Overview
Carefully inspect the patient's fingers, looking for discolouration of the nail beds and distal digits.
Tar Staining
Look For
- Yellow staining to the distal phalanges, especially on the 2nd and 3rd digits.
Significance
- An indicator of significant smoking history.
Respiratory Complications of Tobacco Smoking
- Chronic obstructive pulmonary disease
- Lung cancer
Nail Bed Cyanosis
Look For
- Blue discolouration of the nail beds.
Significance
- Nail bed cyanosis is a type of peripheral cyanosis, characterised by elevated levels of deoxygenated haemoglobin (hypoxaemia) in the peripheries. Always look for central cyanosis (under the tongue) when this is present.
Causes of Nail Bed Cyanosis
Central Cyanosis
- High altitude
- Obstructive lung disease, pulmonary oedema, pneumonia, pulmonary embolism
- Congenital heart disease
- Methaemoglobinaemia / sulfhaemoglobinaemia / carboxyhaemoglobinaemia
Peripheral Cyanosis
- As for central cyanosis
- Reduced cardiac output
- Vasoconstriction
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