14497 Young William

Tagged in Education & Training

Arterial blood gas gone bad

Brief clinical details (80 words):

30 year old previously healthy lady post cholecystectomy one week prior after which she had arterial blood gas samples obtained “several times”. She presents 4 days later with a cool, painful, discolored left thumb. Allen test not documented.

Description of the relevant abnormalities (80 words):

A discolored thumb that is tender, dusky colored, cool and hypesthetic. No radial pulse present

Why this image is clinically or educationally relevant? (50 words)

This common invasive procedure carries a small but significant complication of thumb ischemia due to lack of anastomosis between the superficial and deep palmar arches. This patient required extensive plastic procedures with an amputation of the thumb. Although controversial, the Allen test (or one of it’s congeners) should be done pre-procedure.