Critical Lab Value Changes

Beginning January 4, 2010, the Critical Lab Value changes that will be called to physicians will change. This list was developed using the definition of a critical value as "test results that are abnormal to a degree that it may indicate a life threatening situation" by a group of physicians and staff. Please note changes in the Critical Lab Values that have been identified as Values that must be called within 30 minutes of receipt.  In particular, please note that PT/PTT is not listed. Preoperative lab results, unless they fit the criteria below, will not be called.   Finally, only values listed below within the listed parameters will be called. Abnormal results will no longer be called.

TEST	LESS THAN	GREATER THAN
Sodium (meq/L or mmol/L)	118	160
Potassium (meq/L or mmol/L)	2.5	6.5
CO2 Content (meq/L or mmol/L)	10	45
Glucose (mg/l)	40	700
Creatinine-non-dialysis (mg/dl)	N/A	4
BUN- nondialysis (mg/dl)	N/A	100
Calcium (mg/dl)	6	14
Magnesium (mg/dl)	1	8
Phosphorus (mg/dl)	1	N/A
Troponin I (ng/ml)	N/A	0.5
Hemoglobin-Adult (g/dL)	7	N/A
Hematocrit- Adult	21%	N/A
WBC- Adult (per mm or mL)	N/A	150
Platelets (per mm or mL)	20K	N/A
INR on anticoagulation	N/A	6
Acetaminophen post 4 hrs (mcg/ml)	N/A	150
Magnesium (mg/dl)	1	8
Phosphorus (mg/dl)	1	N/A
Troponin I (ng/ml)	N/A	0.5
Hemoglobin-Adult (g/dL)	7	N/A
Hematocrit- Adult	21%	N/A
WBC- Adult (per mm or mL)	N/A	150
Platelets (per mm or mL)	20K	N/A
INR on anticoagulation	N/A	6
Acetaminophen post 4 hrs (mcg/ml)	N/A	150
Digoxin (ng/ml)	N/A	3
Lithium (meq/L or mmol/L)	N/A	2
Phenobarbital (mcg/ml)		70
Phenytoin (mcg/ml)		40
Phenytoin Free (mcg/ml)		4
Salicylate (ug/ml)		50
Valproic Acid (mcg/ml)		150
Sodium - Pediatric	130 meq/l	145 meq/l
Potassium - Pediatric	3.0 meq/l	5.5 meq/l
CO² Content Pediatric	15 meq/l	30 meq/l
Glucose - Pediatric	40 mg/dl	180 mg/dl
Bilirubin total (NB)		18.0 mg/dl
Bilirubin Indirect (NB)		14.9 mg/dl
Hemoglobin - Newborn	12.0 g/dl
Hematocrit - Newborn	35%	70%
C - Newborn	2000/mm	32,000/mm

 

Microbiology Critical Values

 1.  CSF gram stain or preparation in which organisms are seen.

2.  Blood culture smear in which organisms are seen.

3.  Positive AFB smear done.

4.  Blood Cultures that are positive within the first 48 hours.

 

ABG Critical Results:

 

                              Less Than                 Greater Than

PH (arterial)                  7.20                         7.60 

PCO2                     20 mm hg                   70 mm hg

PO2                      40 mm hg                         NA

Carboxyhemoglobin (CO)   NA                      12.0%

 

 EKG Critical Parameters:

• HR < 50 or > 140
• If the machine interpretation states any of the following:

1.  A-Fib
2. Third Degree Heart Block
3.  Multiple PVC’s in a row
4.  Acute MI

 

Radiology Critical Results:

Physician to physician communication:

• Acute cerebral hemorrhage/hematoma
• Acute carotid/vertebral artery dissection
• Acute unstable cervical spine fracture
• Acute significant spinal cord compression
• Acute aortic dissection
• Ruptured/impending ruptured aortic aneurysm
• Acute pulmonary embolism
• Free intra-peritoneal air(if no recent surgery)
• Placental abruption
• Testicular or ovarian torsion
• Significant line/or tube misplacement (e.g. feeding tube in airway)
• Complicated appendicitis
• Complicated diverticulitis
• Acute infarct
• Ectopic pregnancy
• Acute arterial occlusion