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The night after Christmas day was a busy day in the department. We had already slogged our way through a stream of what seemed like endless patients when Triage alerted the team of a potentially sick patient. “They are coming straight over to the Acute Care side now, and they are turning blue!” With this information, my interest was instantly piqued.
The patient rolled quickly across the ED into a bed via wheelchair. I half-jogged to the room to find a young patient, in no apparent distress. A quick glance up at her monitor revealed normal vital signs, normal oxygen saturations on room air. Hmmm. “What brings you in today?” I started. “My mom told me to come in tonight. She said, I don’t look right and that my face and hands look blue. I feel fine.” It was only then that I was able to see the subtle, but easily recognizable blue hue around her mouth, lips, and her fingertips.
My first thought was, this girl is cyanotic. She sure is. And with the involvement of her face and lips, she has central cyanosis. From what? But, she has normal oxygen saturations, heart rate, and blood pressure. A quick listen to her chest revealed no murmur and no extraneous lung sounds. Hmmm. Very interesting.
I turned my attention to her hands. Closer inspection revealed the subtle blue hue to primarily be located on her fingertips. I squeeze her fingertip to assess her capillary refill, and it was normal. However, when blanched, her fingertip remained slightly blue.
“I don’t know why this is happening to me, I feel fine. I’m a little freaked out right now because everybody looked very worried in triage,” she said anxiously. At this point, she looked very nervous, drumming her fingers on her leg, tapping her foot. I looked at her hands again. She was wringing them, tapping her fingers on her leg, rubbing them together, then back again, drumming her jeans. Her dark blue, denim jeans.
“Did you get some new jeans for Christmas?” I asked. “Yeah….,” she replied, looking very confused. I took an alcohol swab out of the drawer, ripped open the package, and wiped one of her fingertips. I showed her the results. Her face now turned a beet red. “I’m so embarrassed,” she said putting her hands up to her mouth. “It’s a rare disorder, but a very curable case,” I teased.
It’s not every shift you catch a “zebra” like Blue Jean Pseudo-Cyanosis. But when you do, it reminds you why you love this job, even during the holidays.
Jeremy Webb, PGY3
Wake Forest Baptist Health. Winston Salem, NC