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