CYANOSIS in Pediatrics Approach to Diagnosis For 5

CYANOSIS in Pediatrics Approach to Diagnosis For 5 th year Medical Students Norah A. A. Khathlan M. D. Consultant Pediatric Intensivist 11/2006 Approach to diagnosis 1

Introduction ¨ Outline ¨ Age ¨ General condition ¨ History ¨ Physical examination ¨ Associated findings ¨ Investigations Approach to diagnosis 2

Definition: bluish discoloration of tissues caused by increased concentration of reduced hemoglobin > 3 g/dl Approach to diagnosis 3

Problems: ¨ - Skin Color - Temperature - Lighting - Anemia Look At: Lips, Nail Beds, Tongue and Mucous Membranes ¨ Causes: Classify According to Age Approach to diagnosis 4

Cyanosis in a Neonate ¨ Respiratory ¨ Cardiac ¨ CNS ¨ Hematological ¨ Metabolic Approach to diagnosis 5

I – Respiratory: ¨ Apnea ¨ RDS ¨ TTN ¨ Aspiration ¨ Pneumonia ¨ PPHN ¨ Cogenital anomalies/malformations ¨ Diaphragmatic hernia ¨ Tracheal atresia, web, stenosis Approach to diagnosis 6

II- Cardiac ¨ Transposition of the great arteries ¨ Truncus Arteriosus ¨ Tricuspid Atresia ¨ Tetralogy of Fallot ¨ Total anomalous venous pulmonary return Approach to diagnosis 7

III- CNS: ¨ Meningitis ¨ Intra-ventricular or other intracranial hemorrhage ¨ Drugs: respiratory depression, seizures Approach to diagnosis 8

IV- Metabolic ¨ Acidosis ¨ Hypoglycemia ¨ Hypothermia ¨ Sepsis Approach to diagnosis 9

V- Hematological: ¨ Polycythemia ¨ Methemoglobinemia Approach to diagnosis 10

Evaluation: Needs to be tailored to the individuals case. ¨ History ¨ Physical Exam ¨ Vital Signs ¨ Glucose ¨ Give 100% oxygen for central cyanosis. ¨ Hyperoxia test. ¨ Make sure baby is breathing (otherwise oxygen will not be very helpful) ¨ Arterial blood gas is the only way to determine if correct oxygenation ¨ Chest X-ray ¨ CBC with differential ¨ Cardiac Evaluation Approach to diagnosis 11

Cyanosis Beyond Infancy: ¨ Cardiac ¨ Respiratory ¨ CNS ¨ Metabolic To be continued…. . Approach to diagnosis 12