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Emergency medicine

  • Walter Schaffartzik
  • Christian Müller
  • Tobias Lindner
  • Julia Searle
  • Martin Möckel

Abstract

In preclinical and clinical emergency care, laboratory testing is one of the most important aspects of diagnostics, alongside clinical assessment, ECG and imaging (ultrasound, radiology). In this context, lab workups are primarily used to aid diagnosis when the clinical picture is unclear, to support initial therapeutic interventions as well as for risk stratification. The main focus is on the rapid availability of vital parameters such as electrolytes, lactate, cardiac troponin and hemoglobin.

References

  1. 1.
    Asimos AW, Gibbs MA, Marx JA, Jacobs DG, Erwin RJ, Norton HJ, et al. (2000) Value of point-of-care blood testing in emergent trauma management. J Trauma [Internet] 48(6):1101–1108CrossRefGoogle Scholar
  2. 2.
    Bochicchio G V, Ilahi O, Joshi M, Bochicchio K, Scalea TM (2003) Endotracheal intubation in the field does not improve outcome in trauma patients who present without an acutely lethal traumatic brain injury. J Trauma 54:307–311CrossRefGoogle Scholar
  3. 3.
    Bundesärztekammer (2014) Querschnitts-Leitlinien zur Therapie mit Blutkomponenten und PlasmaderivatenGoogle Scholar
  4. 4.
    Bundesministerium für Gesundheit. Drogen- und Suchtbericht 2016. www.bmg.bund.de, www.drogenbeauftragte.de
  5. 5.
    Casserly B, Phillips GS, Schorr C, Dellinger RP, Townsend SR, Osborn TM, et al. (2015) Lactate measurements in sepsis-induced tissue hypoperfusion: results from the Surviving Sepsis Campaign database. Crit Care Med [Internet] 43(3):567–573CrossRefPubMedGoogle Scholar
  6. 6.
    Chalfin DB, Trzeciak S, Likourezos A, Baumann BM, Dellinger RP, Group D-E study (2007) Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit. Crit Care Med [Internet] 35(6):1477–1483Google Scholar
  7. 7.
    Christ-Crain M, Jaccard-Stolz D, Bingisser R, Gencay MM, Huber PR, Tamm M, et al. (2004) Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial. Lancet [Internet] 363(9409):600–607CrossRefGoogle Scholar
  8. 8.
    Dettmer M, Holthaus C V, Fuller BM (2015) The impact of serial lactate monitoring on emergency department resuscitation interventions and clinical outcomes in severe sepsis and septic shock: an observational cohort study. Shock [Internet] 43(1):55–61CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Deutsche Hauptstelle für Suchtfragen. Alkohol in Europa. 2006Google Scholar
  10. 10.
    DiSerio F, Petronelli MA, Sammartino E (2010) Laboratory testing during critical care transport: point-of-care testing in air ambulances. Clin Chem Lab Med [Internet] 48(7):955–961Google Scholar
  11. 11.
    Dretzke J, Sandercock Bayliss S Burls A (2004) Clinical effectiveness and cost-effectiveness of prehospital intravenous fluids in trauma patients. Heal Technol Assess [Internet] 8(23):1–118Google Scholar
  12. 12.
    Engoren M (2005) The effect of prompt physician visits on intensive care unit mortality and cost. Crit Care Med [Internet] 33(4):727–732CrossRefPubMedGoogle Scholar
  13. 13.
    European Stroke Organisation Executive C, Committee ESOW (2008) Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis [Internet] 25(5):457–507Google Scholar
  14. 14.
    Fabbri A, Marchesini G, Morselli-Labate AM, Ruggeri S, Fallani M, Melandri R, et al. (2003) Comprehensive drug screening in decision making of patients attending the emergency department for suspected drug overdose. Emerg Med J [Internet] 20(1): 25–28CrossRefPubMedGoogle Scholar
  15. 15.
    Gemeinsame Erklärung der Deutschen AG, Osterreichischen AG (2009) [Post-exposure prophylaxis of HIV infection. German-Austrian recommendations, update September 2007]. Dtsch Med Wochenschr [Internet] 134 Suppl:S16–33Google Scholar
  16. 16.
    Heyerdahl F, Hovda KE, Giraudon I, Yates C, Dines AM, Sedefov R, et al. (2014) Current European data collection on emergency department presentations with acute recreational drug toxicity: gaps and national variations. Clin Toxicol [Internet] 52(10):1005–1012CrossRefPubMedGoogle Scholar
  17. 17.
    Hilbert-Carius P, Hofmann G, Stuttmann R (2015) [Hemoglobin-oriented and coagulation factor-based algorithm : Effect on transfusion needs and standardized mortality rate in massively transfused trauma patients]. Anaesthesist [Internet] 64(11):828–838CrossRefPubMedGoogle Scholar
  18. 18.
    Jage J, Heid F (2006) Anästhesie und Analgesie bei Suchtpatients. Grundlagen zur Erstellung einer “standard operating procedure“. Anaesthesist 55:611–628CrossRefPubMedGoogle Scholar
  19. 19.
    Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch Institut (2014) Empfehlungen zur Prävention und Kontrolle von Methicillinresistenten Staphylococcus aureus-Stämmen in medizinischen und pflegerischen Einrichtungen Empfehlung der Kommission für Krankenhaushygiene and Infektionsprävention (KRINKO) beim Robert Koch-InstitutGoogle Scholar
  20. 20.
    Konstantinides SV (2014) ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Hear J 35:3145–3146Google Scholar
  21. 21.
    Lazarenko GC, Dobson C, Enokson R, Brant R (2001) Accuracy and speed of urine pregnancy tests done in the emergency department: a prospective study. CJEM 3:292–295CrossRefPubMedGoogle Scholar
  22. 22.
    Lindner G, Exadaktylos AK (2013) [Disorders of serum sodium in emergency patients : salt in the soup of emergency medicine]. Anaesthesist [Internet] 62(4):296–303CrossRefPubMedGoogle Scholar
  23. 23.
    Maegele M, Inaba K, Rizoli S, Veigas P, Callum J, Davenport R, et al. (2015) [Early viscoelasticity-based coagulation therapy for severely injured bleeding patients: Report of the consensus group on the consensus conference 2014 for formulation of S2k guidelines]. Anaesthesist [Internet] 64(10): 778–794.CrossRefPubMedGoogle Scholar
  24. 24.
    Maegele M, Lefering R, Yucel N, Tjardes T, Rixen D, Paffrath T, et al. (2007) Early coagulopathy in multiple injury: an analysis from the German Trauma Registry on 8724 patients. Injury [Internet] 38(3): 298–304.CrossRefPubMedGoogle Scholar
  25. 25.
    Maisel A, Neath SX, Landsberg J, Mueller C, Nowak RM, Peacock WF, et al. (2012) Use of procalcitonin for the diagnosis of pneumonia in patients presenting with a chief complaint of dyspnoea: results from the BACH (Biomarkers in Acute Heart Failure) trial. Eur J Heart Fail [Internet] 14(3): 278–286CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Marti G, Schwarz C, Leichtle AB, Fiedler GM, Arampatzis S, Exadaktylos AK, et al. (2014) Etiology and symptoms of severe hypokalemia in emergency department patients. Eur J Emerg Med [Internet] 21(1):46–51Google Scholar
  27. 27.
    Mastrovitch TA, Bithoney WG, DeBari VA, Gold NA (2002) Point-of-care testing for drugs of abuse in an urban emergency department. Ann Clin Lab Sci [Internet] 32(4):383–386Google Scholar
  28. 28.
    McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, et al. (2012) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart. ESC Eur J Hear Fail 14:803–869Google Scholar
  29. 29.
    Möckel M, Müller C, Lindner T Searle J (2016) Laboruntersuchungen – was ist sinnvoll, was ist überflüssig? (Fast diagnostics in the emergency department: Laboratory testing – what we need and what we don’t). Dtsch med Wochenschr 141(5):322–328CrossRefGoogle Scholar
  30. 30.
    Möckel M, Searle J (2014) [Point-of-care testing in preclinical emergency medicine]. Med Klin Intensivmed Notfmed [Internet] 109(2):100–103CrossRefGoogle Scholar
  31. 31.
    Möckel M, Searle J, Hamm C, Slagman A, Blankenberg S, Huber K, et al. (2015) Early discharge using single cardiac troponin and copeptin testing in patients with suspected acute coronary syndrome (ACS): a randomized, controlled clinical process study. Eur Heart J [Internet] 36(6):369CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Möckel M, Searle J, Huttner I, Vollert JO (2015) Qualitative process analysis and modelling of emergency care workflow and interface management: identification of critical process steps. Eur J Emerg Med [Internet] 22(2):79–86CrossRefPubMedGoogle Scholar
  33. 33.
    Mohammed AA, van Kimmenade RR, Richards M, Bayes-Genis A, Pinto Y, Moore SA, et al. (2010) Hyponatremia, natriuretic peptides, and outcomes in acutely decompensated heart failure: results from the International Collaborative of NT-proBNP Study. Circ Hear Fail [Internet] 3(3):354–361Google Scholar
  34. 34.
    National Health Service England (2015) A & E attendances and emergency admissions: June 2015 monthly report. Monthly reportGoogle Scholar
  35. 35.
    Newbatt E, Beckles Z, Ullman R, Lumsden MA, Guideline Development G (2012) Ectopic pregnancy and miscarriage: summary of NICE guidance. BMJ [Internet] 345:e8136CrossRefPubMedGoogle Scholar
  36. 36.
    Pemmerl S (2013) [Initial diagnosis and treatment for poisoning]. Med Klin Intensivmed Notfmed [Internet] 108(6):459–464CrossRefGoogle Scholar
  37. 37.
    Pollack Jr. CV (2016) Coagulation assessment with the new generation of oral anticoagulants. Emerg Med J [Internet] 33(6):423–430CrossRefPubMedGoogle Scholar
  38. 38.
    Post F, Giannitsis E, Darius H, Baldus S, Hamm CW, Hambrecht R, et al. (2015) Kriterien der Deutschen Gesellschaft für Kardiologie - Herz- and Kreislaufforschung für „Chest Pain Units” Update 2015. Kardiologe 9:171–181CrossRefGoogle Scholar
  39. 39.
    Post F, Gori T, Giannitsis E, Darius H, Baldus S, Hamm C, et al. (2015) Criteria of the German Society of Cardiology for the establishment of chest pain units: update 2014. Clin Res Cardiol [Internet] 104(11): 918–928CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Rixen D, Raum M, Bouillon B, Neugebauer E, der Deutschen Gesellschaft für Unfallchirurgie AGP (2002). Der Base-Excess als Prognose-Indikator bei Polytrauma-patients. Anästhesiol Intensivmed Notfallmed Schmerzther 37:347–349CrossRefGoogle Scholar
  41. 41.
    Robert Koch Institut (2015) InfluenzaGoogle Scholar
  42. 42.
    Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. (2015) 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment. Elev Eur Soc Cardiol (ESC) Eur Hear J. DOI: http://dx.doi.org/10.1093/eurheartj/ ehv320 ehv320
  43. 43.
    Ruchholtz S, Waydhas C, Ose C, Lewan U, Nast-Kolb D, German WGMT (2002) Prehospital intubation in severe thoracic trauma without respiratory insufficiency: A matched-pair analysis based on the trauma registry of the German Trauma Society. J Trauma-Injury Infect Crit Care [Internet] 52(5): 879–886Google Scholar
  44. 44.
    Schmidt BMW (2015) The most frequent electrolyte disorders in the emergency department. What must be done immediately? Internist [Internet] 56(7):753CrossRefPubMedGoogle Scholar
  45. 45.
    Schuetz P, Kutz A, Grolimund E, Haubitz S, Demann D, Vogeli A, et al. (2014) Excluding infection through procalcitonin testing improves outcomes of congestive heart failure patients presenting with acute respiratory symptoms: Results from the randomized ProHOSP trial. Int J Cardiol [Internet] 175(3):464–472CrossRefPubMedGoogle Scholar
  46. 46.
    Selmer C, Olesen JB, Hansen ML, Lindhardsen J, Olsen AM, Madsen JC, et al. (2012) The spectrum of thyroid disease and risk of new onset atrial fibrillation: a large population cohort study. BMJ [Internet] 345:e7895CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J (2004) Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: A systematic review and meta-analysis. Clin Infect Dis [Internet] 39(2):206–217CrossRefPubMedGoogle Scholar
  48. 48.
    Spahn DR, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernandez-Mondejar E, et al. (2013) Management of bleeding and coagulopathy following major trauma: an updated European guideline. Crit Care [Internet] 17(2):R76CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Stengel D, Porzsolt F (2003) Evidence-based medicine: Randomisierung nicht zwingend erforderlich. Dtsch Ärztebl 100:2145Google Scholar
  50. 50.
    Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. (2012) Third universal definition of myocardial infarction. Eur Hear J 33: 2551–2567Google Scholar
  51. 51.
    Van Schaik SM, Scott S, de Lau LM, Van den Berg-Vos RM, Kruyt ND (2015) Short door-to-needle times in acute ischemic stroke and prospective identification of its delaying factors. Cerebrovasc Dis Extra [Internet] 5(2):75–83Google Scholar
  52. 52.
    Wacker C, Prkno A, Brunkhorst FM, Schlattmann P (2013) Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis [Internet] 13(5):426–435CrossRefPubMedGoogle Scholar
  53. 53.
    Wu AHB, McKay C, Broussard LA, Hoffman RS, Kwong TC, Moyer TP, et al. (2003) National academy of clinical biochemistry laboratory medicine practice guidelines: Recommendations for the use of laboratory tests to support poisoned patients who present to the emergency department. Clin Chem [Internet] 49(3):357–379CrossRefPubMedGoogle Scholar
  54. 54.
    Zander BE (2003) Diagnostische and therapeutische Bedeutung von Base Excess und Laktatkonzentration. Anästhesiol Intensivmed Notfallmed Schmerzther 37:343–346CrossRefGoogle Scholar
  55. 55.
    Zorbalar N, Yesilaras M, Aksay E (2014) Carbon monoxide poisoning in patients presenting to the emergency department with a headache in winter months. Emerg Med J [Internet] 31(e1):e66–70CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Walter Schaffartzik
    • 1
  • Christian Müller
    • 2
  • Tobias Lindner
    • 2
  • Julia Searle
    • 2
  • Martin Möckel
    • 3
  1. 1.Unfallkrankenhaus BerlinKlinik für Anästhesiologie, Intensivmedizin und SchmerztherapieBerlinGermany
  2. 2.Charité-Universitätsmedizin BerlinRettungsstellen CVK/CCMBerlinGermany
  3. 3.Charité-Universitätsmedizin BerlinRettungsstellen CVK / CCMBerlinGermany

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