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Approach to a child with cyanosis

RUBA FARSHA

kyanos = dark blue osis = condition

It

is the bluish discoloration of skin and

mucous membrane, which results from an increased concentration of reduced Hb,

or Hb derivatives in the small blood vessels


in that area

Its

apparent when the mean capillary

concentration of reduced hemoglobin >5g/dL

Pathogenesis

Inadequate

O2 delivery to tissues

reduced Hb in the capillary blood

cyanosis

Mechanisms
Hypoventilation Ventilation Diffusion

perfusion unevenness

impairment

Right

to left shunts
transport of O2 by Hb

Inadequate

Types of cyanosis
CENTRAL PERIPHERAL

Hypoxic hypoxia

Stagnant hypoxia

Central cyanosis

Causes

Cardiac

Respiratory

Neurological

Misc

Cardiac causes
Cyanotic heart disease Others

PBF (TGA)

PBF (TOF)

Persistant pulm HTN Lt vent outlet obstrctn

Truncus arteriosus (1 vessel)

Transposition of great arteries (2

vessels)
3 4 5

Tricuspid atresia (tri=3) Tetralogy of fallot (tetra = 4) Total anomalous pulm venous

circulation (5 words)

Respiratory causes

Airway obstr

Parenchymal dis
RDS/MAS

Ext compresn
Pneumothorax

Choanal atresia

A/c epiglottitis
Lary edema

Pneumonia
Asp pnemonitis

CDH
LNE

Neurological causes
CNS

lesions hemorrhage, cerebral

edema, infections
Paralysis

of resp muscles polio, GBS

Vocal

cord paralysis

Sedation

RESPIRATORY CAUSE

CARDIAC CAUSE

NEUROLOGICAL CAUSE

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

Miscellaneous

Methemoglobinemia Sulfhemoglobinemia Polycythemia

High altitude
Medications amiodarone Hypoglycemia

Sites examined
Tongue Inner

aspects of lips memb of gum and soft palate

Mucus

Tip
Tip

of fingers and toes


of nose, ear lobule

Peripheral cyanosis

Causes

Low CO
Shock LVF

Stagnation of bld
Polycythemia

Others
Cold exposure

Arterial/venous obst

Sites examined
Tip Ear Tip

of nose lobules of fingers and toes

CENTRAL

PERIPHERAL

Etiology Sites Application of 100% O2 Hand shake

Hypoxic hypoxia Tongue, lips, extremities Improves Warm

Stagnant hypoxia Extremities No change Cold Improves Absent

Application of warmth No change Clubbing Present

Dyspnoea

Present

Absent

Differential cyanosis
Hands PDA

red and feet blue

with reversal of shunt due to pulm

HTN

Reverse differential cyanosis


Hands

blue and feet red of aorta with TGA

Coarctation

Local cyanosis

Peripheral cyanosis seen in newborns

Shoulder presentation, arm will be cyanosed

Acrocyanosis

Cyanosis extremities in new born when unwrapped

Can

be seen in children who are well also

Enterogenous cyanosis
Also

called pigment cyanosis cyanosis is produced due to excess

When

of

MetHb (> 1.5 g/dl), or


SulfHb (> 0.5 g/dl)

Cyanotic spells
Also

called tet spell or hypercyanotic onset, progressive cyanosis with

spell
Sudden

hyperpnoea ( rate and depth of breathing)


Seen

in typical cases of TOF

8 steps of treatment
Knee

chest position oxygen

Humidified Morphine

0.1 to 0.2 mg/kg, s/c

Propranolol

0.1 mg/kg (during spell); 0.5-1

mg/kg/6 hrly orally (if not)

If

acidosis present, sod bicarbonate 1-3

ml/kg IV
Vasopressors:

methoxamine IM/IV

Correct

anemia
surgery

Consider