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cool derm case


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Hmmm ok. I was thinking methemoglobinemia but outside of medication use and chemical exposure, I'm not sure what else might cause that. I'll put that DDx on the back burner for now. 

I'll let someone else chime in on history.....

PE: particularly interested in sclera color and pupil size/reactivity, any odor to her breath (has she been exposed to toxic levels of something without realizing it?), cardiac murmurs, adventitious lung sounds, respiratory rate/effort, blanching vs. non-blanching cyanosis (honestly not entirely sure why I'm checking for that but I have a gut feeling that is important), capillary refill, volume status, fingernails (clubbing?), skin temperature, GCS/look for focal neuro deficits

Initial labs....CBC, reticulocyte count, peripheral blood smear, CMP, ABG, UA, +/- CXR and/or echo depending on cardiopulmonary exam...also debating whether arterial or venous blood sample would be more informative for gross examination, but definitely want to take a look at one of those before it goes off to the lab. 

Not quite sure what I'm treating and she doesn't seem very symptomatic, so I'd say just keep her on a cardiac monitor until labs come back. 

Might think of more later!

Edited by karebear12892
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all exam features negative aside from blue skin on face/hands/forearms. ABG and methemoglobin level done and nl. cxr initially ordered then cancelled. ekg nl. 

when you check for blanching vs non-blanching on the forearms your fingers come away blue(and no, this isn't about new blue clothes, sheets, etc). 

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don't feel bad. major zebra:

https://www.ejcrim.com/index.php/EJCRIM/article/view/84/174

pseudochromhydrosis. basically sweat mixes with bacteria present on the skin , causing a discoloration. can be lots of different colors depending on the bacteria involved.  treatment is topical antibacterial preparations like hibiclens/chlorhexidine. 

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Similar to my last ride along w/ Dallas Fire. First pt called out as an “unconscious person”, so Rescue/Engine dispatch. Get there and there’s a guy in a shower chair in the tub with a Foley back with bluish/purple discoloration inside the bag. EMS didn’t inquire but I asked family about it and there were no home meds or recent contrast studies that would explain same. Never got an answer. He was a no transport.

 

 

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