ERDoc Posted December 21, 2006 Author Share Posted December 21, 2006 Are his hands blue when you get there? Are they cold? It is cold here in Denver...........big blizzard. Yup, his hands are still blue. They are not cold. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted December 21, 2006 Share Posted December 21, 2006 This is a toughie what was the Sample PQRST? Link to comment Share on other sites More sharing options...
ERDoc Posted December 21, 2006 Author Share Posted December 21, 2006 This is a toughie what was the Sample PQRST? 12 y/o male with h/o asthma on albuterol prn who noticed his hands were blue just prior to you being called. He denies any pain. The only activity was some American football after school (two-hand touch) but he does not remember and injuries. He has no allergies, last ate dinner about 4 hours ago. Did not eat anything unusual. Nothing seems to make it better or worse, although he really hasn't tried to do anything other than call 911. Link to comment Share on other sites More sharing options...
Asysin2leads Posted December 21, 2006 Share Posted December 21, 2006 Does he seem hypoxic? Is the blue appear to be a cyanosis or a pigmentation? Link to comment Share on other sites More sharing options...
ERDoc Posted December 21, 2006 Author Share Posted December 21, 2006 Does he seem hypoxic? Is the blue appear to be a cyanosis or a pigmentation? It only appears on the hands from about the wrists down. It does not cover all of the hands. It is mostly over the extensor surfaces and fingertips. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted December 21, 2006 Share Posted December 21, 2006 so have we asked all the history questions? If so what does the exam list that I put out in a previous post reveal? I'm still kind of leaning towards raynauds due to the presentation of the hands with the cyanosis. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted December 21, 2006 Share Posted December 21, 2006 off subject a little, did the end result require the Norwood Procedure? What did his feet look like? ARe they normal color or cyanotic also? The other thing that I thought was maybe a late finding of coarctation of the aorta but that's usually a toddler/2-3 year old issue Maybe Abernethy Malformation or Hepatopulmonary Syndrome And could it be so simple as blue food coloring - like he maybe drank blue food coloring thinking it would be good to drink. Or had he baked cookies with mom and used blue food coloring? That sure would make the skin appear cyanotic and it would be on his fingers via the palmar aspect? It is around the holidays that we do a lot of baking. Here's a neat article on blue coloring in parenteral nutrition - http://www.theannals.com/cgi/content/abstract/34/7/868 Link to comment Share on other sites More sharing options...
DwayneEMTP Posted December 21, 2006 Share Posted December 21, 2006 Maybe a foolish question, but I notice we keep refering to the hands and/condition as cyanotic. Would this still be the correct terminology when the coloration is restricted to the flexor region (do I understand this to be the tops of the hands, following/near the tendons?) and fingertips? Or would this term refer to a more generalized coloring issue. The colorization seems too specific to be a general circulation issue involving the whole hand(s). Are the hands a normal shape? Left and right appear equal in all respects? Do they function fully and normally? He doesn't complain of pain, but is there any loss or change of normal sensation? Is he a new user of albuterol? Did he use it during or after his ball game? How long since the end of the ball game? I don't suppose kneeling in the ready position could have pinched the dorsal arteries distal to his wrists? My apologies Doc if you've answered these questions and I missed them...and to everyone else if these are silly questions...I don't mean to muddy up the thread. Have a great night all... Dwayne Link to comment Share on other sites More sharing options...
Chrisclark Posted December 21, 2006 Share Posted December 21, 2006 Does he exhibit cold symptoms? Does he have any kind of cough? Has he used any illegal drugs? Pulse oximetry? What kind of lung sounds does he have? What is his race? Pulse and B/P? Are his feet changing too? Has he had any recent injuries or invasive surgeries? Does he have problems keeping his hands or feet warm (does he generally have cold hands)? What is his temperature? Link to comment Share on other sites More sharing options...
ERDoc Posted December 21, 2006 Author Share Posted December 21, 2006 To sum up the physical, other than the blue hands as described there are no other abnormalities. The feet and ears are normal color. He has been taking the albuterol on a prn basis for 4 years and the last time he used it was several months ago. His pulse ox is 100% on RA. No trauma to the hands during the game which was about 7 hours prior to the call to 911. He has not been baking any cookies. Link to comment Share on other sites More sharing options...
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