Cyanosis resident survival guide (pediatrics)

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Usman Ali Akbar, M.B.B.S.[2]

Cyanosis resident survival guide (pediatrics) Microchapters
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

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	Pulmonary Causes	Congenital Cardiac Conditions	Hematological Causes	Peripheral Cyanosis
Decreased inspired FiO2 Smoke inhalation Exposure to toxic gases	Asthma Bronchiolitis Bronchopulmonary dysplasia Cystic fibrosis Empyema Hyaline membrane disease Pneumonia	Atrioventricular canal defect Epstein anomaly Hypoplastic left heart syndrome Pulmonary atresia Pulmonic stenosis Tetralogy of Fallot Total anomalous pulmonary venous drainage Transposition of the great vessels Truncus arteriosus	Methemoglobinemia Polycythemia	Acrocyanosis Cold exposure Shock Vasomotor instability Hypothermia Arterial or venous obstruction
Upper airway obstruction Tracheitis Croup Epiglottitis Foreign body aspiration	Pulmonary vascular disorders Pulmonary edema Pulmonary embolism Pulmonary hemorrhage Pulmonary hypertension
	Other Causes Flail chest Hemothorax Open pneumothorax Pneumothorax

FIRE: Focused Initial Rapid Evaluation

Patients presenting to the emergency department with cyanosis and respiratory distress require emergency supplementation of O2, 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 present with cyanosis

No Respiratory Distress

Respiratory Distress

Peripheral Cyanosis

Central

Differential Cyanosis

No Obstruction

Obstruction

Reassurance & Warming

Hypoxia Test

Cardiac Evaulation

Hyperoxia Test

Give O2 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 O2 and positive pressure Ventilation

Complete Diagnostic Approach

Shown below is an algorithm summarizing the diagnosis of [[disease name]] according the the [...] guidelines.

Patient presents with cyanosis

History Age: Certain conditions are more common in neonates than the older children such as cyanotic heart conditions and polycythemia Presence/Absence of Fever: A history of fever shows the presence of existing infection History of Trauma : Chest wall trauma can cause central cyanosis. Exposure to toxic gases: Exposure to certain gases and smoke can cause cyanosis. Nitrates containing food can also cause methemoglobinemia. Medication Induced Cyanosis: Certain medications such as amiodarone can be a cause of cyanosis. Co-existing Pulmonary Pathology: Conditions such as asthma or bronchopulmonary dysplasia can result in cyanosis. History of Congenital Heart Disease: Central cyanosis can be caused by a number of cyanotic congenital cardiac conditions and may result in shock. History of Neurological Disease:Respiratory depression due to drug or toxin ingestion, CNS lesions, a history of seizures, breath-holding spells in infants, and neuromuscular disease should be asked and rule out while pursuing causes of cyanosis.

Pysical Examination Fever :An intrinsic pulmonary pathology such as pneumonia can cause fever and cyanosis in children. Pulmonary Examination : Pulmonary examination may elicit flaring, grunting, retractions and respiratory distress. Tachypnea is an important finding in patient with respiratory cause of cyanosis. An upper airway obstruction can cause stridor. Pulmonary edema can cause rales or crackles.Clear lung sounds may be associated with cardiac conditions which cause cyanosis. Injury to lung may present with abnormal chest wall movement, sucking chest wound, ecchymosis on chest wall, tracheal deviation, subcutaneous crepitus and abnormal breathing sounds. Cardiac Examination: Look for cardiac murmur.A loud or single second heart sound can be present in cyanotic cardiac conditions or pulmonary hypertension. Skin Examination : Cold exposure can cause peripheral vasoconstriction causing cyanosis whereas central cyanosis due to methemoglobinemia may present with gray appearing skin.

Diagnostic Studies CBC with differential : An elevated white blood cell may indicate infection. Arterial Blood Gases: Hematocrit : Chest X-ray: ECG : Methemglobinemia serum level : Differential Saturation:

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

Do's

• The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.