ED Stat Panel
| PATIENT INFO |
| Patient Name: |
| Medical Record #: |
| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
| Address: |
| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
| Ph: ( ) - Fax: ( ) - |
| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. ED Stat Panel | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
EDPAN
Test Workstation :
BGAS
Specimen Type:
Blood
Tube Type:
Heparinized syringe or Green top (lithium heparin) macrotainer. NO GEL SEPARATOR TUBES.
Collection Volume:
4.0 ml or 600 uL (minimum 400 uL)
Minimum Volume:
0.5 mL syringe; 1.5 mL macrotainer.
Preferred Volume:
1 mL syringe; 3 mL macrotainer.
Cause for Rejection:
Clotted, air bubbles, tubes with gel separator.
Storage:
Room Temperature
Availability:
Daily, 24 hours; STAT
Methodology:
Ion Selective Electrode/Calculations
Special Instructions:
Notify laboratory if patient's temperature is other than 37 C to correct results (temperature dependent). Deliver immediately to laboratory at room temperature.
Lab/Phone:
330-543-8418
TAT:
30 minutes
Additional Info:
Reference ranges available under individual tests.
Panel Includes:
Venous Gases, Whole blood Analytes to include: Ionized Calcium, Chloride, Glucose, Potassium, Sodium, Lactate
