cyanosis latest pediatrics

1. APPROACH TO CYANOSIS
Sarath tk
116 batch

2. DEFINITION
• Cyanosis is derived from the word ‘CYAN’,which comes from ‘Kyanous’,the greek
word for blue.
• Cyanosis is the bluish discolouration of the skin and mucous membrane due
to the presence of increased amount of reduced
haemoglobin/deoxyhaemoglobin (>5g/dl)or of haemoglobin derivatives
(sulphhaemoglobin and methaemoglobin) in the capillary blood.
• Cyanosis is normally detected when the oxygen saturation is (SaO2) is <85%

3. TYPES
1.Peripheral cyanosis
2.Central cyanosis

4. PERIPHERAL CYANOSIS
• Arterial blood is normally saturated but there is oxygen unsaturation
at the venous end of capillary. may be due to sluggish peripheral
circulation
• Excessive extraction of oxygen by the peripheral tissues from the
arterial blood .

5. • SITES- Tip of nose
Ear lobules
Outer aspect of lips,cheeks and chin
• Tips of fingers and toes.
• Nail bed of fingers and toes.
• Palms and soles.
• Tongue remains unaffected

6. CAUSES
• Exposure to cold air or cold water (vasoconstriction)
• Reduced cardiac output(Congestive cardiac failure)
• Shock or peripheral circulatory failure
• Hyperviscosity syndromes(Polycythemia, Multiple myeloma)
• Mitral stenosis( Lips, tip of nose and cheeks cyanosed in mitral
facies)
• Venous obstruction (SVC syndrome)-local cyanosis
• Arterial sclerosis ( Atherosclerosis)

7. CENTRAL CYANOSIS
• Pathological condition caused by decreased arterial oxygen
saturation either due to defective oxygenation in lungs or
admixture of venous and arterial blood.
• Usually detected when the oxygen saturation of arterial
blood goes below 80 - 85%.
• it involves highly vascularized tissues through which blood
flow is at brisk.
• Cardiac output is normal and patients have warm extremities.

8. SITES
• Tongue(margins and
undersurface)
• Inner aspect of lips
• Mucous membrane of gums ,soft
palate, cheeks.
• Lower palpebral conjunctiva.
• Also the sites mentioned in
peripheral cyanosis ( both can
occur together)

9. CAUSES
• Cyanotic congenital heart diseases eg: Tetralogy of fallot
,transposition of great aorta,Total anomalous pulmonary venous
return,Truncus arteriosus,Tricuspid atresia.
• Eisenmenger’s syndrome(ASD,VSD,PDA with reversal of shunt)
• Single ventricle.
• Acute pulmonary edema ( due to left sided heart failure)-most
common cause.
• Lobar pneumonia
• Asthma

10. • COPD ,cor pulmonale
• Congenital diaphragmatic hernia.
• Birth asphyxias.
• Seizures.
• ICH
OTHERS-Polycythemia,methaemoglobinemia,metabolic
disease,infections(sepsis)

12. DIFFERENTIAL CYANOSIS
• Hands red (less blue)and feet blue seen in PDA with
reversal of shunt
• I t requires pulmonary vascular resistance elevated to
a systemic level and a patent ductus arteriosus.
• Desaturated blood from the ductus enters the aorta
distal to subclavian artery,sparing the brachiocephalic
circulation.

13. MIXED CYANOSIS
• Central and peripheral cyanosis present in a single
patient.
• Seen in -Acute MI with acute LVF
CCF due to left sided heart failure
Rarely in polycythemia

14. ENTEROGENOUS OR PIGMENT CYANOSIS
• Cyanosis due to excessive
sulphaemoglogin(>0.5g/dl)or methaemoglobin
(>1.5g/dl)in blood.
• Causes are hereditary haemoglobin M
disease,poisoning by aniline dyes ,drugs like nitrates
and nitrites(nitroglycerin,sodium nitroprusside
etc),carboxyhaemoglobinaemia (a cherry red flush in
smokers)

15. DIFFERENTIAL DIAGNOSIS OF BLUISH
DISCOLOURATION OF BODY
• Cyanosis
• Carbon monoxide poisoning.
• Argyria -silver poisoning-does not blanch on pressure
• osteogenesis imperefcta-sclera is blue due to thinness
• Drugs like amiodarone -ceruloderma

16. MANAGEMENT
• AIM:
To differentiate physiological and pathological
cyanosis
To differentiate cardiac from non cardiac causes.
Find causes which needs urgent referral or treatment.

17. • Do: Complete maternal and newborn history
Perform a full physical examination.
Investigations

27. INVESTIGATION
• PULSE OXIMETRY
• Standard methord pf monitoring infants with rds cyanosis
• Normal >=95%
• Mesurements usually not performed when child is crying or moving as it
reduces the quality of signal

28. ARTERIAL BLOOD GAS
• Arterial PO2: to confirm central cyanosis :SaO2 not as good
an indicator dueto Increase fetal Hb affinity for O2 (left-shift)
• Increase PaCO2: may indicate pulmonary or CNS disorders,
heart failure
• Decrease pH: sepsis, circulatory shock, severe hypoxemia
• Methemoglobinemia: Decrease SaO2, normal PaO2,
chocolate-brown blood

29. HYPEROXIA TEST
• Hyperoxia test is the initial method to distinguish CCHD from pulmonary
disease.
• The test consists in measuring an arterial blood gas at room air and 100%
inspired oxygen after 10 minutes.
• Neonates with congenital heart disease are usually not able to increase PaO2
above 100 mm Hg during 100% oxygen administration
• . In patients with pulmonary disease, PaO2 generally increased greater than or
equal to 100 mm Hg with 100% oxygen as ventilation-perfusion discrepancies
are overcome.
• A positive result indicates the cardiac origin and further cardiac workup is
indicated to rule out CCHD

30. BLOOD INVESTIGATIONS
• INCREASE OR DECREASE WBS INDICATES SEPSIS
• HAEMATOCRIT>65%:POLYCYTHEMIA

31. • FURTHER X RAY AND ECG HELPS CONFIRM CARDIAC OR PULMONARY
CAUSE

32. TREATMENT
• Warming of the affected area - in peripheral cyanosis
• Oxygenation and adequate ventilation.
(Partial press of oxygen normalises completely during artificial ventilation
in infant with CNS disorder)
.IV fluids- children with feeding difficulty
. If sepsis is suspected or another specific cause is not identified ,start on
broad spectrum antibiotics and then obtain a full septic screening.

33. .Drugs- Prostaglandin E1
For ductal dependant CHD- iv infusion of PGE1 to maintain patency 0.1mcg/kg/min.
. Surgery

34. THANK YOU