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Hypoxia and Cyanosis

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peter ibrahim

on 19 December 2012

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Transcript of Hypoxia and Cyanosis

Types of hypoxia Hypoxia 1. Hypoxic hypoxia
 is the most common and is caused by decreased oxygen in air or Lack of oxygen getting from the lungs to the heart, defective mechanism of oxygenation in the lungs, abnormal pulmonary function. 2. Hypemic hypoxia
Or anemic is caused by the reduction of the oxygen carrying capacity of the blood. Anemia (low hemoglobin) can cause this. The oxygen is available, but there isn’t enough good blood to carry the oxygen. 3. Stagnant hypoxia
Or circulatory hypoxia
In this type of hypoxia there is slow or no circulation to the tissue .It may be localized disturbance of circulation to certain part of the body
e.g. the limbs or it may be generalized or central as in heart 4. Histotoxic hypoxia
 occurs when all systems are working but the cells can’t "take" the oxygen from the blood although the oxygen is available.
Histotoxic hypoxia occurs when a toxic substance, such as cyanide, interferes with the ability of tissues to use available oxygen. Definition
Cyanosis is derived from the color "cyan" which comes from "kyanous" the Greek word from blue.
Cyanosis is a physical sign causing bluish discoloration of the skin and mucous membranes. Cyanosis is caused by a lack of oxygen in the blood. Definition

 Hypoxia is defined as inadequate oxygen supply to the cells and tissues of the body.

Hypoxia – “Hypoxia occurs when oxygen concentrations fall below the level necessary to sustain most animal life. Hypoxia, or hypoxiation,
is a pathological condition in which the body as a whole (generalized hypoxia) or a region of the body (tissue hypoxia) is deprived of adequate oxygen supply. •Heart Attack
A heart attack occurs when the coronary arteries stop supplying oxygenated blood to the heart. If there is a blockage in the arteries, it will result in a heart attack. The shortage of oxygen leads to hypoxia. •Asthma
Asthma is a very common disease seen mostly in children, but also in adults. Sometimes the alveoli and bronchioles, the two airways responsible for carrying oxygen to the blood become inflamed or swollen, will leading to a block in the passage of air. Less oxygen in the blood will lead to hypoxia. •Intake of Carbon Monoxide
Carbon monoxide is a poisonous gas. When carbon monoxide enters our lungs, it combines with oxygen to form carbon dioxide. As more and more carbon monoxide is decreased, the quantity of oxygen in the body, and causing hypoxia. •High Altitudes
The higher the altitude, the lesser the amount of oxygen in the air. Less oxygen would mean that you are gradually moving towards a state of hypoxia. •Pneumonia
•Hepatic failure
•Pulmonary hypertension
•Acute lung syndrome
•Bronchiolitis Cyanosis is due to deficient oxygenation of the blood, evident when reduced Hemoglobin in the blood exceeds 5 gram/100 ml Site to detect cyanosis
•Nail beds
•Malar prominences
•Palms and soles
•Mucous membranes The blue discoloration of cyanosis is seen most readily in the beds of the fingernails
and toenails, and on the lips and tongue.
It often appears transiently as a result of
slowed blood flow
through the skin due to the cold. As such,
it is not a serious symptom.
However, in other cases cyanosis is a serious symptom of underlying disease. {Types of cyanosis}
1.Central cyanosis
2.Peripheral cyanosis
3.Mixed cyanosis {Other types}

•Enterogenous / pigment cyanosis
•Differential cyanosis
•Orthocyanosis central cyanosis

1- central cyanosis refiects sgstemic hypoxia

2- it may be seen in patient with congenital cynotic heart disease or acnte hypoxia from pulmonary oedemc

3- the sensitivity of the finding reflects the level of the plasma hemoglobin

4- in patient with anormal hemoglobin
( 13.5g/dl in men )
( 11.5.16g/dl in women )

5- central cyanosis become delectable with oxygen saturation valne between 80 and 87%

6- with hemoglobin of 6 g/dl oxgen satnration Peripheral cyanosis
•Decreased cardiac output
•Redistribution of blood from extremities
•Arterial obstruction-embolus, Raynaud’s phenomenon
•Venous obstruction-thrombophlebitis, SVC syndrome
•CCF, shock , peripheral circulatory failure
•Hyper viscosity – Multiple myeloma , Polycythemia
•Peripheral Vascular Diseases- atherosclerosis , buerger`s Mixed Cyanosis

•Cardiogenic shock + pulmonary oedema
•CCF due to lt.sided heart failure
•Polycythemia (rare)
•Present in upright position due to hypoxia occurring in erect posture in pulmonary Arteriovenous Malformation Other types
•Differential cyanosis is the bluish coloration of lower not upper extremity and the head
•Entrogenons a syndrome due to absorption of nitrites from the intestine
•Acrocynanosis is a painless disorders caused by constriction or narrowing of small blood vessel in the skin
•Orthocyanosis Causes of cyanosis
*Causes of central cyanosis in neonates
1- Transient cyanosis after delivery
It clears after few minutes of birth but in perioheral after day or days 2- Cardiac and circulatiry causes
•Transposition of great orteries
•Fallot `s tetralogy
•Total anomalus of pulmanory veins
•RT left shunt between the rights of left atrium (A.S.D)
•Hypolastic left heart
•Truncus arteriosus 3- Respiratory cause includes:
1-R.D.s respiratory distress sydrone) eg:preumania ,
Bronchi pneumonia , emphyseum
2-Birth thorax: due to truma of the chest of wall
3-Pnumo thorax : due to truma of the chest of wall
4-Meconium aspiration
5-Cougenital diaphragmatic hernia
6-Pulmonary cedema ( RT heart failure )
7-Pleural effusion eg TB

4- Other causes in clude infection, seizures and metabolic abnormalities eg:
Hypo g/y caemia *causes of central cyancsis in adult
1- Lung disease any severe respiratory
disease, pulmonary cedema
2- Right to left cardic shunt eg
Cyanotic congenital heart disease
3- abdormal haemcglcbins :
Mathaemcglobinemia Causes of peripteral cyanosis:
1-All causes of central cyanosis Causes peripteral cyanosis
2-Reducedcardic output eg:
Heart failure – shock
3-Peripleral vascular disease
-Cold exposure
-Raynaud’s disease
5-Venus destruction of the lower limb
6-Obstruction of superior vena cava ceclema of the face Symptoms of cyanosis

Diseases of heart and lung
Abnormal hemoglobin methemoglobin and sulf hemoglobin
Deoxygenated veanous blood instead going to the general blood circulation of blood leading to symptoms of cyanosis Symptoms of central cyanosis

1-Bluish purple discoloration of tongue and lips and discoloration of the oral mucous membranes

2-Breath lessees
( shortness of breathing )

3-Hands and feet are usually normal temperature or warm Symptoms of peripheral cyanosis
1-The peripheral organs and limps turn bluish or purple and they are cold to touch
It commonly seeing in the nail beds
2-There is no bluing of the mucous membrane of the mouth Age and onset of cyanosis
1-Cyanosis begins at birth or within the first few years of life
2-Cyanosis may have abrupt onset as the patient Symptoms of cyanosis in infants
1-Infants with cyanosis get tired or sweat while feeding and show lack of weight gain
2-Low birth weight
3-Some babies may grunt or emit a noise with each breath Symptoms of cyanons in children

1-Children cyanotic heart diseases
have problems with breathing
( dyspnea ) so after physical activity
to relieve breathlessness
2-Fainting spells Other symptoms that may occur along with cyanosis: 1-Chest pain 2-Leaning forward when sitting to breathe more easily 3-Use of rib cage musdes in attempt
to breath more easily 4-Loss of consciousness for even a brief moment 5-Clubbing 6-Fever 7-Lethargy 8-More frequent headaches more than normal 9-Limpness, anxiety, being tired all 10-Puffy face or eye Management
Management = investigation + treatment

Complete blood picture
A B G {arterial blood gases }
Liver function test
-renal function test
_Prothrombin Activity Radiological
_x_ray chest
_ ECCho cardiography
_ C.T chest
_ C.T angio causes : Treatment may be either

medical or surgical
Treatment is the treatment of the cause Cyanosis occurs when there is a diseas in
Congenital heart disease
Surgery as a treatment for cyanosis
Treatment of central cyanosis due to congenital heart defects may often involve surgery.
For example, therapy of Tetralogy of Fallot (TOF) needs surgery soon after birth. If the symptoms are less severe, surgery may be performed at the age of three to six months.
Open heart surgery is usually used to treat TOF. The defects of the heart valves are corrected during the surgery. Oxygenation as a treatment for cyanosis
Initial stabilization requires oxygenation. Sometimes a breathing machine or ventilator might be required.
First the physician checks with the airway or the wind pipe are clear before oxygenation.
If there is an obstruction or difficulty, an endotracheal tube is inserted and oxygen is administered through it. Drugs as a treatment for cyanosis
In heart failure patients drugs are prescribed to reduce the excess accumulation of fluids. These are called diuretics.
Heart failure patients and those with cyanotic heart disease also need drugs that help the heart pump harder. Drugs may also be prescribed to treat abnormal heartbeats or rhythms.
Antibiotics are prescribed to prevent infections and also for treatment of pneumonia and other infections Acquired
May by acute or chronic myocardites
Trauma in pericardium may be
Acute: pericardium effusion
Chronic: constrictive pericarditis this is treated by releas fibrosis
Trauma is treated by aspiration of blood repaire to myocardium
Tumour either benign or malignant treated by excision of tumour
Cyanosis also due to depression of respiratory center and this lead to serebral hemorrhage and treated by surgical aspiration Glucose administration
Cyanosis due to other causes like low blood sugar can be managed by glucose infusions and glucose administration Defect in lung lead to cyanosis
lung diseases is either congenital or acquired
Congenital lung diseases
1-congenital egenesis of one lung lead to death
2- congenital trachoesopgageal fistula and this is treated by surgical excision of fistula
3-congenital lung fibrosis and this is treated by lung transplantation [surgical operation ] Trauma
Injuries to lungs may also lead to cyanosis

Patient with lung injuries require
1-more than one chest tube insertion and supportive care
2-tgey may need to surgical repair because serious morbidity may follow lung injuries
tumor in lungs either benign or malignant also lead to cyanosis and treated by surgical operation to excision of this tumor Deficiency of surfactant may also lead to cynosis
Treatment of deficiency of surfactant
Currently, there is no specific treatment for any of the surfactant protein deficiencies. For affected newborns, surfactant replacement therapy may improve respiratory status transiently but is ineffective in treating the underlying deficiency.
Lung transplantation may be considered. Pleural
•Pleural effusion is one of the causis of cyanosis
•Pleural effusion is excess fluid that accumulates between the two pleural layers, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation.
•Treatment depends on the underlying cause of the pleural effusion.
•Therapeutic aspiration may be sufficient; larger effusions may require insertion of an intercostal drain (either pigtail or surgical). When managing these chest tubes, it is important to make sure the chest tubes do not become occluded or clogged. Hemothorax
A hemothorax (or haemothorax) is a condition that results from blood accumulating in the pleural cavity
Hemothorax is also one of the causes of cyanosis
Intercostal tubes or chest tube Pneumothorax
is an abnormal collection of air or gas in the pleural space separating the lung from the chest wall which may interfere with normal breathing.
Treatment of pneumothorax
Treated by intercostal tubes
Cyanosis may also because of foreign body in larynx ,trachea or left and right bronchi and this is treated by extract of this foreign body by Bronchoscopy Cyanosis is associated with cold temperatures, heart failure, lung diseases, and smothering. It is seen in infants at birth as a result of heart defects, respiratory distress syndrome, or lung and breathing problems. Acquired
Treated by
Medical treatment by
-antibiotics drugs
-anti inflammatory drugs
-broncho dilator drugs However, given the critically-ill and unstable state of these infants, the pre-transplant period is associated with a high risk of dying (up to 30%). The 5-year survival rate following lung transplantation has been reported to be about 50%.
In older children with milder forms of surfactant protein deficiency, corticosteroids and hydroxychloroquine may be considered. Further studies are needed to evaluate the benefits of these medications.
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