Jamees - Cyanosis Introduction

7/31/2019 Jamees - Cyanosis Introduction

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J A M E E S P K

CYANOSIS


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CYANOSIS

kyanos= dark blue

osis= condition


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Introduction

Definition

Types

Main causes


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definition

Bluish discolouration of skin & mucous membrane

Results from an increased quantity of reduced Hb (deoxyHb), or ofhemoglobin derivatives, in the small bloodvessels of those areas.

Apparent when the mean capillary concentrationof reduced hemoglobin > 5g/dL


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Dependent on the Absolute quantity only.

Not on the Relative quantity.


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severe anemia

the relativeamount of reduced hemoglobin in the

venous blood may be very large

the absolutequantity of reduced hemoglobin may stillbe small

So may not be visible


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polycythemia

Higher the total Hb content, greater the tendency

towards cyanosis.

patients with marked polycythemia tend to be cyanotic

at higher levels of SaO2 than patients with normalhematocrit values.


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Normal Polycythemia Anaemia


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Degree depends on

1. Thickness of skin

2. State of cutaneous capillaries3. Colour of cutaneous pigment


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Mechanism

1. - Not enough oxygen in

2.- Oxygen mal-absorption

3. - Too much oxygen out


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Not enough oxygen in

Apnea

Neurologic and Pharmacologic causes

a) Birth asphyxia

b) Intracranial hemorrhage

c) Neuromuscular disorders

d) Sedation

Diffusion barrier RDS, aspiration, pneumonia

Obstruction pneumothorax, head position


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Oxygen mal-absorption

Shunting lesions

Cardiac lesions : CCHD

Non-cardiac

Hematologic

methemoglobinemia

carboxyhemoglobinemia


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Too much oxygen out from the blood

Due to high O2 consumption

sepsis

low flow, high extraction

acrocyanosis

hyperviscosity/polycythemia

extravasated (ie bruising)


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RESPIRATORY CARDIAC NEUROLOGICAL

MARKED DYSPNOEA MILD / NO DYSPNOEA SLOW RESPIRATION

IMPROVES WITH O2 NO IMPROVEMENT

WITH O2

IMPROVES WITH

STIMULATION AND O2

RESP SIGNS CARDIAC SIGNS NEUROLOGICAL SIGNS


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TYPES

1. CENTRAL CYANOSIS

2. PERIPHERAL CYANOSIS


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Central Cyanosis

Caused by either

1. in SaO2

2. Abnormal Hb derivative

Mucous membrane & skin are affected.


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WHERE TO EXAMINE ???

Tongue

Inner aspects of lips

Mucus memb of gum and

soft palate

Tip of fingers and toes

Tip of nose, ear lobule


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CENTRAL CYANOSIS


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CAUSES OF CENTRAL CYANOSIS

Decreased arterial o2 saturation [less than

85%]

1. Decreased atm pressure at high altitudes.

2. Impaired pulmonary function

a. Alveolar hypoventilation

b. Ventilation-Perfusion mismatch

c. Impaired O2 diffusion.


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3. Anatomic shunts

a. Cyanotic Congenital Heart Diseases

b. Pulmonary Arteriovenous fistulas

c. Multiple small intrapulmonary shunts

4. Hb with low affinity for o2 (Hb K)


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Abnormal Hb derivatives

1. Methemoglobinemia (>1.5g/dL) Hereditary

Acquired : Nitrates, Nitrites, Sulphonamides

2. Sulfhemoglobinemia (>0.5g/dL)


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PERIPHERAL CYANOSIS


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Involves bluish discolouration of skin, but spare themucus membrane and tongue.

PaO2 normal


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CAUSES OF PERIPHERAL CYANOSIS

1. Reduced cardiac output

2. Cold exposure

3. Redistribution of blood flow from extremities

4. Arterial obstruction

5. Venous obstruction


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Mechanism

Causes

Cutaneous vasoconstriction

(compensatory mechanism)

Slowing of blood flow

Abnormallygreat extraction of O2 fromnormally saturated arterial blood.


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WHERE TO LOOK ???

Tip of nose

Ear lobules

Tip of fingers and toes


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CENTRAL Vs PERIPHERAL

CENTRAL PERIPHERAL

MECHANISM Rt to Lt shunt or lungdisorders

Peripheral stasis

SITE Tongue, lips, extremities Nose tip, ear lobes,

extremitiesASSOCIATION Clubbing, polycythemia

EXTREMITIES warm cold

ON WARMINGEXTREMITES

No change Disappears

O2 INHALATION Slight improvement No change

ARTERIAL BLOOD GASPaO2Low


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DIFFERENTIAL CYANOSIS

Only in lower limbs : PDA with pulmonaryhypertension with Rt to Lt shunt

Only in upper limbs : PDA with reversal of shunt &TGA


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Cyanotic Congenital Heart Diseases

Right-to-Left shunt

Two subgroups

a) With pulmonary stenosis

b) With pulmonary hypertension


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Tetralogy of Fallot (TOF)


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Severity of cyanosis depends on the severity of

pulmonary stenosis.

In ne0nates anoxic spells with cyanosis

Other symptoms

Dyspnoea on exertion

Squatting position on dyspnoeic


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Tricuspid Atresia

Congenital absence

of tricuspid valve.

ASD & VSD

Pulmonary blood

flow dependant on

the size of VSD.


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Transposition of Great Vessels

Aorta arising from the RV

Pulmonary artery arising from the LV


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Ebstein Anomaly

Abnormality in tricuspid valve

causes

Obstructive flow of blood into RV &

regurgitation from RV to RA

Decreased pulmonary blood flow

Cyanosis


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Total Anomalous Pulmonary Venous


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Total Anomalous Pulmonary VenousCongestion

Pulmonary veins join to the RA instead of LA.

Associated with ASD.


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RESPIRATORY IN NEWBORN

Hyaline membrane disease

Meconium aspiration syndrome

Persistent pulmonary hypertension

Transient tachypnoea of newborn Pneumonia

Diaphragmatic hernia

Septicaemia


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INFANTS

Transient Tachypnea of the Newborn

Respiratory Distress Syndrome

Aspiration

Meconium aspiration Blood or amniotic fluid aspiration

Pneumonia

Pneumothorax

Pleural Effusion Congenital Diaphragmatic Hernia

Persistent Pulmonary Hypertension


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Causes: Airway Disorders Choanal Atresia

Pierre-Robin Syndrome

Macroglossia

Vascular Ring or Pulmonary Sling

Neck mass (e.g. Cystic Hygroma)


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CHILDREN

Bronchiolitis Bronchospasm(e.g. Asthma)

A/c epiglottitis

Pneumonia

Lary edema

Asp pneumonitis

Pulmonary Hypertension Pulmonary embolism Hypoventilation FB aspiration

Jamees - Cyanosis Introduction

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