Cyanosis resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Chandrakala Yannam, MD [3]

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

Common Causes

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cyanosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Central cyanosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Peripheral cyanosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hematologic abnormalities: [13]

Methemoglobinemia (congenital or acquired)
Sulfhemoglobinemia (acquired)
❑ Hemoglobin mutations with low oxygen affinity:

❑ Hb Kansas
❑ Hb Beth israel
❑ Hb Saint Mande
❑ Hb Bruxells

Polycythemia vera
Disseminated intravascular coagulation
Metabolic disorders:
❑ Severe hypoglycemia
Inborn errors of metabolism
Miscellaneous:
Drugs and chemicals: [14][15]

Beta blockers
Nitrite or nitrate-containing compounds (eg, nitroglycerin)
Dapsone
Sulfonamides
Benzocaine
Chloroquine
Heroin

❑ Venomous snakebites [16] ❑ Brief resolved unexplained events (BRUE) [17]
High altitude [18]
Congenital diaphragmatic hernia
Cirrhosis of liver
Drowning
❑ Chocking
❑ Hanging

Hypothermia
 
 
 
 
 
Hypoventilation::
Upper airway obstruction: [19][3]

Foreign body aspiration
Pertussis / Croup
Epiglottitis
Bacterial tracheitis
❑ Traumatic disruption (thermal injury, fractures)
Acute chest syndrome [20] ❑ Congenital airway abnormalities:

Choanal atresia
Laryngotracheomalacia
Macroglossia
Micrognathia or retrognathia (eg, Pierre-Robin syndrome)

Neurologic abnormalities: [21][22][23]
CNS depression
Birth asphyxia
❑ Severe head trauma
Apnea of prematurity
Obstructive sleep apnea
❑ Infections (eg, meningitis, encephalitis)
Intraventricular hemorrhage
Seizures
❑ Cyanotic breath holding spells [24]
Coma
Neuromuscular disorders:
Myasthenia gravis
❑ Injury to the phrenic nerve
❑ Type 1 spinal muscular dystrophy (Wernig-Hoffman disease)
Intrinsic lung diseases:[25][26][27][28][29]
Asthma
COPD
Pneumonia
Bronchiolitis
Respiratory distress syndrome (Hyaline membrane disease)
Empyema
Pleural effusion
Cystic fibrosis
Atelectasis
Bronchopulmonary dysplasia

Alveolar capillary dysplasia
 
 
 
 
 
Vascular causes:

Cardiac tamponade
Cyanotic congenital heart diseases (Right to left shunts): [30][31][8]

Decreased pulmonary flow:
Tetralogy of fallout [8]
❑ Tricuspid valve anomalies:
Tricuspid atresia
Tricuspid stenosis
Ebstein's anomaly
Pulmonary stenosis (critical valvular)
Pulmonary atresia with intact ventricular septum
Increased pulmonary flow:
TGA (Transposition of great arteries, most common dextro type)
Truncus arteriosus
TAPVC (Total anamalous pulmonary venous connection)
Heart failure: Condition that present with cyanosis and severe heart failure include:
❑ Left sided obstructive lesion (HLHS)
Coarctation of aorta
❑ Critical valvular aortic stenosis

Eisenmenger syndrome
Congestive heart failure
Atrial septal defect
Pulmonary hypertension
Pulmonary edema
Pulmonary hemorrhage
Pulmonary embolism
❑ Pulmonary arteriovenous malformations
❑ Multiple small intrapulmonary shunts
Shock
Sepsis

Amniotic fluid embolism [12]
 
 
 
 
 
Conditions associated with decreased concentration of inspired oxygen (FiO2): [32]

Smoke inhalation most commonly from house fires
Carbon monoxide poisoning
❑ Hydrogen cyanide poisoning
❑ Intentional or unintensional exposure to asphyxiating gases (eg, Propane, methane, butane, hydrogen sulphide)
Impairment of chest wall or lung expansion:
❑ External compression
Pneumothorax [33]
Hemothorax

Flail chest
 
 
 
Causes: [34][35]

Cold exposure
Acrocyanosis
Erythrocyanosis
Raynaud's phenomenon
Raynaud's disease
❑ Arterial obstruction:

Peripheral vascular disease
Buergers disease

❑ Venous obstruction:

Thromboembolism
Deep vein thrombosis
Superior vena cava syndrome

❑ Decreased cardiac output:

Left sided heart failure
Shock
Hypovolemia
❑ Redistribution of blood flow from extremities
 
 
 
 
 
Pseudocyanosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Metals
 
 
 
 
Extensive tattoos
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Drugs
 
 
 
 
Pigmentary lesions
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consumption of dyed food
 
 
 
 
 
 
 
 
 
 
 
 

Diagnosis

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Do's

  • The content in this section is in bullet points.

Don'ts

  • The content in this section is in bullet points.

References

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  2. Parker-Cote JL, Rizer J, Vakkalanka JP, Rege SV, Holstege CP (February 2018). "Challenges in the diagnosis of acute cyanide poisoning". Clin Toxicol (Phila): 1–9. doi:10.1080/15563650.2018.1435886. PMID 29417853.
  3. 3.0 3.1 Zoorob RJ, Campbell JS (November 2003). "Acute dyspnea in the office". Am Fam Physician. 68 (9): 1803–10. PMID 14620600.
  4. Just-Viera JO, Norwood T, Yeager GH (April 1967). "Importance of shock and cyanosis in pulmonary embolism". Ann. Surg. 165 (4): 528–35. PMC 1617449. PMID 6021453.
  5. Barton ED (July 1999). "Tension pneumothorax". Curr Opin Pulm Med. 5 (4): 269–74. PMID 10407699.
  6. Wang RF, Hung TY, Chong CF, Wang TL, Chen CC (February 2008). "Central cyanosis due to severe pulmonary hypertension combined with pericarditis as the initial manifestation of systemic lupus erythematosus". Am J Emerg Med. 26 (2): 248.e1–2. doi:10.1016/j.ajem.2007.04.007. PMID 18272123.
  7. Costello RA, Nehring SM. PMID 28722864. Missing or empty |title= (help)
  8. 8.0 8.1 8.2 Bailliard F, Anderson RH (January 2009). "Tetralogy of Fallot". Orphanet J Rare Dis. 4: 2. doi:10.1186/1750-1172-4-2. PMC 2651859. PMID 19144126.
  9. Bodson L, Bouferrache K, Vieillard-Baron A (October 2011). "Cardiac tamponade". Curr Opin Crit Care. 17 (5): 416–24. doi:10.1097/MCC.0b013e3283491f27. PMID 21716107.
  10. Komine S (February 1964). "In vitro studies on the degradation and synthesis of serum proteins in placentae. I. Synthesis of serum proteins". Nippon Juigaku Zasshi. 26 (1): 15–23. PMID 4173631.
  11. Steinhorn RH (September 2008). "Evaluation and management of the cyanotic neonate". Clin Pediatr Emerg Med. 9 (3): 169–175. doi:10.1016/j.cpem.2008.06.006. PMC 2598396. PMID 19727322.
  12. 12.0 12.1 Kaur K, Bhardwaj M, Kumar P, Singhal S, Singh T, Hooda S (2016). "Amniotic fluid embolism". J Anaesthesiol Clin Pharmacol. 32 (2): 153–9. doi:10.4103/0970-9185.173356. PMC 4874066. PMID 27275041.
  13. Martínez de Zabarte Fernández JM, García Íñiguez JP, Domínguez Cajal M (February 2018). "Metahemoglobinemia in infants over one year". Med Clin (Barc). doi:10.1016/j.medcli.2017.12.009. PMID 29439874.
  14. Günal E, Akkuş Y, Çığşar G, Çiftçi H, Kahramanca Ş, Özdemir M (October 2017). "Methemoglobinemia incidence after the application of lidocaine for small surgical procedures". Agri. 29 (4): 173–176. PMID 29171648.
  15. Hilbert P, Zur Nieden K (September 2004). "[Suicidal fatal beta-blocker intoxication]". Anaesthesist (in German). 53 (9): 826–9. doi:10.1007/s00101-004-0721-1. PMID 15249969.
  16. Hifumi T, Sakai A, Kondo Y, Yamamoto A, Morine N, Ato M, Shibayama K, Umezawa K, Kiriu N, Kato H, Koido Y, Inoue J, Kawakita K, Kuroda Y (2015). "Venomous snake bites: clinical diagnosis and treatment". J Intensive Care. 3 (1): 16. doi:10.1186/s40560-015-0081-8. PMC 4393627. PMID 25866646.
  17. Kondamudi NP, Virji M. PMID 28722926. Missing or empty |title= (help)
  18. Jensen JD, Vincent AL. PMID 28613569. Missing or empty |title= (help)
  19. Gossman WG, Burns B. PMID 29261942. Missing or empty |title= (help)
  20. Jain S, Bakshi N, Krishnamurti L (December 2017). "Acute Chest Syndrome in Children with Sickle Cell Disease". Pediatr Allergy Immunol Pulmonol. 30 (4): 191–201. doi:10.1089/ped.2017.0814. PMC 5733742. PMID 29279787.
  21. Kondamudi NP, Dulebohn SC. PMID 28722923. Missing or empty |title= (help)
  22. Kondamudi NP, Wilt AS. PMID 28722998. Missing or empty |title= (help)
  23. Memon J, Manganaro SN. PMID 28722938. Missing or empty |title= (help)
  24. Bergeron M, Cohen AP, Cotton RT (2017). "The Management of Cyanotic Spells in Children with Oesophageal Atresia". Front Pediatr. 5: 106. doi:10.3389/fped.2017.00106. PMC 5430373. PMID 28555179.
  25. Maitre B, Similowski T, Derenne JP (September 1995). "Physical examination of the adult patient with respiratory diseases: inspection and palpation". Eur. Respir. J. 8 (9): 1584–93. PMID 8575588.
  26. Hermansen CL, Mahajan A (December 2015). "Newborn Respiratory Distress". Am Fam Physician. 92 (11): 994–1002. PMID 26760414.
  27. Bishop NB, Stankiewicz P, Steinhorn RH (July 2011). "Alveolar capillary dysplasia". Am. J. Respir. Crit. Care Med. 184 (2): 172–9. doi:10.1164/rccm.201010-1697CI. PMC 3172887. PMID 21471096.
  28. Justice NA, Le JK. PMID 28722988. Missing or empty |title= (help)
  29. Reuter S, Moser C, Baack M (October 2014). "Respiratory distress in the newborn". Pediatr Rev. 35 (10): 417–28, quiz 429. doi:10.1542/pir.35-10-417. PMC 4533247. PMID 25274969.
  30. Woods WA, McCulloch MA (November 2005). "Cardiovascular emergencies in the pediatric patient". Emerg. Med. Clin. North Am. 23 (4): 1233–49. doi:10.1016/j.emc.2005.07.003. PMID 16199347.
  31. Driscoll DJ (February 1990). "Evaluation of the cyanotic newborn". Pediatr. Clin. North Am. 37 (1): 1–23. PMID 2407997.
  32. Dueñas-Laita A, Burillo Putze G, Alonso JR, Bajo A, Climent B, Corral E, Felices F, Ferrer A, Hernández Frutos MP, Nogué S, Puiguriguer J (December 2010). "[Basis for the clinical management of fire smoke poisoning "Docohumo Madrid 2010"]". Med Intensiva (in Spanish; Castilian). 34 (9): 609–19. doi:10.1016/j.medin.2010.07.007. PMID 21051109.
  33. Costumbrado J, Ghassemzadeh S. PMID 29083723. Missing or empty |title= (help)
  34. Fardoun MM, Nassif J, Issa K, Baydoun E, Eid AH (2016). "Raynaud's Phenomenon: A Brief Review of the Underlying Mechanisms". Front Pharmacol. 7: 438. doi:10.3389/fphar.2016.00438. PMC 5110514. PMID 27899893.
  35. Das S, Maiti A (November 2013). "Acrocyanosis: an overview". Indian J Dermatol. 58 (6): 417–20. doi:10.4103/0019-5154.119946. PMC 3827510. PMID 24249890.