Methemoglobinemia
Abstract This simulation is the recreation of an emergency department (ED) case regarding a patient presenting with cyanosis caused by methemoglobinemia. The patient had a previous ED visit that was vaguer, with far less dramatic changes in vital signs and documented physical findings. The patient r...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Association of American Medical Colleges
2014-12-01
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| Series: | MedEdPORTAL |
| Subjects: | |
| Online Access: | http://www.mededportal.org/doi/10.15766/mep_2374-8265.9973 |
| _version_ | 1798021951220875264 |
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| author | Richard Stair Luan Lawson |
| author_facet | Richard Stair Luan Lawson |
| author_sort | Richard Stair |
| collection | DOAJ |
| description | Abstract This simulation is the recreation of an emergency department (ED) case regarding a patient presenting with cyanosis caused by methemoglobinemia. The patient had a previous ED visit that was vaguer, with far less dramatic changes in vital signs and documented physical findings. The patient returned with worsening symptoms, but much more dramatic vital sign abnormalities, hypoxia, and cyanosis. Given the patient's past medical history, infectious and pulmonary etiologies were initially considered, but one of the key features to the case was the lack of response to supplemental oxygenation and clear lungs, making a pulmonary etiology less unlikely. Another important feature of the case is the need to consider medications as a cause of pathology rather than a cure. At times, medications are familiar causes of acute medical conditions, such as rashes with penicillin or angioedema with angiotensin converting enzymes inhibitors. But medications are not necessarily considered in the differential diagnosis of acute medical conditions by providers. Methemoglobinemia is a much less frequently encountered condition that many providers have not encountered, and this simulation was developed to discuss these issues. Performers of this case have almost universally been able to quickly recognize the clinical features and degree of cyanosis present from the actual clinical scenario. We have used a Laerdal 3G mannequin when running this case, and learners very quickly recognize that there is cyanosis, as a blue light is activated with low oxygen saturation values. In addition, the tachycardia, high respiratory rates, and low oxygen saturation levels observed on the monitor dramatically reproduce the important features needed to recreate the clinical scenario we observed. The addition of the clinical pictures taken from the actual patient further rounds out the clinical appearance and degree of this patient's cyanosis. This combination has pretty impressively reproduced the necessary findings to manage the case. Mannequins without such capabilities should still be reasonable to use with the clinical pictures provided, but may not be as overwhelmingly recognized. |
| first_indexed | 2024-04-11T17:21:51Z |
| format | Article |
| id | doaj.art-f310134339514f9fa62ab26ddf822129 |
| institution | Directory Open Access Journal |
| issn | 2374-8265 |
| language | English |
| last_indexed | 2024-04-11T17:21:51Z |
| publishDate | 2014-12-01 |
| publisher | Association of American Medical Colleges |
| record_format | Article |
| series | MedEdPORTAL |
| spelling | doaj.art-f310134339514f9fa62ab26ddf8221292022-12-22T04:12:29ZengAssociation of American Medical CollegesMedEdPORTAL2374-82652014-12-011010.15766/mep_2374-8265.9973MethemoglobinemiaRichard Stair0Luan Lawson11 The Brody School of Medicine at East Carolina University2 The Brody School of Medicine at East Carolina UniversityAbstract This simulation is the recreation of an emergency department (ED) case regarding a patient presenting with cyanosis caused by methemoglobinemia. The patient had a previous ED visit that was vaguer, with far less dramatic changes in vital signs and documented physical findings. The patient returned with worsening symptoms, but much more dramatic vital sign abnormalities, hypoxia, and cyanosis. Given the patient's past medical history, infectious and pulmonary etiologies were initially considered, but one of the key features to the case was the lack of response to supplemental oxygenation and clear lungs, making a pulmonary etiology less unlikely. Another important feature of the case is the need to consider medications as a cause of pathology rather than a cure. At times, medications are familiar causes of acute medical conditions, such as rashes with penicillin or angioedema with angiotensin converting enzymes inhibitors. But medications are not necessarily considered in the differential diagnosis of acute medical conditions by providers. Methemoglobinemia is a much less frequently encountered condition that many providers have not encountered, and this simulation was developed to discuss these issues. Performers of this case have almost universally been able to quickly recognize the clinical features and degree of cyanosis present from the actual clinical scenario. We have used a Laerdal 3G mannequin when running this case, and learners very quickly recognize that there is cyanosis, as a blue light is activated with low oxygen saturation values. In addition, the tachycardia, high respiratory rates, and low oxygen saturation levels observed on the monitor dramatically reproduce the important features needed to recreate the clinical scenario we observed. The addition of the clinical pictures taken from the actual patient further rounds out the clinical appearance and degree of this patient's cyanosis. This combination has pretty impressively reproduced the necessary findings to manage the case. Mannequins without such capabilities should still be reasonable to use with the clinical pictures provided, but may not be as overwhelmingly recognized.http://www.mededportal.org/doi/10.15766/mep_2374-8265.9973MethemoglobinemiaCyanosisMethylene BlueG6PD |
| spellingShingle | Richard Stair Luan Lawson Methemoglobinemia MedEdPORTAL Methemoglobinemia Cyanosis Methylene Blue G6PD |
| title | Methemoglobinemia |
| title_full | Methemoglobinemia |
| title_fullStr | Methemoglobinemia |
| title_full_unstemmed | Methemoglobinemia |
| title_short | Methemoglobinemia |
| title_sort | methemoglobinemia |
| topic | Methemoglobinemia Cyanosis Methylene Blue G6PD |
| url | http://www.mededportal.org/doi/10.15766/mep_2374-8265.9973 |
| work_keys_str_mv | AT richardstair methemoglobinemia AT luanlawson methemoglobinemia |