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Showing posts from September, 2020

When A Non Lab Person Walks Into Microbiology

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I can't even begin to think of how an uninitiated being would react to the myriad smells emanating from the Micro lab. Do you remember your first whiff when you were a student? Can we consider that a sort of Whiff Test in itself? If a student is fine with the smells, you'll do just fine in the clinical lab environment. Once they pass that initial test, you get to tell them about the REAL Whiff Test.  If they're fine with the resultant putrescine, cadaverine, trimethylamine, etc you get after adding 10% KOH to a potential BV patient....weird flex but ok Hold your breath when walking by the stool cultures. Put a gas mask on when opening the anaerobic cultures. Do our scrubs get permeated with the yeasty, brothy, peptony, general micro lab smell? God forbid you autoclave anything that had microbiological media in it. The autoclave serves to atomize the scents beyond regular capabilities. Maybe those who get mild COVID symptoms and lose their sense of smell are actually at an a

He Went To Jared :(

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Cubic zirconia would have even sufficed but all I get is STRUVITE. Can I wear magnesium ammonium phosphate without looking totally ridiculous? I think not. I do think Jared has a urea-splitting bacterial infection somewhere up in there that needs attending to. I'm not wearing a struvite necklace anytime soon so.... Urine diamonds are NOT a fashion statement. They're a medical emergency.  It does make me ponder the thought though... I do drink a lot of tea which can increase the chance of oxalate crystals. Maybe I can make my own crystal jewelry as well? Nephro-Zirconia. I'm not expecting to sell to Jared or Zales or anything, but maybe local pawn shops at least? For little bit of beer money? Fun Facts: Urea splitting bacteria contain an enzyme, urease, that cleaves urea into pieces leaving behind byproducts that include ammonia and bicarbonate. This increases the pH of the urine and produces an environment where struvite crystals can precipitate out of solution if existent.

My pleasure. Ya'll come back now

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Tourniquets? Where we're going we don't need tourniquets. Palpation? I'm going straight in. The space station could see this vasculature. That's a wonder of a cubital fossa.  A good phlebotomist is worth their weight in antigen negative blood. Easily the worst part of clinical rotation was having to do phlebotomy. I was so nervous it took me almost 10 minutes just to get the tourniquet on my brave volunteer. I still never really got tourniquet application right. I spent hours practicing at home. Watching Youtube videos, borrowing arms. I pulled the hair off of an outpatient victim, I mean patient, once. I was so nervous I nearly dripped sweat onto another poor soul. I'm in the lab because I enjoy laboratory medicine and science and because I like to help people... FROM A DISTANCE.  Every phlebotomist is a saint and you need to be recognized more for your work and contributions.  Oh the things I saw during rotation. Isolation rooms, trying to draw on the pysch ward w

Oh, the cultures are STAT?? Yaaaas Queen

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  Let me sprinkle some of our lab grade fertilizer onto those plates then. I'm not sure how we bill for that but here we are.  Someone should see what is affected and how things are affected by adding fertilizer to plates/agar/broth. Could we potentially create a superbug and start a new pandemic? All because of ammonium phosphate and the like?  In the future I do feel like physicians will get their way. Kind of like how "tube testing" is still the gold standard for blood bank, perhaps plate cultures will still be the gold standard for microbiology as technology continue to develop. Right now, stool cultures are being rapidly set off to the side. PCR is rearing it's head into microbiological identifications.  The BioFire Stool Panel tests for 22 separate targets, five being viruses. Let's see a routine stool culture catch that. The BioFire can find: Campylobacter (jejuni, coli, and upsaliensis) Clostridium difficile (toxin A/B) Plesiomonas shigelloides Salmonella

They're Putting Chips In Our Brains I Tell You!

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 It doesn't even exist! The flu kills WAY more people per year. Wait now it does exist but they manufactured it to sell vaccines and get chips implanted into our bodies. Bill Gates has been wanting this for years! Masks actually keep the virus in and make you sicker! I never even met anyone who had the virus, how do we know anything?? It's crazy knowing how many people buy in conspiracy theories about things. I feel like social media's grasp on society has only made things worse.  One panel study showed that nearly 30 percent of adult Americans believed the virus was created by the Chinese government as a bioweapon. As months moved on, nearly 40 percent said they could believe this theory.  A similar portion of people said that the CDC and other agencies were exaggerating the virus for political reasons. (Yes, of course the entire world is faking COVID to try to make the American president look bad. Of COURSE) Another common one was that COVID was created to sell medicines

You've Been Mixing Wrong for 25 years?

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 Or: "It can't be clotted, I pulled out the clot before sending it, just RUN IT" Okay I ran it. Your patient's platelet count is 22. "Oh boy, gotta see if the Doc will want a dose of platelets ordered!" Tubes clot because of poor technique, rough draw, excessive tissue factor inlet on a heelstick, improper mixing to ensure anticoagulant coverage, etc. Not because the tube is sitting waiting to be manually run. In fact, we ream it for clots BEFORE we run it, as soon as we receive the tube. It's still clotted, please mix your tubes next time. "But I've been doing this for 25 years! I'm not wrong" You can't argue with that kind of attitude The NICU got so fed up, they were invited to come watch our process from specimen receipt to resulting the microtainer CBC. They still were not convinced that it wasn't the labs fault.  Fun facts: No calcium -- No clots As soon as you strike through the endovasculature you've activated the in

Automatic Slide Stainers are the Best and Worst invention for the Hematology Lab

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  Today's popular heme instruments run (mostly) buttery smooth. Low maintenance, low downtimes, less confusion. Oh but then the instrument reflexes a peripheral smear and then it gets ugly. To the slide stainer it goes. Will the tube even make it through it? Who knows. Go ahead, stainer, and mix the tube before making the slide then.. oh you threw the tube. Where did it go. Did it roll into chemistry? Did it fall INSIDE of the stainer? Oh god, there's stain leaking all over the inside too. Wait no, the methanol line burst leaking onto some old stain buildup and it's all washing away. It just tried to make a slide, but somehow lost it. Now the slide stainer literally has no idea where the slide is and neither do I because the little diagram map isn't very helpful. It's not by the drying fan like you say it is. Oh the label ribbon is out too. How do you even install a new one of these? Oh okay, we figured it out with a team effort. But now the ribbon isn't transla

If You Can Hear Me Call Me. I M O K

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 I crammed it all in during an entire shift. QC and calibrations were even in before the morning rounds started. It was a GOOD day. How are you all fairing? Oh reagent probe up/down errors? Oh the green rack got stuck and now you have to spend 30 minutes restarting the system? YOU FORGOT TO CHECK THE TUBINGS ON THE ISE ELECTRODES? They're probably spewing electrolytes everywhere now. god help us all. 

You Can't Have It Both Ways

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 You have an empty bladder. A full stomach. A renewed energy. It's always nice to be able to make it on break and get your simple human needs out of the way. That doesn't always happen though, especially when you have a 3 hour long MTP on a AAA patient and then have to clean up for 3 more hours with computer work, paperwork, documentation, etc. A slow night is a happy night. 

THE MITOCHONDRIA IS THE POWERHOUSE OF THE CELL

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  How many times did we endure THE MITOCHONDRIA IS THE POWERHOUSE OF THE CELL in high school sciences. I feel like going through the clinical chemistry portion of my Medical Laboratory Science clinicals had a similar ring to it.  THE NEPHRON IS THE FUNCTION UNIT OF THE KIDNEY. THE NEPHRON IS THE FUNCTION UNIT OF THE KIDNEY. THE NEPHRON IS THE FUNCTION UNIT OF THE KIDNEY. I can say that 3 times fast. I sure couldn't say Glomerular three times fast though. I can't even say it one time without slurring and sounding drunk.  I will never forget the kidney though. Especially not the nephron and how fun the ascending and descending loop of Henle sounds. If I owned an action adventure park I would definitely consider building a Loop of Henle.  "TAKE SOME SICK CURVES ARE THE BOWMANS CAPSULE THEN PLUNGE INTO THE LOOP OF HENLE FOR GRAVITY DEFYING FUN" Bonus Awkward Yeti

Effin A man...

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  That's a FINE needle aspirate if I do say so myself. Alright, I'll see myself out. 

Old Habits Are Hard To Quit

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  Working a double while they work on the hospital addition close to the lab which requires them to shut off the water for 8 hours? Better drink my own urine.  Humans were very effective urine analyzers. Sweet? High glucose. Meaty? Proteinuria. Malodorous? Infection. Probably some leukocytes as well. Gums all cut up? Well those are simply from crystals.  Physicians in the middle ages would use smells and tastes of urine for actual diagnostic purposes. Hippocrates even correctly postulated that urine was a a filtrate of blood. These top minds even crafted up a wonderfully elaborate "Urine Flavor Wheel". How else did we get Maple Syrup Urine Disease??? An English physician, Thomas Willis, said that diabetic urine was "wonderfully sweet as if imbued with honey or sugar". Man. I might have to ask my diabetic friend if I can borrow some of their urine for my next cuppa tea... Some of the "flavors" described on the chart speak of sticky cane-sugar like urine, ur

CAP Inspection Week --

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  Did you date your reagents?! Do you know where the (M)SDS is?! Do you know where our spill kit is?! Make sure you readback the blood type before issuing that! Label your tubes properly!! "This is how we're supposed to do it, but usually we just do this" You can't say that!! Make sure the QC logs are initialed! Are you doing everything right?!  AACC.org put together a chart of the most common deficiencies found in the clinical laboratory during inspection days. It encompasses the major bodies such as CMS labs, CMS Physicians Office Lab, CAP, COLA, and Joint Commission. Competency assessments, accurate procedure manuals, correlations of instruments, reagent labeling/expiration, and method validation approval are some I think are the most drilled into people's heads.  Activity Menu by CAP is defined as the type and complexity of testing per department. A survey put out by  CMS  highlights some of the most common deficiencies with a detailed explanation of each.  At

Transfusion Requirements: Leukoreduced, Irradiated, .....

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  What is the definition of organic that these hipsters even try to stipulate. "Relating to or derived from living matter." is one of the definitions. Red Blood Cells are most certainly living matter. I'm also pretty sure they contain carbon--hydrogen bonds. I'd say blood is pretty damn organic.  Don't let them influence how we label blood! The FDA will start requiring ORGANIC on the ISBT labels soon. AABB will issue deficiencies for those not following the organic protocols.  "Hi this is Dr. Sohn, my patient needs a dose of platelets. Please make it irradiated, leukoreduced, ORGANIC, oh and washed because why not, it sounds good." Is this the kind of future you want to be living in?! Next you're going to tell me they're going to be ranting and raving about GMO free blood! I say forget, while we're free and young we should genetically modify everything. Heck, make the infusion more pleasurable for the patient. Maybe add some strawberry vanill

Pseduo-trust-the-lab-emia.

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  Reverse-psuedohyperkalemia sounds like it might be Elon Musks new child but it's a real thing. The fragility of excessive leukemic white cells combined with a possible cellular sensitivity caused by Lithium Heparin causes an increase in extracellular potassium upon any excessive mechanical manipulation/stress such as riding along in the tube system or centrifuging. One way of combating this is to draw a serum tube rather than a plasma tube (LiHep) and maybe even hand deliver it to our smiling MLS faces. Of course this does't work in every R-PK+ case, and the only way to get an accurate potassium may be to order a whole blood K+.  It's called reverse-pseudohyperkalemia because the K+ is falsely elevated in plasma rather than serum. When K+ is falsley elevated in serum rather than plasma, it is simply known as psuedohyperkalemia.  Unlike reverse-psuedohyperkalemia which, as previously touched upon, usually results as a consequence of leukocytosis, regular pseudohyperkalemia

Another Fun Drinking Game With Your Buddies --- SED Rate Stalemate

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  Draw and run Sed Rates on each other! Assuming you have phlebotomy equipment and an analyzer at home. Who wouldn't? We're not laymen here, now are we? The one with the highest Sed Rate after the allotted time takes a shot. Since they're probably feeling pretty crappy anyway due to having the highest level of overall inflammation out of the group, this game is sure to be a hit. Make the sickest person feel BETTER. Can't beat that logic.  Make sure you QC and Calibrate first. You wouldn't want someone to have an unfair advantage/disadvantage, right? Make up your own rules too! For every mL your blood settles, you have to drink a light 4% ABV lager. Feeling inflamed? Stay away from this game! If you do the shot method, it's actually a very safe way to drink. 1 shot per hour (if you're using the classic 1 hour Westergren method of course). As you may know, our poor livers can only process one "standard" drink per hour on average. A typical 1.5ml shot

Is That A Banana In Your Nucleus?

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  This little guy REALLY likes finding and internalizing bacteria. Keep your granules in your cytoplasm for Pete's sake. Now I understand why hematology is some peoples favorite department *shivers*.  Lecture and clinical never prepared me for this. "Report what you see. Report what you see. Report what you see." WELL THIS IS WHAT I SEE. How should I report this without getting sent to HR?  What if the differential was full of these? Is that a novel disease? Hereditary Phallicytosis? HP. Hewlett-Packard would have to change their name. Man, they would need to build new ICD 10 codes and everything. ESSENTIAL phallicytosis first encounter. What happens when you get to Phallicytosis -- Subsequent encounter??  I assume these still have normal function to them? So do they still perform phagocytosis? phagophallicytosis??? Phallic phagocytosis? Halitosis secondary to phallic phagocytosis? I feel like writing a new age book on disease here.  We would probably come up with a nice,

In Da Lab

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This is way overdone at this point and has been shared literally everywhere but it's certainly still a classic.  Go, Go, Go, Go, Go, Go Go redraw, there's no birthdate You didn't label it, there's no birthdate It's in the wrong tubes and yo, there's no birthdate And you know we don't run no blood without a birthdate You can find me in da lab, bottle full of crap But mommy I got the plates if ya into growin' that You gonna have to wait though you wanna have it STAT So call talkin' that smack, I'll just tell you it ain't back You can find me in da lab, bottle full of crap But mommy I checked the plates and they growin' hella staph You better ask your date why broke out in that rash Cuz RPR is back, Treponema in dat a** When I pull out dat slide, you see the whites in clumps When the blood's hemolyzed, they all deny they the one Nurses mad I said "redraw", and now they NEVER show me luv But when you work in da lab, your best pa

OMG. Recognition?? I'm not used to this

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  Someone appreciates what we do down here? I'm not sure how to react. I think denial is the first step. Maybe it's a cruel joke. Is this real life? It literally makes my day when another department, especially doctors and nurses, give us some recognition here and there. I knew going into this field that we were "behind the scenes" and that patients wouldn't get to see us or really know we exist. That's fine. What I was unprepared for was the underappreciaition and lack of understanding of what we do in the lab. "Yes I do in fact know what I'm talking about" "Yes, I have a 4 year degree just like you!" I wish clinical staff and laboratory could try to understand each other better. We work in a very different world than nurses/doctors even though we work towards the same common goal, the patient. We do not work in 'practice' either. Everything we do in the lab is very SOP based and there is very little room for deviation, ESPECIA

GCS-3? BP 70/40? Well It's Been Fun Guys

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  I've got one foot out the door. We made it an entire shift without an MTP, nothing can stop me now. Good luck everyone else! Hurry and badge out of Kronos. You might be able to make it outside to see the helicopter land.  (I'm kidding of course, we always stay to help the less fortunate -- 3rd shift) What is the difference between a level 1 and a level 2 trauma code page anyway? Upstate defines their traumas as level 1 if they meet the criteria: Airway • In need of emergent airway • Intubated in the field Breathing • Ongoing respiratory compromise • Respiratory arrest Circulation • SBP < 90 • Clinical Signs of Shock Neurological • GCS <=9 • Open skull fracture Anatomic Diagnosis • Penetrating trauma to head, neck, torso, groin or proximal to knee or elbow (unless obvious or known superficial injury only) • Partial or complete amputation of major limb (not isolated hand/finger injury) Pregnant Trauma Patients • >23 weeks (Fundus palpable at or above umbilicus) Meeting

Do You Have The X Factor?

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  Bro the Neisseria complements the hemin and NAD so well, bro.  Was this made from fair trade cocoa? It actually tastes pretty processed though, I'm guessing a Hershey formulation? Actually I taste vomit, is it the butyric acid in the Hershey's chocolate or is it me? Bro? I always though chocolate agar was pretty neat. Not just how it looks, but that all we needed to do to isolate Neisseria meningitidis and Haemophilus influenzae was be a curious creep and boil some blood. (Not actually boil but you get it.) Like hey wow all of a sudden now we have available hemin and NAD. Here you go you fastidious cretins. Grow. So I can tell these poor people they have pink eye... or worse.

A Great Way To Ruin The Beginning Of The Next Shift Too

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  Why are all my screening cells coming up question mark or positive?? That can't be right. Let me run QC. Aaaaand that failed too. Let's call the tech support hotline something is REALLY wrong here.  "Sir did you recently change the indicator cells on the instrument?" Yeah, why "Did you remember to add a stirball?" ---silence--- Thanks, have a goodnight. Bye.  They really need to have a light sensor that checks for the stir ball or a scale on the reagent rack lane that knows when a full bottle is too light and likely doesn't have a stir ball in it. Call up the manufacturer, I have a million dollar idea. They need to idiot proof their machines, because I'm an idiot. It's kind of like those hackers that break into a companies website and then say hey pay me, I just discovered a major flaw in your security design. Better yet, hire me as a security consultant because I already know the inner-workings of it.  You can actually probably hire an idiot t

I Wonder What A Concurrent Pseudomonas + Proteus Infection Would Smell LIke

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 I am definitely in the camp that believes Pseudomonas smells like grapes and Proteus like chocolate. I have certainly heard other creative ideas for what bacteria smell like. E. coli always had a distinctive smell to me as well. It wasn't necessarily a bad or putrid smell, just... unique.  I will never forget the smell of Clostridium perfringens and Citrobacter though.  The coolest scent would be that of Actinobacteria such as Streptomyces. They create geosmin which is well associated with the earthy odor in 'dirt' and is responsible for the "smell of rain". Humans are particularly sensitive to Geosmin and can smell it down to 5 parts per TRILLION.  

I Take All The Bags At Once From Grocery Shopping -- Why Would This Be Any Different?

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 Good thing I decided to wear my bright yellow scrubs today.  Oh hey, a few of them weren't screwed closed correctly. Huge surprise. 

The Intrinsic Pathway to the Christmas Factor

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 Do modern classrooms allow you to simply take a smartphone photo of the whiteboard? I think it would certainly amplify the ease in copying down this nightmare that everybody, without fail, forgets 3 days after they take their ASCP BOC exam.  I have a new drinking game. Let's play "pin the kallikrein on the coagulation cascade". Whoever comes closest doesn't have to drink and the rest of your buddies do. I sense a pattern of  lab drinking games .  You thought once you learned photosynthesis, the krebs cycle (citric acid cycle), glycolysis, pentose phosphate pathway, etc. that you'd be done with all of this random cramming of cycles and pathways. Then you decided to become an med lab scientist/tech. You masochist.  Coagulation is brimming with an amalgam of sweet topics-- I mean you have the Christmas factor, so there's that. Russell's Viper Venom? I'm not sure what Russell did to figure this one out but tops marks to you, Russ, whoever you are. (Oh it&

It takes SO LONG

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 Why does it take so long?! An entire 8.5 hour shift can be wiped out doing monthly maintenance and the monthly pipe.  - Clean basically everything with varying levels of wash, water, or alcohol. Nothing like shooting 50ml or 100ml of clean solution / water down each drain.  - Replace the little PC/CC cups on the e side.  -Poke a little cleaning q tip through each hole of the incubator on the e side. plonk plonk plonk - Liquid flow path clean  -If you're a heavy use lab you change out the cells and clean the bath, maybe even change the electrodes and their tubings (we did every month regardless because of high use) -Pool some serum and prime the above electrodes and tubings :( Save that serum for the green rack clean/prime.  -Hope to god the new cells pass their check when it comes back up  -Reagent up/down error? UGH. Why is the probe stuck in the ALP pack again?? -"FATAL FUSE ERROR or you just didn't lock the hood of the 501 side properly. But I won't tell you which

No You Don't Understand, Not THAT Coronavirus

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 I would really hate to be that guy who somehow catches Coronavirus OC43, HKU1, 229E, or NL63 during all of this pandemic mess. Who is gonna believe this guy when he says "Well yes, but no" to the answer "So you have coronavirus?". Will organization's lack of knowledge cause this guy to be quarantined for 14 days even though he has a very mild virus? I would feel almost ripped off. Like, I survived the coronavirus pandemic and all I got was this lousy...other coronavirus. At least you're not going to die, ey?

We All Have That One Coworker

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    A little TOO eager to be working in molecular testing tonight, Jim? You're not Barry Marshall dude, you don't need to infect yourself with C diff to prove it causes colitis. I wonder if Barry Marshall mouth pipetted his H. pylori broth? The more I look into the history of mouth pipetting, I honestly wouldn't be surprised.  There's many an anecdote online from seasoned laboratorians and how prevalent mouth pipetting used to be. Accidental infections were something that definitely happened. You got Chlamydia at work? Hey it's the 60s! You could smoke and eat in the lab too, which isn't as surprising. Imagine having to clean smoke and tar off of the microscope lenses. Would you have to clean the instrument filters more often? Or I guess things were more manual back then, so less filters in the first place. I'm sure there was a Peggy or a Evelyn that could smoke and mouth pipette at the same time.  Oh darn, dropped some ashes in the nutrient broth. Oh well,

ZAP APERTURES!!

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  eBay is literally an endless source of amazing finds. If your lab instruments keep breaking at work... let your manager know there's a cheaper option. Just buy another one on eBay! Although Sysmex has captured the scene, I miss the old Beckman LH-750. Heck, I'd press ZAP APERTURES just for the heck of it. It added spice to the night. Phone call with an angry clinician? ZAP APERTURES. Forgot your lunch? ZAP APERTURES. Working a double? ZAP APERTURES. I'm sure you could find parts on there as well. Company taking too long to get you that pressure valve? Syringe Driver? Transducer? Flow Cell?! Just buy one on eBay! As long as it calibrates its good to go right?  Who ARE the actual buyers of these things? Small time research labs or something? Some poor grad student is helping to pay for these second hand analyzers.  Some desperate techs looking to get away from hospitals and create their own lab? Maybe even compete with Quest? Man I could live out my dream of using the Sieme

Rural Blood Bankers Are a Different Breed

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 I don't believe our racks are ever put away. Maybe that's simply because of our higher testing rate so the vials get used up quicker than a rural blood bank. The package insert does say to store at 1-10degC when "not in use", but what is considered not in use?? As soon as you're done? Within an hour? Within a shift?? I guess mandatory daily QC is a good way to mediate this.  What's going to happen? Is the Anti-D reagent going to disintegrate? Everyone's suddenly Rh negative?? RhoGAM for everyone!

Histology IS Art

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  There's something beautiful about viewing life microscopically through the paintings of a hematoxylin and eosin stain. Or the hunger inducing cotton candy colors of Fite's method. Methyl violet is a good early March kind of aesthetic stain.  You're telling me this Mowry staining of human skin ISN'T supposed to be some poised art piece?

No Label. No Peace.

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I'll tell you what, I'll accept the tube. And thirty minutes later I'm going to call you with results. I won't give a name. I won't give an MRN. I won't give a room number. I'll keep this guessing game going full circle! 

Blood Bank

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  If this isn't hanging in your Blood Bank somewhere , you should fail your next CAP/AABB inspection. I believe they are gong to start considering that a deficiency in the 2021 rulebook. Steven Seagall would be a welcome body of security in the blood bank. 

F5 F5 F5 F5 F5

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 Your EMR probably doesn't auto update. We've been done with those labs for 20 minutes now. We've moved on. We're doing something else. Press F5 to refresh the chart. Or the refresh button. Those beautiful laboratory numbers will populate with enthusiasm.  Most of the time the person calling has a very poor tone, maybe even holier-than-thou. It's hard stifling when your laughter when you know the test has been done for ages now. 

Downtime Should Only Last an Hour

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 Aaaaaand it's gone. Sunquest is broken. Down for 6 hours now. Novius, Cerner, Beaker, whatever you're using. It's down. And it's not coming back. Guaranteed, it's going to be busy during that time too. Where are the backups? How do we find the mirrors?? Shouldn't we have downtime patient labels?? Where are those? Collecting dust somewhere?? Wait the backups are on CD but our new computers don't have CD drives?? An MTP? Seriously? I have to handwrite all of these tags?? It took 7 hours for you to realize the hospital firewall threw a fit and decided to randomly disallow important functions from running?!  They should advertise scheduled downtime as simply being on a day. Tell us the day it's happening, tell us the time it's supposed to start. Don't even bother with an end cap. We know it could be tomorrow. Our backups aren't very fresh either. I don't remember if that guy made a new Anti-c? I can't look it up though. Nobody gets a tra

Just Give O Neg

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 I've been told that medical students get about an hour of Immunohematology/Blood Bank/Transfusion Medicine training during their entirety of medical school. With how many unique situations in which a patient may need a transfusion of many different product types, this seems almost criminal.  "Blood will be delayed on this patient. They have multiple antibodies so we need to finish the workup and then find blood for them" "Well, his hemoglobin is 4. We need this blood yesterday, can't you just give O negative, what's the big deal?" Actual conversation I've had. Given that one of the antibodies is an Anti-c. No, no I cannot just give O neg as it's likely c positive.  I'd be glad to help set up some blood bank education modules for clinical staff. I firmly believe that doctors and nurses should rotate through the laboratory to get a better understanding of what we do, why we ask for the things we ask for, why we reject things the way we do, et

3rd shift runnin'

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SORRY GUYS GOTTA GO. TELL ME HOW YA FIXED IT TOMORROW  

Ion Selective Electrodes or?

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  Just in time for the daily morning draws, the ISE results start delta failing. Every patient. Dear God what did I screw up during maintenance.  Did I mismatch the reference solution? Did I not prime the new tubing well enough with pooled serum? The QC and calibrations were in though??? Ughh. More like Ion Selectively-working electrodes.   I think every chemistry instrument in existence is in a constant state of having the ion selective electrodes not working in some way or another. We should just start reporting semi-qualitatively. Probably low, Probably normal, probably high. 

We Need That Type and Screen Done Like...Yesterday

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 1 minute to accession. 5 minutes to spin. 29 minutes to run on the Echo. That's a minimum of 36 minutes. If I do it by hand, maybe I can get that down to 28-30 minutes. I unfortunately cannot make the process of potentiating reactions between antigens and antibodies any faster than what time + PeG/LISS + 37degC can afford me.  Once Immucor, Ortho, Bio-Rad or someone else figures it out though... oh yeah.

Nurses and Lab Scientists Live In Harmony

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  You want us to add on a calcium to the comprehensive chem panel? Do a type a screen on the troponin tube they sent down 2 hours ago?  Order washed and irradiated blood not because it's indicated, but because it sounds good so why not? Order a red cell phenotype when all you wanted to know was a pregnant female's Rh status? and please don't order a urine culture stat. E. coli, K pneumo, and the like don't know you want them to grow faster. 

Everyone draws 25 :(

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  Hey guys we're short-staffed in blood bank and could use a hand? *tumbleweed* *saloon door swings* *crickets* You mean you don't want to volunteer for a possible massive transfusion or possible multiple antibody workup?? Or page the on call resident 10 times because platelets was ordered on people and we're clearing platelets due to low inventory?? 1st shift just lost two people, and now 2 people from 3rd shift are leaving, and 2nd shift has been working short for god knows how long now. Can someone come in to fill these holes? Full shifts? Doubles? I guess half shifts / 4 hour blocks as well? Please? We'll approve the overtime! But we won't post new positions with sign on bonuses which is what every hospital in the area does so of course nobody is going to come here. MONEY TALKS BABY.

Bands vs Segs

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  Is it a band? Is it a seg? The longer I stare at it the longer I start to see folds and twists that aren't actually there in the nucleus. Hurry up, these NICU babies need their bands vs segs differentiated! 

Medical Technologist -- What Do We Actually Do Anyway?

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  I was told when starting the field that Medical Lab Science is a thankless field, where most people don't know you even exist. I had no idea that meant that people who work in the hospital -- nurses, doctors, secretaries, etc etc etc ad naseum, have no idea who you are or what you do either.  The "what I actually do" picture is accurate though. It's just missing "waiting for Sunquest to unfreeze during an MTP" or doing 4 hour long maintenance on the chemistry analyzers.

Lab Noises

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  Did a probe just break? Did a tube get thrown from the Sysmex? Did a plate just jam on the Neo? Did the water line blow from the Cobas? I need an adult

Is This Enough

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  Also, the doctor is going to be putting in a few add-on orders, so try to do those as well. Do you think you can do a COVID-19 test off of the fumes too?