Awareness
When someone is seriously ill or injured, some clues may be visible before they say a word.
Changes in skin colour, temperature or moisture can give paramedics valuable information about what may be happening inside the body.
From pale or ashen skin to cold, clammy hands or a blue tinge around the lips, these changes can provide clues about circulation, oxygenation and hydration.
“The skin is a good indicator of how well your heart is pumping, whether you are breathing sufficiently and how well hydrated you are, to name a few examples,” says Daniëlle Sparrow, an operational paramedic at ER24 Potchefstroom.
Pale or ashen skin
A patient who suddenly appears unusually pale or ashen may have reduced blood flow to the skin. This can occur during shock, significant blood loss, severe dehydration or when the heart is not pumping effectively, including in some patients experiencing a heart attack or other serious cardiac problems.
“We see this in trauma patients who have lost a lot of blood, either internally or externally,” Sparrow explains.
She adds that it can also occur when severe dehydration begins to affect circulation or when the heart is not pumping effectively.
However, pale skin does not automatically mean that a person’s blood pressure is low. Paramedics assess it alongside other signs, including the patient’s pulse, breathing, blood pressure and level of consciousness.
Blue or grey skin
A blue or grey tinge, known as cyanosis, can indicate a problem with oxygenation or circulation. Blue or grey discolouration around the lips, tongue or inside the mouth can be particularly concerning, while changes in the hands and feet may occur when blood flow to the extremities is reduced.
Skin colour can be more difficult to assess in people with darker skin tones, so paramedics may also look at areas such as the lips, gums, tongue, palms, soles of feet and nail beds.
The colour change itself does not identify the cause, which is why it is assessed alongside symptoms such as breathing difficulties, chest pain or altered consciousness.
Cold, clammy skin and sweating
“Cold skin can simply result from exposure to cold weather,” says Sparrow. “In an unwell patient, however, it can indicate that the body is redirecting blood towards vital organs, leaving less blood flow to the skin.”
Cold, clammy skin can occur in shock and may also be associated with low blood sugar. “People naturally sweat when exercising, in hot weather or with a fever, but sudden or excessive sweating, particularly alongside pale, cool or clammy skin, can occur during serious illness, reduced circulation and some cardiac emergencies,” she adds.
Other clues in the skin
Skin can also provide clues about hydration. Skin that remains raised or “tented” briefly after being gently pinched can occur with dehydration, although it is not a reliable standalone indicator. Paramedics consider this alongside other signs and the patient’s overall condition.
A yellowish appearance of the skin or whites of the eyes, known as jaundice, can have several causes, including liver or gallbladder problems and certain blood disorders.
It’s never just about the skin
Skin signs can provide valuable clues, but they are only one part of a patient’s assessment.
“A patient is not diagnosed or treated based on one sign alone,” says Sparrow. “We must take into account all the other signs that a patient might be experiencing.”
For example, someone who has been in the sun may have hot, flushed skin. That does not automatically mean they have a serious infection. Paramedics consider what happened before the patient became unwell, their vital signs, symptoms and overall presentation.
“The overall picture is much more useful than any single skin sign,” Sparrow says.