Tuesday, December 19, 2006

My, your hair smells like insectiside, my dear

Excerpts from a New York Times article by Drs. Larry and Jonathan Zaroff posted this afternoon on AOL:
A 50-year-old woman was admitted to the hospital with complaints of severe weakness and difficulty breathing. She had been quite healthy until the afternoon of the admission, with no history of serious illnesses.

The doctors at the university hospital where she became a patient are known for using their brains. They also use their stethoscopes wisely, and observe closely how a patient looks.

On examination this one was sweaty and had pinpoint pupils, and her lungs were wheezy. But unlike physicians of centuries ago, doctors today do not regularly use their noses. (In the 18th century, doctors could make diagnoses of kidney failure, diabetes and liver disease by smelling a patient.) For this woman, the diagnosis remained obscure for the next hour as her breathing got more labored and she became comatose.

A tube was placed in her windpipe and she was attached to a breathing machine. Then an experienced nurse, with good sense and a good sense of smell, came to the rescue. The nurse noted that the patient had a peculiar odor, resembling garlic, most prominently from her hair. The unusual odor raised the suspicion of insecticide poisoning with organophosphates.

The patient was immediately treated with atropine and 2-PAM to reverse the effects of the poison, while blood was sent to the lab to verify the diagnosis. Each time she received the medications she woke and improved, but then lapsed back into a coma with increasing lung problems. Her skin was washed and her hair was shampooed several times with no lasting improvement.
So they shaved her head -- and she woke up just fine. And she remembered what had happened.

Seems she'd gone to her neighbor's house and let her neighbor give her a shampoo.
The neighbor, when contacted, was willing to bring in the shampoo. Chagrined, she showed up shortly, bringing two containers. One held shampoo. The other, a similar jug, contained an organophosphate insecticide. Both receptacles were the same size, the labels old and blurred.

I must have used the wrong one, she said, when told that her friend was just recovering from insecticide poisoning.

Organophosphates have a bad reputation, and quite correctly. They are extremely dangerous, even in small amounts, and are easily absorbed through the skin as well as the lungs. They poison an important enzyme, acetylcholine esterase, without which acetylcholine accumulates in the body, disabling muscles and nerves and important centers in the brain.

* * *

In this case, the patient recovered well, after the correct diagnosis by a nurse with a sensitive nose, proper treatment with drugs and the elimination of the insecticide by balding.
And it looks like I found this before MJ, May, or Dr. A.

Oh, that's got a meter to it, doesn't it?


Anonymous said...

nurses with excellent noses rock! :)


Barb said...

I never heard of Orgasmophosphates. (Snicker.)

sari said...

I wouldn't be visiting or shampooing or eating at that lady's house anymore.

Mother Jones RN said...

Good morning, Counselor.

What a get story! When I was in nursing school, I had teachers who taught us to use ALL of our senses when caring for our patients. Warning: What I'm about to share with you may gross you out.

Stool, urine, and other body secretions give off a different type of odor when they are mixed with blood. The urine of a diabetic patient smells differently if they have a high blood sugar. Cancer patients can look and SMELL differently than other patients. When I walk into a patient’s room, I’m not only looking at them, I’m sniffing them out. I wonder how old that nurse is that was mentioned in the story. I bet she’s no Spring chicken. I don’t think many kids get that kind of education in nursing school anymore.