Initial assessment – history and examination

Initial assessment should follow an ABCDE approach as for every hypoxic patient, supporting ventilation and circulation and identifying and treating other causes of cyanosis or other effects of toxin exposure. Anaesthetics or ITU input may be required.

If methaemoglobinaemia is suspected there are key points of the history and examination that should be elicited to aid diagnosis, identify cause and allow assessment of severity.

The most important part of the history is to elicit any history of exposure to account for the methaemoglobinaemia. It is also necessary to identify co-morbidities and any history of cyanosis or haematological abnormality.

Examination should look for evidence of compromise (i.e. signs of hypoxia) and any clues as to the cause including presence of sepsis

Learning bite

Be thorough in eliciting a history of exposure to toxins. It is the most common cause of methaemoglobinaemia

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Excellent visual representation of the approach !

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