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Recognizing Cyanosis
The Journal of Emergency Medicine, Vol. -, No. -, p. 1, 2016 Copyright Ó 2016 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/$ - see front matter
Letter to the Editor , RECOGNIZING CYANOSIS
discharge in the patient reported by Levine and colleagues are therefore of interest (2).
, To the Editor: Prasad R. Koduri, MD Division of Hematology-Oncology Department of Medicine Medicity Hospital Hyderabad 500063, India
I read with interest the paper by Levine and colleagues that appeared in a recent issue of the Journal (1). It is not clear whether or not the oxygen saturation value of 92% on admission was obtained with a pulse oximeter. In view of the markedly low methemoglobin reductase level in the patient, it is quite likely that methemoglobinemia was present at admission rather than being delayed onset (as suggested by the authors). The difficulty recognizing cyanosis in dark-skinned people is well established. I have found it to be helpful to examine the patient’s nail beds with the examiner’s fingers next to the patient’s while looking for cyanosis or slate-gray coloration. The presence of a saturation gap, the methemoglobin level, and the presence of cyanosis at
http://dx.doi.org/10.1016/j.jemermed.2014.07.068
REFERENCES 1. Levine M, O’Connor AD, Tasset M. Methemoglobinemia after a mediastinal stab wound. J Emerg Med 2013;45:e153–6. 2. Akhtar J, Johnston BD, Krenzelok EP. Mind the gap. J Emerg Med 2007;33:131–2.
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Letter to the Editor , RECOGNIZING CYANOSIS
discharge in the patient reported by Levine and colleagues are therefore of interest (2).
, To the Editor: Prasad R. Koduri, MD Division of Hematology-Oncology Department of Medicine Medicity Hospital Hyderabad 500063, India
I read with interest the paper by Levine and colleagues that appeared in a recent issue of the Journal (1). It is not clear whether or not the oxygen saturation value of 92% on admission was obtained with a pulse oximeter. In view of the markedly low methemoglobin reductase level in the patient, it is quite likely that methemoglobinemia was present at admission rather than being delayed onset (as suggested by the authors). The difficulty recognizing cyanosis in dark-skinned people is well established. I have found it to be helpful to examine the patient’s nail beds with the examiner’s fingers next to the patient’s while looking for cyanosis or slate-gray coloration. The presence of a saturation gap, the methemoglobin level, and the presence of cyanosis at
http://dx.doi.org/10.1016/j.jemermed.2014.07.068
REFERENCES 1. Levine M, O’Connor AD, Tasset M. Methemoglobinemia after a mediastinal stab wound. J Emerg Med 2013;45:e153–6. 2. Akhtar J, Johnston BD, Krenzelok EP. Mind the gap. J Emerg Med 2007;33:131–2.
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