Cyanosis resident survival guide

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.

• Carbon monoxide poisoning
• Cyanide poisoning
• Malathion
• Parathion
• Ethylene glycol
• Epiglottitis
• Foreign body aspiration
• Pulmonary embolism
• Tension pneumothorax
• Hemothorax
• Pulmonary hemorrhage
• Pulmonary hypertension
• Myocardial infarction
• Congestive heart failure
• Disseminated intravascular coagulation
• Tetralogy of fallout
• Cardiac tamponade
• Eisenmenger syndrome
• Anaphylaxis
• Birth asphyxia
• Amniotic fluid embolism

Common Causes

Cyanosis

Central cyanosis

Peripheral cyanosis

Hematologic abnormalities: ❑ 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: ❑ Beta blockers ❑ Nitrite or nitrate-containing compounds (eg, nitroglycerin) ❑ Dapsone ❑ Sulfonamides ❑ Benzocaine ❑ Chloroquine ❑ Heroin ❑ Venomous snakebites ❑ Brief resolved unexplained events (BRUE) ❑ High altitude ❑ Congenital diaphragmatic hernia ❑ Cirrhosis of liver ❑ Drowning ❑ Chocking ❑ Hanging ❑ Hypothermia

Hypoventilation:: Upper airway obstruction: ❑ Foreign body aspiration ❑ Pertussis / Croup ❑ Epiglottitis ❑ Bacterial tracheitis ❑ Traumatic disruption (thermal injury, fractures) ❑ Acute chest syndrome ❑ Congenital airway abnormalities: ❑ Choanal atresia ❑ Laryngotracheomalacia ❑ Macroglossia ❑ Micrognathia or retrognathia (eg, Pierre-Robin syndrome) Neurologic abnormalities: ❑ CNS depression ❑ Birth asphyxia ❑ Severe head trauma ❑ Apnea of prematurity ❑ Obstructive sleep apnea ❑ Infections (eg, meningitis, encephalitis) ❑ Intraventricular hemorrhage ❑ Seizures ❑ Cyanotic breath holding spells ❑ Coma Neuromuscular disorders: ❑ Myasthenia gravis ❑ Injury to the phrenic nerve ❑ Type 1 spinal muscular dystrophy (Wernig-Hoffman disease) Intrinsic lung diseases: ❑ 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): ❑ Decreased pulmonary flow: ❑ Tetralogy of fallout ❑ 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

Conditions associated with decreased concentration of inspired oxygen (FiO2): ❑ 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 ❑ Hemothorax ❑ Flail chest

Causes: ❑ 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

Treatment

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Do's

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Don'ts

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References

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