Synopsis
Collect, test, interpret and transport urine, capillary blood and diagnostic swabs while controlling preanalytical error and acting on time-critical results.
- Confirm identity, indication, specimen type, timing, recent treatment and local laboratory or device instructions before collection.
- Urine dipsticks are screening tools whose pad timing, expiry and storage matter; interpret results with symptoms, concentration, menstruation, medicines and contamination.
- For a midstream urine culture, use a sterile container, discard the initial stream, collect the middle portion without touching the inside, label immediately and transport promptly.
Key red flags
Confusion, seizure, coma, shock or acidotic breathing with abnormal glucose requires immediate treatment and escalation.
Hyperglycaemia with ketones, vomiting, abdominal pain or deep rapid breathing needs urgent pathway.
Reasoning priorities
Screen for blood, protein, glucose, ketones and infection indicators.
Pad timing and context matter; confirm clinically significant findings with appropriate quantitative or laboratory tests.
Worked reasoning
An insulin-treated adult is sweating and drowsy, cannot swallow safely and has a meter reading LO. A reliable repeat is 2.1 mmol/L; IV access is patent and there is no immediate fluid restriction.
- Call urgent medical help, assess ABCDE and protect the airway. Do not give oral food or drink while swallowing is unsafe. Repeat measurement and laboratory confirmation must run alongside treatment, without delaying it.
- Under the adult emergency pathway give glucose 20% 100 mL IV over 15 minutes. This contains 20 g: 20 g per 100 mL × 100 mL. The pump rate is 100 mL ÷ 0.25 hours = 400 mL/hour; set the volume to be infused to 100 mL and observe access and delivery.
- Recheck glucose after about 10 minutes and reassess consciousness throughout. If still below 4 mmol/L, repeat emergency glucose treatment under the responding clinician’s direction and continue reassessment; persistent impairment despite corrected glucose needs urgent investigation of other causes.
- Once above 4 mmol/L and clinically recovered with safe swallowing, provide 20 g longer-acting carbohydrate or a due carbohydrate-containing meal. Review insulin, missed intake and renal function; document treatment and arrange repeated monitoring for recurrence. Do not simply omit necessary basal insulin in type 1 diabetes.