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Klinisk Biokemi i Norden · 4 2013
The clinical point of view – the basic laboratory
investigation in the critical emergency patient
Ulf Martin Schilling
Institute of Clinical and Experimental Medicine, IKE; HU Linköping, Department of Accidents
and Emergencies, Linköping University Hospital, Linköping
During only a few years, the picture of emergency medicine in Sweden has changed
rapidly. Three major changes have occurred in parallel: The introduction of the speci-
alty of emergency medicine with connected advantages and disadvantages, the ongoing
reduction of hospital beds contributing to a chronic shortage of these, and the change in
searching pattern among the population resulting in an explosive increase in demand of
emergency medical service. Simultaneously, medical progress has led to massive chan-
ges in diagnose and therapy of major groups of medical syndromes, as for example the
evolution of non-cumarinic anticoagulant drugs, the thrombolysis in ischemic stroke and the syndromes
evolving due to ovarial stimulation or postoperative after bariatric surgery.
As a result, modern emergency medicine in Sweden is very unlike the form it has been practiced in 1990
or 2000, and has become more and more important in Swedish public health with 2.75 million emer-
gency visits in 2011.
To treat such a number of patients with virtually all
potential diagnosis to be found in current textbooks
of the majority of clinical specialties, emergency
physicians rely on the clinical picture, clinical rules
as diagnostic aides, radiology including bedside ultra-
sound and a number of laboratory analysis.
The emergency laboratory
To understand the importance of different laboratory
or radiological analysis, it must be kept in mind that
emergency medicine is based not on a clear diagnosis
but on the presented complaints, signs and symp-
toms. Even if only a minority of emergency patients
finally is revealed to suffer from acute life-threatening
disease, for most of these patients the severity of
illness cannot be determined ex-ante. As a result,
a common pragmatic approach for the emergency
physician is to address or exclude immediately life-
threatening pathology, potentially life-threatening
pathology, pathology requiring admission and other
complaints or disease. Due to this and in combina-
tion with the requirement of high patient-throughput,
a final definitive diagnosis is very often not made
at the emergency department (ED). To reveal these
different types of pathology, clinical experience, the
appropriate use of clinical decision rules and the use
of supportive investigation methods as the analysis
of blood samples or radiological investigation are of
uttermost importance.
Akutsäng (Foto: Per Simonsson).
