Updated June 17, 2014
Do you smell?
You can remove your nose from your armpit as this question does not refer to your personal level of hygiene. It refers to the conscious use of your sense of smell to search for odors on a scene, or emanating from your patient, that may help keep you safe or establish a diagnosis.
My guess is you’re like the rest of us who have become overly dependent on medical devices and lab tests to provide patient information without spending enough time at the source.
Follow your nose
Have you ever smelled a “fruity odor” on the breath of a patient breathing 22 times a minute with a glucometer reading that was too high to read? The ketones produced by the patient with diabetic ketoacidosis may cause a fruity breath — which is likely only noticed if you consciously think about its potential presence, and get close enough to the patient’s mouth to get a good whiff.
Other odors may not be as subtle, such as the rotten egg smell of a leaking gas line in the house you just entered to respond to a call for a “man down;" or the call for a patient complaining of leg pain and the smell of rotten, infected human flesh greets you at the door.
Scientists are also studying the inability of patients with Alzheimer’s to recognize various odors, and a scratch and sniff test may help detect the disease early on.
Electronic receptors can also detect and identify odors like fermenting wine, spoiled meat and human disease. The future will yield a hand-held sniffer to analyze your patient’s breath for a variety of problems, including those you may not be able to smell yourself.
Get a good whiff
To maximize the number of odor molecules hitting the smell receptors in your nose, take several active, short nasal inhalations, or sniffs. The more molecules that reach the smell receptors, the more likely you will recognize the odor. But excessive sniffing can overwhelm the receptors and cause the odor to fade — a useful maneuver in some stinky situations.Looking back, our historical medical colleagues often had to depend on their senses for a diagnosis, and everything was touched, tasted and smelled from outside to inside. Of course that means they had to wait until the patient’s inside stuff travelled to the outside, such as , urine, stool, vomit, pus ... you get the picture. Today, our society seeks to cover even mildly unpleasant odors with a variety of hygiene products, cleansers, deodorizers, and sprays that will make your room smell like it was actually cleaned recently. All this has added to the desensitization of our ability to smell.
Use common ‘scents’
It’s too bad, because of all the senses, smell has the most direct connection to the brain. Once those scent-carrying molecules enter the nose, they are absorbed by receptors that send a signal directly to several areas of the brain where the odor is interpreted in part by our past experiences.
A decomposing animal likely to be interpreted as unpleasant. However, if you were raised in a culture that ate properly prepared but somewhat decomposed animal or plant tissue, the smell would be interpreted differently.
So next time you’re on a call, don’t be afraid to take a deep breath, and smell your patient.
References
1. Su CY, Menuz K, Carlson JR. Olfactory Perception: Receptors, Cells, and Circuits. Cell. 2009;139:45-59.
2. Bynum WE, Porter R (Eds.). (1993). Medicine and the Five Senses. New York: Cambridge University Press.
3. Anthes E. E-noses Could Make Diseases Something to Sniff at. Scientific American. 2008. Retrieved from www.scientificamerican.com/article.cfm?id=electronic-noses-could-make-diseases-something-to-sniff-at.
