Question about the blue lips thing

[tilder]

Where did this come from? Just curious really. I've not seen it written down anywhere or heard it given as advice.

Only place I have heard it is on MN. Am asking because I mentioned it on a zoom chat with friends, several of whom are medics. It raised eyebrows to say the least.

One even said the Italians sent people home if their o2 levels were 92% or above, commenting that she would be concerned at that level (No reference for that anecdote, sorry).

So my question is:

(a) is the blue lips thing something you heard from a friend/read on MN/read on SM; or
(b) is it something you were told by a medical professional.

Totally unscientific poll!

No it’s a mumsnet thing. Really dangerous.

I think blue liips is one of the criteria ambulances were looking at in deciding whether to take people in with CV19 (one of several factors).

"Someone with lips that have a bluish tinge or outline may be suffering from undiagnosed heart problems that are causing poor circulation, says Dr Adam Simon, a GP in Manchester. It's a sign that the blood is depleted of oxygen because the heart isn't functioning properly - this changes the blood colour from bright red to darker in colour, which makes the skin and lips look blue, he says."

Blue lips is a standard triage question as it is an indication of oxygen deprivation. If you think back to the good olds days it was asked in the same list of questions as are they breathing? Are they conscious? Etc.

Yes obviously it’s a triage question but mumsnet decided that you should not seek medical help unless you had blue lips because there wouldn’t be any point - ‘they’ (the NHS?) would rather leave you at home to die. This is rubbish and dangerous and as far as I can tell originated from one poster then took on a life of its own.

Paramedics who came out to check me over. Told me to call 999 if I deteriorated further and blue lips was one example of how I would know that I needed to call them (they were sent out by 111).

It's from the paramedics people have been given a list of what to look out for before they call them back they suggest things like blue lips its unhelpful unless your a milk bottle colour my daughter is olive toned she goes greenish purple I've told her flatmates this and amended their advice because ffs

Its a normal question.

I had a chest infection a couple of years ago. Called nhs direct as it was a Saturday and I was struggling.

Anyway, they said a doctor would call back. In the meantime if I got worse or any happened to call them back. If xyz happened to call and ambulance.

Part of xyz was 'if your lips turn blue'.

Its also standard for paramedics who are not transporting to hospital to give that advice too. You must call us back if your lips turn blue.

Its the same advice given out now.

But on mn people have decided that meant they couldn't be taken to hospital or call an ambulance until their lips turned blue.

People with a loved one who is sick, may have heard the actual advice and interpreted it as something different.

But as of yet, there's been no proof that any area had a rule that they wouldn't do anything, unless your lips went blue.

The blue lips thing is racist.

It was called out decades ago which is why no doctor or nurse will mention it.

If there is any proper evidence of paramedics mentioning it then it needs to be brought to media and political attention.

No, but there is evidence that, in the early part of April, they revised their guidelines to increase the threshold for being taken to hospital with breathing difficulties. That's what happened to me - was told that in normal circumstances I would have been taken in with suspected pneumonia .

They then revised the threshold down again when too many people started dying at home.

www.theguardian.com/world/2020/may/03/happy-hypoxia-unusual-coronavirus-effect-baffles-doctors?CMP=Share_iOSApp_Other

Many with hypoxia aren’t showing signs of distress.

I had this for a few weeks myself in Jan/Feb and they didn’t know what it was.

Guessing we know now...

'Happy hypoxia' does occur outside covid as well.

But yes, I was ill with similar symptoms to covidate February. Still don't have my sense of taste back. I suspect if I was that ill now, it would be presumed covid.

Porcupineinwaiting was that because the hospital was over whelmed or because they suspected it wasn't covid related and taking you there may have put you at alot of risk?

@BeforeIPutOnMyMakeup
'The blue lips thing is racist.
It was called out decades ago which is why no doctor or nurse will mention it.
If there is any proper evidence of paramedics mentioning it then it needs to be brought to media and political attention'

Blue lips is listed in the NICE guidance for hospital admission section 3.4 assessing severity
www.nice.org.uk/guidance/ng165/chapter/diagnosis-and-assessment#assessing-severity

Porcupine is right but it was regional - eg I live in Covid central in outer London and the instructions to ambulances required a particular number of issues 5? and were reduced down to 3 once it was clear there was space in hospitals again.

It was instructions for those with covid 19 I think and not necessarily wrong that people in some cases are better off at home by the way. It is not an easy issue unless you are really ill although at what point you need to be in is not always easy to assess - too late and it might be a worse outcome. I think in bits of busy London we were a bit late to take people in until the instructions changed.

Thanks all. So basically the MN view of 'do not go to hospital unless your lips are blue' is not NHS advice nor has it been NHS advice. It remains an indicator of a problem, one of several signs to look out for. And not to wait for.

Am also that I didn't think of different skin colours in this. Makes total sense. Sorry.

I think that is why it is a good idea to have a pulse oximeter at home to check oxygen levels long before lips turn blue.

It's just not true for my region.

Anybody reporting subjective shortness of breath on phone triage would be assessed with sats and RR - in their car at the start of the pandemic, more recently at community Covid centres or if severe sounding straight to A&E. 111 does not operate here, all triage is by a GP (24/7 sevice) or perhaps a practice nurse or ANP working alongside GPs.

Sats 94% and under go to ED - 95% in more recent guidance.

In terms of safety netting I would be emphasising the need to ring 999 if there is a subjective worsening of breathing. If there is a carer able to measure RR this might be helpful but it's not always fair to put this responsibility onto someone else. I have bought an extra sats probe and would drop it though the letterbox if necessary though I haven't needed to as yet mainly due to the Covid centre availability.

The blue lips has become a hard fact on Mumsnet though even on the more scientific evidence based threads. It is depressing.

Thankfully very few people seem to be dying at home. A surgeon died during SI despite his colleagues begging him to seek help. It seems that the cytokine storm is without warning in some.

@Peggysgettingcrazy no idea. I wasn't really in a condition to ask questions. Not in London but was in another hotspot city (it was a hotspot at the time).

"The blue lips has become a hard fact on Mumsnet though even on the more scientific evidence based threads"

It was a problem in London and possibly other areas of the country, but policy was changed over Easter

www.bbc.com/news/health-52317781

"Some seriously-ill Covid-19 patients in London may not have been taken to hospital by ambulance because of a system temporarily used to assess people, a BBC investigation suggests.
....
Medical professionals use a scoring system, called 'NEWS2', as one way of identifying patients at risk of deteriorating, a check normally used for sepsis patients.

Under normal circumstances, ambulance teams would blue-light anyone with a score of five or above to hospital.

But on March 18, LAS workers were told to apply the NEWS2 check to suspected Covid patients -
and that many of those with a score up to seven could be "suitable for community care", even if there were issues with breathing rate, oxygen supply and consciousness.
.....
Over the Easter weekend, the LAS changed its guidance to say suspected coronavirus patients with a wider range of symptoms

and a much lower NEWS2 score of three to five should be taken to A&E for assessment.

It was all ever so strange it happened London rather than elsewhere...given we were repeatedly told by posters on the Keep Out threads that London's hospitals were well equipped to cope....they refused to accept that it wouldn't be the case.

I was told to call an ambulance if my O2 went into the 80s (am asthmatic and have oximeter at home) As it was it was very low 90s for number of days. I'm ok, but am still having a lot of lung problems and very breathless 8 weeks later.

No one on MN has ever sad only go to hospital if your lips are blue. What we did say is that for some of us in London the triage list for getting an ambulance was very steep - saying only 2 words and if yo manage 5 you are not taken in - during the peak period which wqas a fact and was not fake news at all and that we all wished there was the capacity to bring people in sooner as getting treatment only very late in the day was a bit issue.

Why did it happen in London - because they had many more cases sooner and that was the instructions to avoid hospitals being overwhelmed. It is perfectly understandable and in today's press a doctor (probably in London ) has written a diary and she says that they are now much less busy and are not being forced to choose who lives and dies in the same way as a week or two ago.

@BeforeIPutOnMyMakeup and yet it’s still an easy way to identify hypoxia in people with light enough lips to have blue lips. Surely you don’t think they should stop asking for a clear symptom of a life threatening condition just because it doesn’t apply to everyone?

I am white but my lips have never gone blue. My sats have been in the 80s and my lips have not gone blue. I dont think it's a good indicator for every person.

The blue lips thing is racist

Against blue people?

Does anyone know why paramedics don't carry oximeters and the NICE guidance could then refer to oxygen saturation rather than the rather misleading blue lips indicator?