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Cyanosis
Dr. Girish jain (1st
yr PG)
Department :- Respiratory Medicine
Mahatma Gandhi Medical College and Hospital
Contents
• Introduction
• Mechanism
• Central, Peripheral and Differential cyanosis
• Factors affecting the detection of c...
Introduction
Bluish discoloration of the tissues and mucous
membrane that results -
• when the absolute level of reduced h...
Mechanism of cyanosis
• Alveolar hypoventilation
• Diffusion impairment
• Ventilation-perfusion mismatch
• Right-to-left s...
central cyanosis Perpheral cyanosis
Area generalize localize
Tongue involve Not involve
Hand shake Feel warm Feel cold
clu...
Central cyanosis
• Pathologic condition caused by reduced
arterial oxygen saturation (SO2).
• Involves highly vascularized...
Central cyanosis
Peripheral cyanosis
• Normal systemic arterial oxygen saturation and
increased oxygen extraction from peripheral blood,
re...
Peripheral cyanosis
Differential cyanosis
• When cyanosis is present only in the toes but not in
the fingers, it is called Differential cyanos...
ETIOLOGY
Pulmonary causes
1. Alveolar hypoventilation
A. Central nervous system depression: asphyxia,
maternal sedation, intraventr...
2. Ventilation/perfusion mismatch
A. Airway disease: pneumonia, aspiration, cystic
adenomatoid malformation, diaphragmatic...
3. Diffusion impairment
A. Pulmonary edema: left-sided obstructive cardiac
disease, cardiomyopathy
B. Pulmonary fibrosis
C...
Cardiac causes
1. Decreased pulmonary blood flow-
A. Tetralogy of Fallot
B. Tricuspid valve anomaly
C. Pulmonary valve atr...
3. Severe heart failure-
A. Hypoplastic left heart syndrome
B. Coarctation of the aorta
C. Interrupted aortic arch
D. Crit...
Hemoglobinopathy :
. Methemoglobinemia: congenital or
secondary to toxic exposure >1.5gm/dl
.sulphaemoglobinemia: secondar...
Factors affecting the detection of
cyanosis
1. Hemoglobin concentration -
– Detected at higher levels of saturation in
pol...
2. Fetal hemoglobin —
. Binds oxygen more avidly than adult
hemoglobin.
. The oxygen dissociation curve is shifted to
the ...
3. Skin pigmentation -
. Less apparent in the skin of patients with darker
pigmentation.
. Examination should include the ...
Investigation
• Hematocrit or hemoglobin
• Sepsis screening
• Blood glucose concentration
• Arterial blood gases (Pao2, Pa...
Treatment of cyanosis
• It is a symptom of an underlying condition rather
than being a disease in itself.
• Treatment of c...
2. Oxygenation as a treatment for cyanosis-
Initial stabilization requires oxygenation. Sometimes
a breathing machine or v...
THANK YOU
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Cyanosis ppt by dr girish jain

  1. 1. Cyanosis Dr. Girish jain (1st yr PG) Department :- Respiratory Medicine Mahatma Gandhi Medical College and Hospital
  2. 2. Contents • Introduction • Mechanism • Central, Peripheral and Differential cyanosis • Factors affecting the detection of cyanosis • Etiology • Principles of Treatment
  3. 3. Introduction Bluish discoloration of the tissues and mucous membrane that results - • when the absolute level of reduced hemoglobin (Deoxyhemoglobin) in the capillary bed exceeds 5g/DL. or • increased concentration of abnormal Hemoglobine derivatives (eg. Methemoglobinemia, sulphaemoglobinemia) in the superficial blood vessels.
  4. 4. Mechanism of cyanosis • Alveolar hypoventilation • Diffusion impairment • Ventilation-perfusion mismatch • Right-to-left shunting at the intracardiac, great vessel, or intrapulmonary level • Hemoglobinopathy (including methemoglobinemia, sulphaemoglobinemia) that limits oxygen transport
  5. 5. central cyanosis Perpheral cyanosis Area generalize localize Tongue involve Not involve Hand shake Feel warm Feel cold clubbing Usually present Not present On O2 application Pulmonary cause improved Not improved Application of warming Not improved improved Mechanism Diminution of oxygen saturation Diminution of blood flow Capillary refill time <2 sec >2 sec
  6. 6. Central cyanosis • Pathologic condition caused by reduced arterial oxygen saturation (SO2). • Involves highly vascularized tissues, such as the lips, tongue and mucous membranes, through which blood flow is brisk and the arteriovenous difference is minimal. • Cardiac output typically is normal, and patients have warm extremities.
  7. 7. Central cyanosis
  8. 8. Peripheral cyanosis • Normal systemic arterial oxygen saturation and increased oxygen extraction from peripheral blood, resulting in a wide systemic arteriovenous oxygen difference • The increased extraction of oxygen results from sluggish movement of blood through the capillary circulation. • Affects the distal extremities, and circumoral or periorbital areas .
  9. 9. Peripheral cyanosis
  10. 10. Differential cyanosis • When cyanosis is present only in the toes but not in the fingers, it is called Differential cyanosis. It is seen in PDA.
  11. 11. ETIOLOGY
  12. 12. Pulmonary causes 1. Alveolar hypoventilation A. Central nervous system depression: asphyxia, maternal sedation, intraventricular hemorrhage, seizure, meningitis, encephalitis B. Neuromuscular disease: myasthenia gravis, phrenic nerve injury C. Airway obstruction: choanal atresia, laryngotracheomalacia, macroglossia,
  13. 13. 2. Ventilation/perfusion mismatch A. Airway disease: pneumonia, aspiration, cystic adenomatoid malformation, diaphragmatic hernia, pulmonary hypoplasia, lobar emphysema, atelectasis, pulmonary hemorrhage, hyaline membrane disease, transient tachypnea of the newborn B. Extrinsic compression of lungs: pneumothorax, pleural effusion, chylothorax, hemothorax, thoracic dystrophy
  14. 14. 3. Diffusion impairment A. Pulmonary edema: left-sided obstructive cardiac disease, cardiomyopathy B. Pulmonary fibrosis C. Congenital lymphangiectasia
  15. 15. Cardiac causes 1. Decreased pulmonary blood flow- A. Tetralogy of Fallot B. Tricuspid valve anomaly C. Pulmonary valve atresia D. Critical valvular pulmonary steanosis 2. Increased pulmonary blood flow- A. Transposition of great arteries B. Truncus arteriosus C. Total anomalous pulmonary venous connection
  16. 16. 3. Severe heart failure- A. Hypoplastic left heart syndrome B. Coarctation of the aorta C. Interrupted aortic arch D. Critical valvular aortic steanosis
  17. 17. Hemoglobinopathy : . Methemoglobinemia: congenital or secondary to toxic exposure >1.5gm/dl .sulphaemoglobinemia: secondary to toxic exposure >0.5gm/dl .
  18. 18. Factors affecting the detection of cyanosis 1. Hemoglobin concentration - – Detected at higher levels of saturation in polycythemic than in anemic patients. – Significant oxygen desaturation can be present in an anemic patient without clinically detectable cyanosis.
  19. 19. 2. Fetal hemoglobin — . Binds oxygen more avidly than adult hemoglobin. . The oxygen dissociation curve is shifted to the left, so that for a given level of oxygen tension (PO2), the oxygen saturation (SO2) is higher in the newborn than older infants or adults . It explains that for a given level of oxygen saturation(SO2), the PO2 is lower in newborns. . As a result, cyanosis is detected at a lower PO2 in newborns compared with older patients.
  20. 20. 3. Skin pigmentation - . Less apparent in the skin of patients with darker pigmentation. . Examination should include the nail beds, tongue, and mucous membranes, which are less affected by pigmentation.
  21. 21. Investigation • Hematocrit or hemoglobin • Sepsis screening • Blood glucose concentration • Arterial blood gases (Pao2, Paco2, pH) • Blood cultures • Electrocardiography • Echocardiography, cardiac catheterisation, angiocardiography • Hemoglobin electrophoresis- Hb M
  22. 22. Treatment of cyanosis • It is a symptom of an underlying condition rather than being a disease in itself. • Treatment of cyanosis thus focus on the Treatment of underlying disease rather than the symptom alone. • Symptomatic treatment of cyanosis - 1. Warming of the affected areas- Peripheral cyanosis brought about by exposure to cold or Raynaud’s phenomenon and acrocyanosis may be treated symptomatically using gentle warming of the fingers and toes.
  23. 23. 2. Oxygenation as a treatment for cyanosis- Initial stabilization requires oxygenation. Sometimes a breathing machine or ventilator might be required. 3.Intravenous fluids- Children who have difficulty in feeding due to cyanosis and heart failure due to an underlying cyanotic heart disease need to be administered intravenous fluids.
  24. 24. THANK YOU
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