ECG
Consider rhythm, conduction, QTc, symptoms, cardiac history, electrolyte abnormalities, overdose, and medication-specific risk.
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Laboratory & Diagnostic Services
Use laboratory and diagnostic testing to answer a defined clinical question: diagnostic clarification, urgent exclusion, pretreatment safety, baseline monitoring, or follow-up monitoring.
Commonly considered studies
Match each test to the patient and the clinical question
This table is a clinical reference rather than a required universal panel. Selection, timing, interpretation, and follow-up depend on the presentation, setting, population, medication, and local protocol.
StudyWhat it may clarifyWhen it may be considered
Complete blood count (CBC)Anemia, infection or inflammation clues, platelet abnormalities, and red-cell indices that may support B12 or folate evaluation.Fatigue, cognitive change, nutritional concern, infection symptoms, bleeding risk, or medication monitoring when indicated.
Comprehensive metabolic panel (CMP)Electrolytes, glucose, renal function, hepatic function, protein, and calcium.Altered mental status, dehydration, nutritional concern, organ-function assessment, medication selection, toxicity risk, or monitoring.
TSH with free T4 when indicatedThyroid dysfunction that may contribute to mood, anxiety, sleep, cognitive, or psychotic symptoms.Compatible symptoms, new or atypical presentation, relevant history, medication effect, or baseline assessment when clinically appropriate.
Vitamin B12 and folatePotential nutritional or absorption-related contributors to anemia, neuropathy, cognitive change, fatigue, or mood symptoms.Macrocytosis, restricted intake, malabsorption risk, neurologic findings, or unexplained cognitive and affective symptoms.
UrinalysisHydration, glucose or ketones, renal findings, and evidence that may support evaluation for urinary infection.Urinary symptoms, delirium risk, dehydration, pregnancy-related concerns, or a medical differential supported by the presentation.
Urine drug screen and serum ethanolRecent exposure to selected substances; results vary by assay, detection window, and cross-reactivity.Intoxication or withdrawal concern, unexplained behavioral or cognitive change, overdose risk, or treatment planning with informed consent and context.
Urine pregnancy testPregnancy status relevant to medication, imaging, and treatment decisions.When pregnancy is possible and the result would change diagnosis, medication choice, procedure, imaging, or level-of-care planning.
Lipid panel and fasting glucose or HbA1cCardiometabolic baseline and longitudinal risk.Before and during treatment with medications that can affect weight, glucose, or lipids, following the medication-specific monitoring plan.
Creatine kinase (CK)Muscle injury or rhabdomyolysis; interpretation depends on symptoms, examination, activity, injections, restraint, and other causes.Rigidity, hyperthermia, severe agitation, prolonged immobility, suspected neuroleptic malignant syndrome, or other muscle-injury concern.
RPR or VDRL with confirmatory testingScreening for syphilis, a treatable infection that can rarely produce neuropsychiatric findings.Compatible neurologic or psychiatric findings, risk history, pregnancy, or population-based screening indications.
Diagnostic services
Use the modality that fits the suspected process
Neuroimaging
CT or MRI may be indicated for acute injury, focal findings, severe new headache, rapid cognitive change, suspected structural disease, or another defined neurologic question.
EEG
Supports evaluation of suspected epileptic activity or selected encephalopathic states. A routine study may not capture intermittent events.
Specialty testing
Toxicology consultation, lumbar puncture, sleep studies, neuropsychological testing, or other studies follow a specific differential and appropriate clinical pathway.
Ordering and follow-up
Close the loop on every result
Before ordering
Document the clinical question, urgency, expected interpretation, patient preparation, and how the result could change management.
After the result
Review trends and reference ranges in context, communicate meaningful findings, address urgent abnormalities, and document the action taken.
Ownership
Identify who will review pending studies, contact the patient, coordinate referrals, repeat monitoring, and respond if the clinical condition changes.
Equity and burden
Consider cost, transportation, fasting requirements, timing, accessibility, prior trauma, and whether a less burdensome route can answer the same question.
References
Medical assessment and testing guidance
AAEP Medical Clearance Consensus, Part I
Evidence review for medical assessment of adults presenting with psychiatric symptoms in emergency settings.
Open source ↗AAEP Medical Clearance Consensus, Part II
Consensus recommendations emphasizing individualized assessment and clinically directed testing.
Open source ↗Neurologic Diagnostic Tests
NINDS overview of imaging, EEG, lumbar puncture, and other neurologic studies.
Open source ↗