An Unusual Hypoxia Patient

​BY GORDON MURPHY, PA-C, MPHThe patient was blue, her primary care physician noted. Quite literally, in fact.The 38-year-old woman had sought care for a recurrent urinary tract infection, and that's when her primary care physician found her pulse oximetry to be 74%. He was concerned about hypoxia and asked us to evaluate her.The patient reported taking an SSRI for anxiety and having a hormone-eluting IUD. She had previously had a Roux-en-Y gastric bypass. She said she had a headache, but had been instructed not to take NSAIDs. She said she had just finished a course of Cipro for her UTI, but continued to be symptomatic with urinary frequency, urgency, and burning, for which she had been taking the over-the-counter drug phenazopyridine (Azo, Pyridium). Her exam was otherwise unremarkable, with no fever, chest pain, or shortness of breath.Her vital signs were a pulse of 104 bpm, respirations of 24 bpm, blood pressure of 138/74 mm Hg, and SpO2 of 92% on 4 lpm via nasal cannula (low 80s on arrival). The patient was cyanotic, and her lips and fingers were blue, but she was not dyspneic in conversation and walked to the bathroom without difficulty. She was mildly tachypneic and tachycardic, but her lung sounds were clear and she had no cardiac murmurs or thrills, abdominal abnormalities, or peripheral edema.Her white blood cell count, hemoglobin, hematocrit, and D-dimer were within normal limits, and her arterial blood gas was unremarkable, not acidotic, and she had no oxyge...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research

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