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My hand is bluer than blue

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My hand is bluer than blue
A case of a 39 year old male with cyanosis and numbness of the distal phalanges of the left hand
Angelo P. Ampong, MD
Emergency Medicine Resident
East Avenue Medical Center
HISTORY OF PRESENT ILLNESS
Patient is a 39 year old single unemployed male from Payatas, Quezon City, who came in with a chief
complaint of cyanosis of the left finger tips. At approximately 7am patient experienced sudden cyanosis,
numbness and tingling sensation of the distal phalanges of the left hand. Patient sought consult at a
local clinic because of persistence of previous symptoms. He was found to have a BP of 170/100 on the
right hand but absent blood pressure and radial pulse on the left hand. Patient was advised to seek
further evaluation from a tertiary hospital.
REVIEW OF SYSTEMS
(-) anorexia (-) weight loss (-) malaise (-) fever
(-) chest pain, difficulty of breathing (-) vomiting, abdominal pain, diarrhea
(-) dysuria
PERSONAL SOCIAL HISTORY
Non smoker
Occasional Alcoholic beverage drinker
No intake of illicit substances
FAMILY HISTORY
(+) Hypertension - Mother (-) Diabetes (-) PTB
(-) Asthma (-) Cardiac disease (-) Thyroid disorder

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PHYSICAL EXAMINATION
Conscious, coherent ambulatory, not in distress
BP: 170/100 (RA) no appreciable BP (LA)
HR: 76 RR: 19 Temp: 36.6
HEENT: ancteric sclerae, pink palpebral conjunctivae, (-) nasal flaring (-) CLAD
Chest: SCE, (-) wheeze (-) crackles, (-) retractions
Heart: Adynamic precordium, normal rate, regular rhythm, (-) murmur
Abdomen: flat, normo active bowel sounds, soft, non-tender
Extremity: (+) cyanosis on the distal phalanges of the left hand, (-) clubbing, (-) bipedal edema
Motors: 5/5 on all extremities
Sensory: 100 %
INITIAL IMPRESSION
Acute Arterial Occlusion , t/c Takayasu’s Arteritis, t/c Polycythemia vera

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My hand is bluer than blue A case of a 39 year old male with cyanosis and numbness of the distal phalanges of the left hand Angelo P. Ampong, MD Emergency Medicine Resident East Avenue Medical Center HISTORY OF PRESENT ILLNESS Patient is a 39 year old single unemployed male from Payatas, Quezon City, who came in with a chief complaint of cyanosis of the left finger tips. At approximately 7am patient experienced sudden cyanosis, numbness and tingling sensation of the distal phalanges of the left hand. Patient sought consult at a local clinic because of persistence of previous symptoms. He was found to have a BP of 170/100 on the right hand but absent blood pressure and radial pulse on the left hand. Patient was advised to seek further evaluation from a tertiary hospital. REVIEW OF SYSTEMS (-) anorexia (-) weight loss (-) malaise (-) fever (-) chest pain, difficulty of breathing (-) vomiting, abdominal pain, diarrhea (-) dysuria PERSONAL SOCIAL HISTORY Non smoker Occasional Alcoholic beverage drinker No intake of illicit substances FAMILY HISTORY (+) Hypertension - Mother (-) Diabetes (-) PTB (-) Asthma (-) Cardiac disease (-) Thyroid disorder PHYSICAL EXAMINATION Conscious, coherent ambulatory, not in distress BP: 170/100 (RA) no appreciable BP (LA) HR: 76 RR: 19 Temp: 36.6 HEENT: ancteric sclerae, pink palpebral conjunctivae, (-) nasal flaring (-) CLAD Chest: SCE, (-) wheeze (-) crackles, (-) retractions Heart: Adynamic precordium, normal rate, regular r ...
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Awesome! Perfect study aid.

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