Positive with online version to verify that it is up-to-date before use. Page 2

3 Toxicology/TDM Acetaminophen mcg/ml Acetone mg/dl Allobarbital mcg/ml Amikacin (peak) mcg/ml Amikacin (trough) mcg/ml Amiodarone 5 -- mcg/ml Amitriptyline 500 (+ metabolite) -- ng/ml Amobarbital mcg/ml Aprobarbital mcg/ml Barbital mcg/ml Butabarbital mcg/ml Butalbital mcg/ml Caffeine mcg/ml Carbamazepine mcg/ml Carbamazepine, unbound 5 -- mcg/ml Carbamazepine epoxide 4 -- mcg/ml Clomipramine 1000 (+ metabolite) -- ng/ml Clonazepam ng/ml Cyclosporine A ng/ml Desipramine ng/ml Digoxin 0-70 years ng/ml > 70 years 2 -- ng/ml Doxepin 500 (+ metabolite) -- ng/ml Ethanol 0-12 years mg/dl years mg/dl 21 years mg/dl 100 years mg/dl Ethosuximide mcg/ml Fluoxetine 2000 (+ metabolite) -- ng/ml Gabapentin mcg/ml Gentamicin (peak) mcg/ml Gentamicin (trough) mcg/ml with online version to verify that it is up-to-date before use. Page 3

4 CRITICAL VALUES Unit of Toxicology/TDM continued Imipramine 500 (+ metabolite) -- ng/ml Isopropanol mg/dl Lamotrigine mcg/ml Levetiracetam mcg/ml Lidocaine 7 -- mcg/ml Lithium mmol/l Mephobarbital mcg/ml Methanol mg/dl Metharbital mcg/ml Nortriptyline ng/ml Oxcarbazepine Metabolite (MHD) mcg/ml Pentobarbital mcg/ml Phenobarbital mcg/ml Phenytoin mcg/ml Phenytoin, Free 3 -- mcg/ml Primidone mcg/ml Procainamide mcg/ml Procainamide and NAPA mcg/ml Propafenone 8 -- mcg/ml Quinidine 8 -- mcg/ml Salicylate mg/dl Secobarbital mcg/ml Sirolimus ng/ml Tacrolimus/FK ng/ml Theophylline mcg/ml Thiocyanate mcg/ml Thiopental mcg/ml Tobramycin (peak) mcg/ml Tobramycin (trough) mcg/ml Topiramate mcg/ml Trazodone 5 -- mcg/ml Trimipramine 500 (+ metabolite) -- ng/ml with online version to verify that it is up-to-date before use. Page 4

5 CRITICAL VALUES Unit of Toxicology/TDM continued Valproic acid mcg/ml Vancomycin (peak) mcg/ml Vancomycin (trough ) mcg/ml Urinalysis Ketones All Ages 8 days mg/dl Results will not be called to Emergency Centers (Grosse Pointe, Royal Oak and Troy) Ketones Newborn - 7 days mg/dl Results will not be called to Emergency Centers (Grosse Pointe, Royal Oak and Troy) Ketones Newborn - 7 days Farmington Hills 20 Porphobilinogen Positive -- HEMATOLOGY Hematocrit 0-14 days % Hematocrit 15 days % Hemoglobin 0-14 days g/dl days 20 9 g/dl 29 days 2 years 20 8 g/dl EC and s Only 3 years Adult 20 <6.5 g/dl Outpatients 3 years - Adult 20 <7 g/dl Platelets 0-30 days 1, bill/l 31 days - Adult 1, bill/l WBC, Total bill/l Grosse Pointe Only 25 2 bill/l Blasts >5% If previously unknown -- % Blasts <5% If previously unknown -- % Blasts, CSF 1 -- per mcl * *: Troy & Grosse Pointe will call during dayshift only Neutrophils bill/l Fibrinogen mg/dl Farmington Hills only mg/dl with online version to verify that it is up-to-date before use. Page 5

6 HEMATOLOGY continued INR 5 PT Farmington Hills only sec PTT sec Farmington Hills only sec Outpatient CBC Hemoglobin -- 7 g/dl Platelets bill/l WBC -- 2 bill/l Outpatient CBCD Hemoglobin -- 7 g/dl Platelets bill/l WBC -- 2 bill/l Neutrophils bill/l Chemo CBC (No critical WBC or PLT) Hemoglobin g/dl Chemo CBCD (No critical WBC, neut or PLT) Hemoglobin g/dl Outpatient Chemo CBC (no critical WBC) Hemoglobin -- 6 g/dl Platelets bill/l Outpatient Chemo CBCD (no critical WBC or neut) Hemoglobin -- 6 g/dl Platelets bill/l SPECIAL TESTING Heparin Platelet Factor 4 Antibody OD with online version to verify that it is up-to-date before use. Page 6

7 MICROBIOLOGY Critical values reported if test is positive on the following tests: Acanthamoeba/Naegleria culture Acid-Fast smear, culture, PCR Bacterial antigen test Blood culture - smear or culture Blood parasite smear Bordetella pertussis culture or PCR Brain Abscess - smear or culture Bronchoalveolar lavage - influenza, RSV Brucella,Francisella, Bacillus anthracis, Yersinia pestis culture, Burkholderia mallei or pseudomallei, pox viruses, novel viruses Clostridium difficile Cryptococcal antigen CSF positive smear, culture or PCR for bacteria, fungi, or viruses Fungus (Blastomyces, Histoplasma, Coccidioides) Gram stain (STAT) Group A Strep (wound, skin, soft tissue) culture or PCR Internal Organ Tissue smear or culture (excludes GI and Autopsy specimens) Legionella Ag, Strep. pneumoniae Ag N. gonorrhoeae culture, PCR (< 12 years) Ova and parasite Pneumocystis smear Sterile Body Fluid positive - smear, culture or PCR for bacteria, fungi, or viruses (includes amniotic, bone marrow, organ preservation, pancreatic, pericardial, pleural, synovial, and ocular - aqueous or vitreous) Stool culture (Shigella, Vibrio 18 years) Stool culture, E. coli Shigatoxin Strep screen (STAT only) TRANSFUSION MEDICINE / BLOOD BANK Positive Direct Antiglobulin Test (DAT) on a neonate (regardless of strength of reaction) Suspected acute hemolytic transfusion reaction (RED Alerts) (RED Alerts) (BLUE Alerts) (RED Alerts) (RED Alerts) (BLUE Alerts) NA NA NA Document control: Revisions made throught the Royal Oak Clinical Pathology Administration office. Document Control Distribution: External online link sent to Beaumont Laboratory (FH, GP,, RO, Troy) medical, administrative and supervisory staff. with online version to verify that it is up-to-date before use. Page 7