Cyanosis resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]

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.

Common Causes

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cyanosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Central cyanosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Peripheral cyanosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hematologic abnormalities: [1]

❑ 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: [2][3]

❑ Beta blockers
❑ Nitrite or nitrate-containing compounds (eg, nitroglycerin)
❑ Dapsone
❑ Sulfonamides
❑ Benzocaine
❑ Chloroquine
❑ Heroin

❑ Venomous snakebites [4] ❑ Brief resolved unexplained events (BRUE) [5]
❑ High altitude [6]
❑ Congenital diaphragmatic hernia
❑ Cirrhosis of liver
❑ Drowning
❑ Chocking
❑ Hanging

❑ Hypothermia
 
 
 
 
 
Hypoventilation::
Upper airway obstruction: [7][8]

❑ Foreign body aspiration
❑ Pertussis / Croup
❑ Epiglottitis
❑ Bacterial tracheitis
❑ Traumatic disruption (thermal injury, fractures)
❑ Acute chest syndrome [9] ❑ Congenital airway abnormalities:

❑ Choanal atresia
❑ Laryngotracheomalacia
❑ Macroglossia
❑ Micrognathia or retrognathia (eg, Pierre-Robin syndrome)

Neurologic abnormalities: [10][11][12]
❑ CNS depression
❑ Birth asphyxia
❑ Severe head trauma
❑ Apnea of prematurity
❑ Obstructive sleep apnea
❑ Infections (eg, meningitis, encephalitis)
❑ Intraventricular hemorrhage
❑ Seizures
❑ Cyanotic breath holding spells [13]
❑ Coma
Neuromuscular disorders:
❑ Myasthenia gravis
❑ Injury to the phrenic nerve
❑ Type 1 spinal muscular dystrophy (Wernig-Hoffman disease)
Intrinsic lung diseases:[14][15][16][17][18]
❑ 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): [19][20][21]

❑ Decreased pulmonary flow:
❑ Tetralogy of fallout [21]
❑ 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 [22]
 
 
 
 
 
Conditions associated with decreased concentration of inspired oxygen (FiO2): [23]

❑ 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 [24]
❑ Hemothorax

❑ Flail chest
 
 
 
Causes: [25][26]

❑ 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
 
 
 
 
 
 
 
 
 
 
 
 

Diagnosis

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

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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.

References

  1. ↑ Martínez de Zabarte Fernández JM, García Íñiguez JP, Domínguez Cajal M (February 2018). "Metahemoglobinemia in infants over one year". Med Clin (Barc). doi:10.1016/j.medcli.2017.12.009. PMID 29439874.
  2. ↑ Günal E, Akkuş Y, Çığşar G, Çiftçi H, Kahramanca Ş, Özdemir M (October 2017). "Methemoglobinemia incidence after the application of lidocaine for small surgical procedures". Agri. 29 (4): 173–176. PMID 29171648.
  3. ↑ Hilbert P, Zur Nieden K (September 2004). "[Suicidal fatal beta-blocker intoxication]". Anaesthesist (in German). 53 (9): 826–9. doi:10.1007/s00101-004-0721-1. PMID 15249969.
  4. ↑ Hifumi T, Sakai A, Kondo Y, Yamamoto A, Morine N, Ato M, Shibayama K, Umezawa K, Kiriu N, Kato H, Koido Y, Inoue J, Kawakita K, Kuroda Y (2015). "Venomous snake bites: clinical diagnosis and treatment". J Intensive Care. 3 (1): 16. doi:10.1186/s40560-015-0081-8. PMC 4393627. PMID 25866646.
  5. ↑ Kondamudi NP, Virji M. PMID 28722926. Missing or empty |title= (help)
  6. ↑ Jensen JD, Vincent AL. PMID 28613569. Missing or empty |title= (help)
  7. ↑ Gossman WG, Burns B. PMID 29261942. Missing or empty |title= (help)
  8. ↑ Zoorob RJ, Campbell JS (November 2003). "Acute dyspnea in the office". Am Fam Physician. 68 (9): 1803–10. PMID 14620600.
  9. ↑ Jain S, Bakshi N, Krishnamurti L (December 2017). "Acute Chest Syndrome in Children with Sickle Cell Disease". Pediatr Allergy Immunol Pulmonol. 30 (4): 191–201. doi:10.1089/ped.2017.0814. PMC 5733742. PMID 29279787.
  10. ↑ Kondamudi NP, Dulebohn SC. PMID 28722923. Missing or empty |title= (help)
  11. ↑ Kondamudi NP, Wilt AS. PMID 28722998. Missing or empty |title= (help)
  12. ↑ Memon J, Manganaro SN. PMID 28722938. Missing or empty |title= (help)
  13. ↑ Bergeron M, Cohen AP, Cotton RT (2017). "The Management of Cyanotic Spells in Children with Oesophageal Atresia". Front Pediatr. 5: 106. doi:10.3389/fped.2017.00106. PMC 5430373. PMID 28555179.
  14. ↑ Maitre B, Similowski T, Derenne JP (September 1995). "Physical examination of the adult patient with respiratory diseases: inspection and palpation". Eur. Respir. J. 8 (9): 1584–93. PMID 8575588.
  15. ↑ Hermansen CL, Mahajan A (December 2015). "Newborn Respiratory Distress". Am Fam Physician. 92 (11): 994–1002. PMID 26760414.
  16. ↑ Bishop NB, Stankiewicz P, Steinhorn RH (July 2011). "Alveolar capillary dysplasia". Am. J. Respir. Crit. Care Med. 184 (2): 172–9. doi:10.1164/rccm.201010-1697CI. PMC 3172887. PMID 21471096.
  17. ↑ Justice NA, Le JK. PMID 28722988. Missing or empty |title= (help)
  18. ↑ Reuter S, Moser C, Baack M (October 2014). "Respiratory distress in the newborn". Pediatr Rev. 35 (10): 417–28, quiz 429. doi:10.1542/pir.35-10-417. PMC 4533247. PMID 25274969.
  19. ↑ Woods WA, McCulloch MA (November 2005). "Cardiovascular emergencies in the pediatric patient". Emerg. Med. Clin. North Am. 23 (4): 1233–49. doi:10.1016/j.emc.2005.07.003. PMID 16199347.
  20. ↑ Driscoll DJ (February 1990). "Evaluation of the cyanotic newborn". Pediatr. Clin. North Am. 37 (1): 1–23. PMID 2407997.
  21. ↑ 21.0 21.1 Bailliard F, Anderson RH (January 2009). "Tetralogy of Fallot". Orphanet J Rare Dis. 4: 2. doi:10.1186/1750-1172-4-2. PMC 2651859. PMID 19144126.
  22. ↑ Kaur K, Bhardwaj M, Kumar P, Singhal S, Singh T, Hooda S (2016). "Amniotic fluid embolism". J Anaesthesiol Clin Pharmacol. 32 (2): 153–9. doi:10.4103/0970-9185.173356. PMC 4874066. PMID 27275041.
  23. ↑ Dueñas-Laita A, Burillo Putze G, Alonso JR, Bajo A, Climent B, Corral E, Felices F, Ferrer A, Hernández Frutos MP, Nogué S, Puiguriguer J (December 2010). "[Basis for the clinical management of fire smoke poisoning "Docohumo Madrid 2010"]". Med Intensiva (in Spanish; Castilian). 34 (9): 609–19. doi:10.1016/j.medin.2010.07.007. PMID 21051109.
  24. ↑ Costumbrado J, Ghassemzadeh S. PMID 29083723. Missing or empty |title= (help)
  25. ↑ Fardoun MM, Nassif J, Issa K, Baydoun E, Eid AH (2016). "Raynaud's Phenomenon: A Brief Review of the Underlying Mechanisms". Front Pharmacol. 7: 438. doi:10.3389/fphar.2016.00438. PMC 5110514. PMID 27899893.
  26. ↑ Das S, Maiti A (November 2013). "Acrocyanosis: an overview". Indian J Dermatol. 58 (6): 417–20. doi:10.4103/0019-5154.119946. PMC 3827510. PMID 24249890.


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