---

name: langcare-critical-values description: > Detects and alerts on critical laboratory values requiring immediate clinical action per CAP/CLIA thresholds. Generates structured critical value notifications with recommended interventions. Use when asked to check for critical labs, critical value alerts, panic values, stat lab review, or when monitoring for dangerous lab results.

Critical Value Alert Generator

When to Use This Skill

Use when a clinician needs to identify laboratory results that fall outside critical (panic) value thresholds requiring immediate notification and intervention.

Clinical Workflow

1. Use fhir_search to pull recent Observation resources (category=laboratory) with interpretation codes HH or LL, or status=preliminary for pending results
2. Compare each result against CAP/CLIA critical value thresholds (see references/cap-clia-thresholds.md)
3. For each critical value: identify the analyte, current value, threshold breached, and timestamp
4. Use fhir_search to pull active MedicationRequest resources to identify contributing medications
5. Use fhir_search to pull active Condition resources for clinical context
6. Generate structured alert with: critical value details, probable cause, recommended immediate action, and monitoring plan

FHIR Resources

• Observation -- Lab results with interpretation codes (HH, LL, H, L, A) and referenceRange
• MedicationRequest -- Active medications that may contribute to the critical value
• Condition -- Active conditions providing clinical context

FHIR Query Examples

Pull Labs with Critical Interpretation

fhir_search(resourceType="Observation", queryParams="patient=[patient-id]&category=laboratory&_sort=-date&_count=200")

Pull Pending Results

fhir_search(resourceType="Observation", queryParams="patient=[patient-id]&category=laboratory&status=preliminary,registered")

Clinical Guidelines

• CAP (College of American Pathologists) critical value reporting requirements
• CLIA '88 regulations for immediate notification of life-threatening results
• Joint Commission NPSG.02.03.01: Report critical results in a timely manner

Interpretation Guide

• Critical values require immediate clinician notification and read-back confirmation
• For each critical value: state the value, the critical threshold, the clinical risk, and recommended immediate intervention
• Common critical values and immediate actions: K+ <2.5 or >6.5 (ECG, replacement/Kayexalate), Na <120 or >160 (fluid management, correct slowly), glucose <40 or >500 (D50/insulin), Hgb <7 (transfusion threshold), platelets <20 (bleeding risk, transfusion), INR >5 (hold warfarin, vitamin K), troponin elevated (ACS protocol)

Safety

• Never fabricate clinical data -- only report what FHIR returns
• Flag critical/abnormal values immediately
• Scope all FHIR queries to the authenticated patient
• Use standard terminology (LOINC, SNOMED CT, RxNorm, ICD-10)
• Present data in clinician-friendly format with reference ranges