St. Michael’s Emergency Rooms Care Diagnostic Laboratory
St. Michael’s Emergency Rooms have a complete, on-site diagnostic laboratory department, staffed 24 hours each day with specialists trained in lab.
St. Michael’s offers an array of emergent lab testing for our patients. Below is a list of some of the tests our emergency clinic offers, and information about each test. Most of our lab tests results are known within 15 minutes.
St. Michael’s Emergency Rooms offers:
- CBC (complete blood counts)
- Point of Care Testing: Flu, Strep and RSVs
- STD testing
- Pregnancy test (urine)
- Drug screening (rapid)
- Alcohol screening (rapid)
- PT INR testing for blood thinning
- Blood glucose testing
- D-Dimer (detects blood clots)
- Cardiac Enzymer /Cardiac panel
- Brain Natriuretic Peptide (BNP)
What is the complete blood count test (CBC)?
A complete blood count (CBC) test measures the number of red blood cells, the number of white blood cells, the total amount of hemoglobin in the blood and the percentage of the blood made up of red blood cells. The test also establishes the size of an average red blood cell, how much hemoglobin is in the red blood cell and the platelet count.
Why the CBC Test is Performed?
The CBC test is used to assess several different types of medical conditions such as problems with fluid volume (such as dehydration), loss of blood or to diagnose allergies, infections or issues with blood clotting. The test can also be used to help diagnose different forms of anemia.
How Is the CBC Test Performed?
Blood is typically drawn from a vein in the back of the hand or inside elbow area. Next, a needle is inserted into the vein and blood is collected into an airtight vial or tube attached to the needle. The sample is processed by a St. Michael’s lab technician and evaluated by a St. Michael’s Emergency Room doctor.
St. Michael’s Emergency Rooms can test patients for a range of common infections and contagions. Some of the tests available to our patients:
- Flu tests
- Strep infections
What is a Flu Test?
A flu test is comprised of several evaluation methods to determine if you have influenza. If seasonal flu is very widely spread within the community, sometimes symptoms are enough for a doctor to determine if a patient has the flu. If flu-like symptoms are present (see symptoms below) such as a very heavy cough and fever, the exam will include a thorough physical. If the St. Michael’s Emergency Room doctor suspects it could be pneumonia, the patient might require a chest x-ray.
Additional blood work may be needed, which could include a CBC test (described above). The most common method for diagnosing the flu is an “antigen” test which involves using a swab to collect a culture of the nose and throat, then having a St. Michael’s lab technician process the culture. A St. Michael’s Emergency Room doctor would evaluate the culture.
Test results can be developed very quickly so the attending doctor can decide what type of treatment (if any) is appropriate. Since the flu is a viral condition, the doctor will generally treat the symptoms. If the patient is diagnosed with bacterial pneumonia, he or she would be put on an antibiotic in addition to receiving medications to make the patient more comfortable.
Who Should Be Tested for the Flu?
Flu symptoms present differently in children than in adults. It’s important to understand these symptoms so that a patient can seek medical help as soon as the symptoms start. The Center for Disease Control offers the following guidelines:
CHILD SYMPTOMS: The CDC urges emergency medical care for a sick child with any of these symptoms:
- Rapid breathing or trouble breathing
- Skin color looking bluish or gray
- Not drinking enough fluids
- Severe or persistent vomiting
- Not waking up or not interacting; general listlessness
- Not wanting to be held or comforted
- Flu-like symptoms improve, then return with fever and cough
ADULT SYMPTOMS: The CDC encourages adults to seek emergency medical care with any of these symptoms:
- Shortness of breath or difficulty breathing
- Pain or pressure in the chest or abdomen
- Sudden dizziness
- Severe or persistent vomiting
- Flu-like symptoms improve but then return with fever and worse cough
- Having a high fever for more than three days
Who Should Receive the Flu Vaccine?
In the Sugar Land, TX area, the flu season usually occurs from about October – April. Typically, the flu is very prevalent during the November/December holidays. Ideally, the conventional flu vaccine should be administered between September and early November. It takes about one to two weeks after vaccination for antibodies against influenza to develop and provide protection from the flu. Groups at increased risk of complications from the flu include: babies and young children, especially those in daycare; the elderly, people with compromised immune systems, people with generalized breathing issues such as chronic asthma or bronchitis, and women who are pregnant.
Streptococcus (Strep) Tests
Sore throats (pharyngitis) can be caused by bacteria, viruses or reaction to allergens. Most sore throats are caused by sinus drainage or viruses. Fewer than a third of all sore throats are bacterial, and of those, most are from streptococcus bacteria. School aged children 5 years to 15 years of age are the most common age group infected by strep infections during winter and early spring.
What is a Strep Test?
The rapid strep test is a quick and accurate diagnostic tool used to determine whether or not streptococcus bacteria are present in the patient’s throat. The same test may be used to detect Streptococci in other infected areas, such as lesions or wounds on the skin.
Why Is a Strep Test Performed?
Viewing a patient’s throat is not enough information to determine if a sore throat is from a bacterial source. Because a streptococcus infection can be treated with antibiotics, it’s important to have a strep test as soon as possible. Strep can develop into further complications in the body. Although rare, strep can cause kidney disease. It also is the bacterial source of rheumatic fever, which can damage the heart, joints and nervous system.
How Is a Strep Test Performed?
A cotton swab is quickly rubbed over both tonsils and the back of the mouth. The swab is then placed in a container and a St. Michael’s lab technician processes it. A St. Michael’s Emergency Room doctor will evaluate the strep test.
Respiratory Syncytial Virus (RSV)
What Is RSV?
The RSV Virus infection can occur in people of all ages, but is the most common germ that causes lung and airway infections in infants and young children. Most infants have had this infection by age 2. Outbreaks of RSV infections typically begin in the fall and run into the spring. Children in a daycare setting are most susceptible to RSV infections.
RSV is spread easily by physical contact. Touching, kissing, and shaking hands with an infected person can spread RSV. The disease spreads from person to person through contact with contaminated tiny droplets or objects that the droplets have touched. RSV can live for a half an hour or more on hands. The virus can also live for up to 5 hours on countertops and for several hours on used tissues.
How Is RSV Diagnosed?
Symptoms vary and differ with age. Infants under age 1 are most severely affected and often have the most trouble breathing. Older children usually have only mild, cold-like symptoms. Symptoms usually appear 4 – 6 days after coming in contact with the virus.
What is the Test for RSV?
Rapid tests for this virus can be done on a fluid sample taken from a patient’s nose at St. Michael’s Emergency Rooms. A St. Michael’s lab technician will use a swab to collect a sample from saliva or from nasal mucus. A St. Michael’s Emergency Room doctor will evaluate the sample.
What Is the Treatment for RSV?
Antibiotics do not treat RSV. Mild infections go away without treatment. More serious infections may require a ventilator or breathing machine. A St. Michael’s Emergency Room doctor can recommend treatment to alleviate the symptoms and make the patient more comfortable.
If you need emergency care or testing services, come to St. Michael’s Emergency Room now.
What Are Sexually Transmitted Infections or Diseases (STIs, STDs)?
How Are STDs Diagnosed?
There are tests that can diagnose sexually transmitted diseases (STDs) or infections (STIs). While some STIs are caused by bacteria, others are caused by a virus. Screening for bacterial STIs is fairly simple and generally involves collecting a sample of fluid from the potentially infected area. Some viral STIs are screened by drawing blood samples. Other viral STIs, such as herpes and genital warts, are often diagnosed by visual identification of a lesion.
What Is The Test for STDs or STIs?
A doctor or nurse will take a culture of the potentially infected area with a cotton swab or take a small biopsy. Some STDs, such as HIV, herpes, and syphilis, can be identified by blood tests. After being screened for an STD, it takes 2-3 days to receive test results, since St. Michael’s needs to send the sample to an outside lab for analysis.
What Is the Treatment for STDs?
An appropriate prescription for STD treatment can be obtained from a St. Michael’s Emergency Rooms doctor. After the course of medication, the patient can be tested again, to make sure that the medication has removed all of the infection.
How is Pregnancy Determined?
In the early part of pregnancy, the body begins producing a hormone called chorionic gonadotropin or HCG. This hormone stimulates the ovaries to produce the amount of estrogen and progesterone needed for implantation of the egg into the uterine wall and for the embryo’s early development.
How is a Pregnancy Test Peformed?
Because HCG is present in both the blood and urine of a pregnant woman, laboratory diagnosis of pregnancy is relatively easy. A St. Michael’s lab technician will collect a small urine sample from a patient. The lab technician processes the test which determines the presence of HCG in the urine by combining urine and test materials either in a test tube or on a glass slide. A St. Michael’s Emergency Room doctor evaluates the test. A certain reaction occurs if HCG is present, but it does not occur if there is no HCG or if there is too small an amount to react. The test results are available at St. Michael’s during the patient’s visit.
What is a Pregnancy Blood Test?
If the St. Michael’s Emergency Room attending physician still has questions after a urine test is performed, he or she may administer a pregnancy blood test or a pregnancy serum test that measures the exact amount of the pregnancy hormone “human chorionic gonadotropin” (hCG), in the bloodstream. Human chorionic gonadotropin (hCG) is a hormone that is produced by the placenta. It is detectable in the blood and urine within 10 days of fertilization (1 to 2 days after implantation). There are two different pregnancy blood tests to measure human chorionic gonadotropin (hCG).
# Qualitative Pregnancy Blood Test – This test can only give a “yes” or “no” answer as to whether or not HCG is present. This test gives results similar to what urine based home pregnancy test kits do.
# Quantitative Pregnancy Blood Test – This test can actually measure the exact amount of hCG in the woman’s blood. This measurement can help give a rough estimate of the age of the fetus. It can also help determine if the pregnancy is progressing normally. The qualitative test, described above, is not able to provide this extra information.
How is the Pregnancy Blood Test Performed?
St. Michael’s Emergency Rooms can perform a pregnancy blood test as well. The test is performed by a St. Michael’s lab technician. A fine needle is gently inserted into a vein. The blood will be collected in a syringe or vial. The test is not developed at St. Michael’s Emergency Rooms; it is sent out to a lab for processing and will take 1-2 days to receive results.
How Does St. Michael’s Emergency Rooms Screen for Drugs?
St. Michael’s Emergency Rooms only administers rapid drug tests. A rapid drug test is a diagnostic test that very quickly gives the patient the results that show whether or not they have the presence of a specific drug in their body.
How Does a Rapid Drug Test Work?
Rapid drug tests at St. Michael’s Emergency Rooms detect the presence of drug metabolites in urine in minutes. When a detection strip is wetted with a urine specimen, the specimen reacts with the reagents and antigens on the strip and produces a color reading so a result can be interpreted as positive or negative. Unlike many drug testing centers that have to send out for the results, St. Michael’s can have the results within minutes, 24 hours per day.
How Does St. Michael’s Emergency Rooms Screen for Blood Alcohol Content?
St. Michael’s uses saliva tests to screen for blood alcohol content (BAC). The test is minimally invasive and the specimen can be collected with direct observation. St. Michael’s uses rapid tests, which means results can be given quickly.
Sometimes alcohol metabolism mimics other conditions. A St. Michael’s Emergency Room doctor will administer an alcohol test sometimes to rule out the presence of alcohol in the blood before testing the patient for other conditions.
(Prothrombin Time and International Normalized Ratio)
What Is PT INR Testing?
The “PT” part of the test stands for “Prothrombin Time”. It evaluates the ability of blood to clot properly and can be used to help diagnose bleeding. Occasionally, the test may be used to screen patients for any previously undetected bleeding problems prior to surgical procedures.
The second part of the test, “INR,” represents “International Normalized Ratio.” This test is used to monitor the effectiveness of blood thinning drugs such as warfarin (also known as Coumadin). These drugs help inhibit the formation of blood clots and are prescribed on a long-term basis to patients who have experienced recurrent inappropriate blood clotting after heart attacks or other traumatic events to the circulatory system.
Why Is a PT INR Test Ordered?
If a patient is taking an anti-coagulant, a St. Michael’s doctor will check their PT/INR regularly to make sure that the prescription is working properly and that the PT/INR is appropriately prolonged. The PT may be ordered when a patient who is not taking anti-coagulant drugs presents symptoms of a potential bleeding disorder, which can range from nosebleeds, bleeding gums, bruising, heavy menstrual periods, blood in the stool and/or urine to arthritic-type symptoms (damage from bleeding into joints), loss of vision, and anemia.
Sometimes the PT may be ordered when a patient is being scheduled for surgery, to ensure normal clotting ability.
How Is a PT INR Test Done?
St. Michael’s Emergency Room uses a point-of-care test commonly known as “finger stick testing.” To use this device, the St. Michael’s lab technician will prick the patient’s finger and place a drop of blood on a test strip. The test strip is fed into the device, and the device reports the INR. These devices typically are easy to use and report accurate results. Additionally, if an INR result is surprising, another test can be run immediately to either confirm or refute the result.
What Is a Blood Glucose Test?
This is a test that measures the amount of glucose (sugar) in the blood.
How the Test is Performed
Blood is collected by a St. Michael’s Emergency Room technician via a vein into an airtight vial or tube attached to the needle. Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding. In infants or young children, a sharp tool called a lancet may be used to puncture the skin and make it bleed.
The blood collects into a small glass tube called a pipette, or onto a slide or test strip. Within minutes the test strip will give a level in milligrams per deciliter (mg/dl) for the amount of glucose present in the blood. A St. Michael’s Emergency Room doctor will evaluate the results.
How to Prepare for the Test
The test may be done while the patient is fasting or at random. If the patient is having a fasting glucose blood test, he or she should NOT eat or drink for 6 hours before the test.
A random glucose test can be done at any time of the day, but results depend on what the patient drinks or eats before the test, as well as the patient’s activity level.
Why the Test is Performed
The carbohydrates eaten throughout the day eventually end up as glucose in the blood. Glucose is a major source of energy for most cells of the body, including those in the brain. A blood glucose test will help determine how much glucose remains in the blood.
The St. Michael’s Emergency Room attending physician may order this test if the patient has signs of diabetes or pre-diabetes. It is also used to monitor patients who have the disease.
Levels vary according to the laboratory, but in general up to 100 milligrams per deciliter (mg/dL) are considered normal. Normal value ranges may vary slightly among different laboratories. A patient needs to discuss the meaning of specific lab results with their St. Michael’s Emergency Room doctor.
What Is a Urinalysis Test?
A urinalysis test is the physical, chemical, and microscopic examination of urine. It involves a number of tests to detect and measure various compounds that pass through the urine.
How Is A Urinalysis Test Performed?
A urine sample is needed. A St. Michael’s lab technician will collect a “clean catch” urine sample, and a St. Michael’s Emergency Room doctor will evaluate it.
How Is a Urinalysis Test Evaluated?
There are three basic steps to a complete urinalysis:
- The physical color and appearance of the urine: clear or cloudy, pale or dark in color, or another color altogether. A “urine specific gravity test” reveals how concentrated or dilute the urine is.
- The Microscopic appearance: the urine sample is examined under a microscope. This is done to look at cells, urine crystals, mucus, and other substances, and to identify any bacteria or other microorganisms that might be present.
- Chemical appearance: A special stick (“dipstick”) tests for various substances in the urine. The stick contains little pads of chemicals that change color when they come in contact with the substances of interest.
How Are the Test Results Used?
A St. Michel’s Emergency Room doctor will order a urinalysis test to help evaluate symptoms that a patient is presenting when they seek medical help at St. Michael’s Emergency Rooms. The results of the test will give the attending doctor more information in helping determine the right course of treatment for the patient.
What Is a D-Dimer Test?
The D-Dimer test is a blood test used to rule out active blood clot formation. Usually for the D-Dimer test, a small amount of blood is drawn from a vein in the arm. In some cases, such as when the patient is a young child, blood is drawn through a finger tip.
Why the Test is Performed
A D-Dimer test is performed to establish the presence of blood clotting activity in a patient’s body. A positive D-Dimer indicates the presence of an abnormally high level of fibrin degradation products in the body. It tells the St. Michael’s Emergency Room doctor that there has been significant clot (thrombus) formation and breakdown in the body, but it does not tell the location or cause.
What the D-Dimer Test Indicates
A normal D-Dimer test usually indicates that a patient does not have an acute condition or disease that is causing abnormal clot formation and breakdown. A negative D-Dimer is most valid and useful when the test is done on patients that are considered to be low-risk. The test is used to help rule out clotting as the cause for the symptoms.
An elevated D-Dimer may be due to a recent surgery, trauma, or infection. Elevated levels are also seen with liver disease, pregnancy, recent childbirth, heart disease, and some cancers.
The D-Dimer test is recommended as an additional test. It should not be used as the sole test to diagnose a disease or condition. Both increased and normal D-Dimer levels may require follow-up and can lead to further testing.
What is a Cardiac Enzyme Panel?
When a patient visits St. Michael’s Emergency Rooms and is experiencing chest pain, a cardiac enzyme panel is one of the first tests administered. The cardiac enzyme panel will help determine or could potentially rule out a heart attack.
When the heart muscle is damaged from a heart attack, cell walls break down and permit certain enzymes and proteins located within the cell walls to leak into the blood stream. Called cardiac markers, these substances can then be detected in blood samples. The Cardiac Enzyme Panel Test detects these cardiac markers such as Myoglobin and Troponin.
How is a Cardiac Enzyme Panel Test Performed?
This is a simple blood test. A St. Michael’s lab technician will insert a needle into the patient’s arm and extract a small amount of blood and process the test. The attending physician at St. Michael’s Emergency Room will evaluate the blood for the presence of protein markers.
What do the Cardiac Enzyme Test Results Show?
If protein is present in the blood, the test could show that the patient is having or has had a heart attack or has significant arrhythmia. Some patients, however, have elevated protein in their blood for other reasons. The results of the Cardiac Enzyme panel combined with other symptoms such as chest pain, shortness of breath, severe dizziness, pain in an arm or severe pressure in the chest or abdomen could indicate a heart attack, and other tests should be ordered. A St. Michael’s attending physician will take the results of the cardiac enzyme test combined with the presenting symptoms and determine what other tests or next steps should be taken.
What is a Natriuretic Peptide (BNP) Test?
The BNP test measures the amount of a hormone in the patient’s blood called BNP which stands for “Brain Natriuretic Peptide” also called B-Natriuretic Peptide. The BNP hormone is produced in the ventricles of the heart. The level of BNP hormone in the blood can show how efficiently the heart is working. If the heart is working well, a BNP test would reveal a low level of the BNP hormone in the blood. When the the heart has to work harder to circulate blood, the BNP level increases leading to an increase in the presence of this hormone, which is revealed in the BNP test.
How Is a BNP Test Performed?
This is a simple blood test. A St. Michael’s lab technician will draw blood from a vein. The needle will be attached to a tube to collect the blood. The lab technician will process the test. A St. Michael’s Emergency Room physician will evaluate the results.
How Is a BNP Test Evaluated?
Since the BNP test reveals normal or elevated levels of the BNP hormone in the blood, a test showing elevated levels of BNP could indicate heart failure. The greater the amount of BNP in the blood, the greater the patient is at risk for experiencing severe heart failure. Since other factors like kidney disease, age and medications could also increase the BNP level in the blood, a doctor needs to evaluate many factors before determining that the patient could be suffering from heart failure.
High levels of BNP in the blood may indicate to the doctor that he or she needs to order additional diagnostic tests. A St. Michael’s Emergency Room doctor and patient should discuss what the BNP test results could mean. If the doctor rules out other potential factors and determines that the patient is suffering from heart failure, the patient can be treated for this condition. A St. Michael’s Emergency Room patient with a heart failure diagnosis would be referred to a top-notch cardiologist for follow-up.
After a patient has been treated for heart failure, a BNP test can help the doctor determine the effectiveness of the treatment. If the treatment is successful, the “after treatment” test should reveal less BNP in the blood than the baseline test administered before treatment.