Cyanosis resident survival guide (pediatrics)
Synonyms and keywords: Cyanosis approach in children, Cyanosis workup pediatrics, Cyanosis management in newborn, Approach to blue discoloration of skin in infants, Hypoxemia approach in children, Hypoxia approach in children
|Cyanosis resident survival guide (pediatrics) Microchapters|
Cyanosis can be defined as bluish discoloration of skin and mucosa and can also be a manifestation of oxygen desaturation of arterial or capillary blood. Cyanosis, hypoxemia, and hypoxia should be differentiated and can occur independently. The causes of cyanosis in a newborn range from congenital cardiac conditions to life-threatening conditions such as exposure to toxic gases or infections leading to sepsis. The management of cyanosis depends upon the etiology and emergent cases with respiratory distress need rapid evaluation and response with immediate establishment of airway access and oxygen support.
|Life-Threatening Causes||Pulmonary Causes||Congenital Cardiac Conditions||Hematological Causes||Peripheral Cyanosis|
|Decreased inspired FiO2|
|Upper airway obstruction||
Pulmonary vascular disorders
FIRE: Focused Initial Rapid Evaluation
- Patients presenting to the emergency department with cyanosis and respiratory distress require emergency supplementation of oxygen, use of pulse oximetry and airway, breathing, and circulation support.
- A Focused Initial Rapid Evaluation (FIRE) should be performed to identify the patients in need of immediate intervention.
|Patient presents with cyanosis|
|No Respiratory Distress||Respiratory Distress|
|Peripheral Cyanosis||Central cyanosis||Differential Cyanosis||No Obstruction||Obstruction|
|Reassurance and Warming||Hypoxia Test||Cardiac Evaulation||Hypoxia Test||Give oxygen and Positive Pressure Ventilation|
|PaO2<100||PaO2 100-150||PaO2 <100||PaO2 100-150||PaO2 >150||ENT Evaluation|
|Cardiac Evaluation||Persistent pulmonary hypertension of newborn, Cardiac Evaluation||Cardiac Cause||Persistent pulmonary hypertension of newborn||Respiratory management, Give oxygen and positive pressure Ventilation|
Complete Diagnostic Approach
- Shown below is an algorithm summarizing the diagnosis of cyanosis in newborns according to the American Academy of Neonatology guidelines:
|Patient presents with cyanosis|
|Physical Examination |
|Diagnostic Studies |
- Hypoplastic left heart syndrome in infants should be considered with signs and symptoms such as:
- In Ebstein anomaly, repair of tricuspid valve is indicated if the following criteria is met:
- In differential cyanosis, if oxygen saturation of right arm is more than that of legs and improves with oxygen supplemental therapy, then think about the following:
- In the presence of central cyanosis + hemolytic anemia (jaundice, heinz body, fragment RBC) + renal failure, consider diagnosis of methemoglobinemia and treat accordingly.
- Hydration is important in tetralogy of fallot to maintain pulmonary blood flow through atretic pulmonary artery and reducing right to left shunt through VSD.
- If paradoxical embolism is suspected, proceed with a Brain CT scan in the presence of new neurological symptoms in a patient with cyanotic congenital heart disease. It occurs due to passing of emboli from right to left shunt and hyperviscosity ultimately leading to thrombosis.
- There are certain cyanotic congenital heart diseases that are dependent on patent ductus arteriosus (PDA). Don't give indomethacin to patients with the following ductal dependent congenital conditions:
- McMullen, SM; Patrick, W (2013). "Cyanosis". The American journal of medicine. 126 (3): 210–2. doi:10.1016/j.amjmed.2012.11.004. ISSN 0002-9343. PMID 23410559.
- Sasidharan, Ponthenkandath (2004). "An approach to diagnosis and management of cyanosis and tachypnea in term infants". Pediatric clinics of North America. Elsevier BV. 51 (4): 999–1021. doi:10.1016/j.pcl.2004.03.010. ISSN 0031-3955. PMID 15275985.
- Dasgupta, Soham; Bhargava, Vidit; Huff, Monica; Jiwani, Amyn K.; Aly, Ashraf M. (2016-09-30). "Evaluation of The Cyanotic Newborn: Part I—A Neonatologist's Perspective". NeoReviews. American Academy of Pediatrics (AAP). 17 (10): e598–e604. doi:10.1542/neo.17-10-e598. ISSN 1526-9906.
- "Congenital Heart Disease". NCBI Bookshelf. 2010-07-22. Retrieved 2020-10-13.
- Rao, P. Syamasundar (2013). "Consensus on Timing of Intervention for Common Congenital Heart Diseases: Part II - Cyanotic Heart Defects". The Indian Journal of Pediatrics. 80 (8): 663–674. doi:10.1007/s12098-013-1039-2. ISSN 0019-5456.
- Holst KA, Connolly HM, Dearani JA (2019). "Ebstein's Anomaly". Methodist Debakey Cardiovasc J. 15 (2): 138–144. doi:10.14797/mdcj-15-2-138. PMC 6668741 Check
|pmc=value (help). PMID 31384377.
- de Campos F, Benvenuti LA (2017). "Eisenmenger syndrome". Autops Case Rep. 7 (1): 5–7. doi:10.4322/acr.2017.006. PMC 5436914. PMID 28536680. Vancouver style error: initials (help)
- Gobergs R, Salputra E, Lubaua I (2016). "Hypoplastic left heart syndrome: a review". Acta Med Litu. 23 (2): 86–98. doi:10.6001/actamedica.v23i2.3325. PMC 5088741. PMID 28356795.
- O’Brien, Patricia; Marshall, Audrey C. (2014). "Tetralogy of Fallot". Circulation. 130 (4). doi:10.1161/CIRCULATIONAHA.113.005547. ISSN 0009-7322.
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