From the Guidelines
For a patient with point of impact (POI) injury, I recommend a comprehensive laboratory workup including complete blood count (CBC), basic metabolic panel (BMP), liver function tests (LFTs), coagulation studies (PT/INR, PTT), and urinalysis, with test reports that include patient name and identification number, laboratory name and address, test report date, test performed, specimen source, test results, and information regarding specimen condition and disposition, as outlined in the CLIA general test report requirements 1. When ordering labwork for POI, it is essential to consider the type of injury and potential internal damage.
- Additional tests should include creatine kinase (CK) to assess for rhabdomyolysis, especially with significant muscle trauma.
- If head injury is suspected, add toxicology screening and alcohol level.
- For abdominal trauma, include lipase and amylase to evaluate pancreatic injury.
- Type and screen/cross should be ordered if significant bleeding is present or anticipated.
- Arterial blood gases may be necessary for patients with respiratory compromise. These tests should be obtained immediately upon presentation to establish baseline values and guide initial management, with serial testing, particularly of hemoglobin/hematocrit and CK levels, to monitor for delayed bleeding or developing compartment syndrome, as recommended by good laboratory practices for molecular genetic testing for heritable diseases and conditions 1. The laboratory panel should be designed to identify internal injuries that may not be immediately apparent on physical examination and allow for timely intervention before complications develop, with test reports that comply with the CLIA general test report requirements and include the recommended additional information to ensure accurate understanding and interpretation of test results 1.
From the Research
Labwork for Postoperative Ileus (POI)
- Postoperative ileus (POI) is a frequent complication after abdominal surgery, with consequences such as bronchial inhalation or acute functional renal failure 2.
- The pathophysiology of POI has two phases: an early neurological phase and a later inflammatory phase, with a 'pharmacological' phase where analgesic drugs, particularly opiates, play a central role 2.
- POI is still a problematic and frequent complication of surgery, with key mechanisms including fluid overload, exogenous opioids, neurohormonal dysfunction, and gastrointestinal stretch and inflammation 3.
- Experts have reached consensus on the definition, relevant clinical signs, prevention, treatment, and supportive care of POI, including narcotic sparing analgesia, fluid optimization, and stimulation of ambulation 4.
Diagnosis and Treatment of POI
- The diagnosis of POI is often based on clinical signs such as abdominal distension, tenderness, and nausea, with imaging modalities like CT with Gastrografin providing high specificity and sensitivity 5.
- Treatment options for POI include limitation of narcotic use, thoracic epidural with local anesthetic, selective use of nasogastric decompression, and correction of electrolyte imbalances 6.
- Preventive measures such as avoidance of salt and water overload, alvimopan, and gum chewing can help reduce the risk of POI 3.
Clinical Endpoints and Differential Diagnosis
- Postoperative defecation together with tolerance of solid food intake is considered the best clinical endpoint of POI 5.
- Inflammatory parameters like interleukin (IL)-6, IL-1, and TNF-α may assist in early detection of prolonged POI 5.
- CT with Gastrografin has the best differential diagnostic value between POI and other complications 5.