![]() This can help determine if the cyanosis is generalized, limited to extremities, or if there is a difference in the bluish discoloration in different extremities. Cheeks, nose, ears, and oral mucosa are the best areas to assess cyanosis as the skin in these areas is thin, and blood supply is good. Poor light exposure, the thickness of the skin, and pigmentation of the skin can affect the accuracy of physical assessment. Physical examination should be carried out in an adequate light for the correct assessment of cyanosis. Respiratory symptoms are more commonly associated with central cyanosis. The presence of clubbing can most likely be seen in congenital heart conditions, right to left shunts, and pulmonary diseases. ![]() The conditions which usually manifest after the first week are tetralogy of Fallot, transposition of great arteries, truncus arteriosus, etc.įever may be seen if the cause of cyanosis is infectious such as croup, pneumonia, septic shock, etc. In congenital heart diseases, the conditions which present with cyanosis in the first week are tricuspid atresia, Ebstein anomaly, critical pulmonary stenosis, etc. In assessing cyanosis, the onset is an important clue to the underlying cause. It is essential to differentiate the central, peripheral cyanosis, and differential cyanosis as each implies different etiologies. However, a more recent onset is highly suggestive of acquired etiology. If the cyanosis is present since birth, the cause is congenital. The provider should inquire about the onset, duration, intake, or exposure to poisonous substances, exposure to the cold, site where cyanosis can be appreciated, and associated symptoms. The detailed history and physical examination are vital in determining the underlying cause of cyanosis. The diminished blood flow causes a blue discoloration of the fingers and toes.Ībout 98% of oxygen is normally bound to hemoglobin, with the remaining 2% dissolved in plasma. In the Raynaud phenomenon, abnormal vasospasm occurs with exposure to change in temperature and emotional events. It is not considered pathologic unless there is significantly low cardiac output leading to cutaneous vasoconstriction. Additionally, it can also be seen in infancy when babies cry, vomit, regurgitate, cough, hold their breath. It can be a normal finding in babies which resolves within the first few days of life. This results in cyanosis due to increased unloading of oxygen from the blood to the tissues.īenign vasomotor changes can cause acrocyanosis, a form of peripheral cyanosis. This redistribution of blood flow from extremities causes cyanosis of extremities.Įxposure to cold increases the transit time through capillary beds. ![]() Also, hypotension produces reflex cutaneous vasoconstriction to shunt blood from extremities to the internal organs. Lack of pressure prevents an adequate supply of oxygen-rich blood to the extremities. Reduced cardiac output in heart failure and shock can lead to peripheral cyanosis, if severe. This results in a significant difference in the saturation between the arterial and venous blood, with increased deoxygenated blood on the venous side of the capillary beds. In peripheral cyanosis, there is normal arterial oxygen saturation but increased oxygen extraction by the peripheral tissue in the capillary bed in the setting of peripheral vasoconstriction and decreased peripheral blood flow. Ischemic peripheral cyanosis occurs when vasoconstriction leads to diminished peripheral blood flow. Congestive peripheral cyanosis can be caused due to the slowing of blood flow. Peripheral cyanosis occurs due to the inability of the body to deliver oxygen-rich blood to the peripheral tissues. Localized reduced blood flow: Peripheral vascular diseases such as Raynaud which can lead to peripheral vessel spasm (the lack of blood flow leads to the white coloration of fingers, followed by bluish discoloration when the veins dilate to keep the blood flow going, finally returning to red color on the restoration of blood flow)Īsphyxia: In this, there is both hypoxia as well as increased levels of carbon dioxide (hypercapnia)
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