imaging labs and vitals oh my what med slp should understand in medical charts the first time i ever opened up a medical chart it felt like i was lost in the thick vines of an ominous jungle everything looked pretty foreign to me i didn't understand a single acronym or a term didn't help that i didn't fully know what i needed to look for as a medical slp either thankfully those days are over and i'm excited to introduce to you a bite-sized journey on three components of the medical chart that medical slp should keep on their radar imaging labs and vitals let's dive in i'm theresa richard i've been a medical speech pathologist for 15 years i'm a board-certified specialist in swallowing and swallowing disorders i'm the founder and ceo of the medislp collective and medislp education as the slp in your facility you should be familiar with any testing that your patient receives that may illuminate potential swallowing problems that are both a part of and outside of your scope of practice chest x-rays scans mris gi assessments can all help you shape your treatment and outcomes you don't want to be that slp that is doing exercise for a patient with esophageal strictures do you during the chart review check for any sorts of medical imaging which can be a daunting task but what should slps be specifically searching for and why here's a brief non-exhaustive list of what to keep an eye out for chest imaging chest x-ray the most commonly used diagnostic chest imaging this captures a radiographic single image of the chest and air spaces we want to keep a lookout for terms like opacity infiltrate density which could hint at aspiration but does not confirm aspiration the chest x-ray alone can't 100 confirm dysphagia-related aspiration pneumonia as an slp you should take the information you find in the chest imaging notes and add it to your pile of data when formulating an assessment and treatment plan you can't read a chest x-ray report and decide right then and there that this patient is aspirating or the patient has dysphagia the chest ct this produces 3d images of organs bones soft tissues and blood vessels it captures the chest in slices instead of a single image while it's superior to chest x-rays it requires more radiation exposure thus it is not used as often as chest x-ray brain imaging a head ct is best for capturing brain bleeds a brain mri these are better at capturing occlusions ischemic cvas and other soft tissue abnormalities you might see both a head ct and a brain mri when a patient comes in with acute neurological changes esophageal and gi imaging an esopogram or barium swallow is used to assess structural or functional issues of the esophagus or upper gi tract an egd is an esophageal scope to examine the lining of the esophagus stomach and duodenum laryngeal and neck imaging a neck ct can detect disorders and injuries associated with the neck including tumors aneurysms infections and thyroid nodules a laryngoscopic exam is a visual exam to assess the vocal folds pharynx and surrounding structures you might be particularly interested in seeing whether or not the patient has a unilateral or bilateral vocal fold paresis or paralysis nodules polyps or even copious amounts of secretions now let's talk about labs while we can't cover everything we can dive into some of the basics white blood cell count or leukocytes so first let's talk about white blood cells they're also known as leukocytes they are your immunity cells if a patient comes in with altered mental status respiratory decline or really any health decline one of the first things we look to see is whether or not their white blood cell count is high indicating an infection anything above 10 000 is usually a sign of possible infection neutrophils this is a type of white blood cell that acts as the first line of defense for your immune system they're the primary type of white blood cell that responds to bacterial infection you might see that the patient's white blood cell count is normal or low but the neutrophils could be high potentially indicating infection certain types of leukemia or an inflammatory disorder when the white blood cell count is normal and neutrophils are elevated it's known as neutrophilia on the opposite side of the spectrum if the neutrophil count is too low it could be a sign of a weak immune system this is known as neutropenia and it's commonly seen in cancer patients undergoing chemotherapy the red blood cell count this shows us the blood's ability to carry oxygen and nutrients throughout the body if the red blood cell count is low it could mean the patient is anemic or will experience decreased endurance weakness fatigue dizziness dysphagia on exertion or palpitations hemoglobin this measures the blood's capacity to carry oxygen and could indicate blood loss if the hemoglobin is too low it's been suggested that if hemoglobin is lower than eight that therapy should be deferred funky labs do not always lead to a definitive diagnosis for example if this is low they have this they are much more complicated than that the patient with funky labs and no explanation as to why happens much more often than you think could be no sepsis or uti or even an obvious respiratory infection but we still have to consider that the patient may be an aspirator with no significant symptoms no coughing no choking no throat clearing when this patient is being assessed for problems and there is no obvious answer don't be afraid to suggest a fees or video fluoroscopy do you have any specific questions about medical charts leave a comment below and tell me about it we'll be sure to get your questions answered as soon as possible also i'll be posting other videos just like this one that you won't want to miss so make sure to hit that like and subscribe button and turn on the notification bell vital signs what are they and why do they matter o2 oxygen levels they are critical to keep track of especially if you're working with critically ill patients or respiratory care patients side note you'll likely hear people refer to the oxygen level as o2 stats short for oxygen saturation level for healthy individuals a typical o2 stat range is between 95 to 100 percent however this can change based on the patient's diagnosis and respiratory health for example someone with severe copd will have a normal oxygen level between 88 to 92 percent and it's nothing to be alarmed about anything below 88 percent could lead to additional respiratory support respiration rate this is the number of breaths taken per minute you might see an elevation in respiration rate with respiratory disease acute illness fever pain and other medical conditions as slps we want to keep track of the respiratory rate during tasks that might require exertion or endurance like eating a meal this can help us better gauge the patient's endurance tolerance and overall respiratory health a typical respiration rate for a healthy adult is anywhere between 12 to 20 breaths per minute heart rate or pulse rate this is the number of heartbeats per minute with the typical range for a healthy adult being between 60 to 100 beats per minute an elevated heart rate is known as tachycardia whereas a reduced heart rate is known as bradycardia heart rate can also help us gauge endurance and tolerance levels during more demanding tasks like speaking valve trials and meals particularly for our patients who are really deconditioned i've got a free gift for you at medislpcollective.com check out our free med slp collective clipboard kit for access to our editorial reviewed lab value resource to get your free copy head over to medslpcollective.com forward slash clipboard now we also have a robust and vibrant community of slps and mentors there waiting to help you with your toughest clinical cases [Music] you