I went in to see a patient whose hands suddenly turned blue at work. She stated that she couldn’t feel any of her fingertips once they started turning blue and said that she was “cleaning” before the symptoms occurred.
As I walked into the room, all of the fingers on both her hands were definitely dusky appearing. Her upper arms appeared OK. Her lips weren’t cyanotic.
So I sat there taking a history thinking to myself what the hell could be causing this.
Raynauds doesn’t affect the whole hand like that.
Sudden onset of a cyanotic heart lesion wasn’t very likely.
She wasn’t working in the cold, and she was cleaning toilets with a scrub brush, so she didn’t have an exposure to some kind of industrial solvent.
She didn’t have pain, so it wasn’t like she had bilateral arterial occlusions or some other vascular problem.
She wasn’t taking any medications. Was she poisoned?
I was clueless.
I went to examine her. Her hands were warm. She had good pulses. She had normal capillary refill. Good pain sensation with a toothpick. Then I noticed that there was no blue between her fingers, only on front and back of her hands up to her wrist.
Wait a minute.
I grabbed a washcloth, wet it, and scrubbed the back of her hand. The washcloth turned blue and her hand turned pink.
The girl’s mother did a facepalm. “We waited 2 hours to have someone wash your hands?”
“Well, the toilets did have those blue drop-in tablets in them,” the patient mumbled.
So I set them up for discharge and told them “at least there’s nothing serious – right?”
When the nurse went in with their papers, they were all upset because I didn’t do anything to diagnose why the patient’s fingers were tingling.
Um … its probably from the blue dye. See your doctor in a few days if it isn’t better. He can set you up for a neurology appointment and a nerve conduction study if necessary.
When the secretary read the discharge diagnosis, she loudly said “that’s just gross.”
“Why?” I asked.
I saw that girl go to the bathroom twice while she was here and if you got that dye off with a washcloth and water, there was no way in heck that she washed her hands in that bathroom.”
I put my drink down and went to wash my hands again after having touched the patient’s hands … just in case.