Cyanosis · 2018. 9. 19. · • Cyanosis occurs when there is 60g/L deoxyhaemoglobin • Hb 8...
Transcript of Cyanosis · 2018. 9. 19. · • Cyanosis occurs when there is 60g/L deoxyhaemoglobin • Hb 8...
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Cyanosis Dr Jon Bramall
Consultant in Anaesthesia and Intensive Care Medicine
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What colour do Smurfs go when you choke them?
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–Wikipedia
“Cyanosis is defined as the bluish or purplish discolouration of the skin or mucous
membranes due to the tissues near the skin surface having low oxygen saturation”
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Cyanosis
Bluish hue that occurs in the presence of ~60 g/L deoxyhaemoglobin or dyshaemoglobinaemias
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Cyanosis Causes
• Diseases causing hypoxaemia
• Shunt
• Peripheral
• Abnormal Haemoglobin
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Peripheral Cyanosis• Normal PaO2 and Normal SpO2?
• Causes:
• Central causes
• Reduced Cardiac output
• Cold
• Redistribution
• Arterial or venous obstruction
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Oxygen Content
CaO2 = 1.34 x Hb x SaO2 0.01 x PaO2+
Oxygen in solutionOxygen carried by blood +
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Methaemoglobinaemia
• Fe2+ oxidised to Fe3+
• Unable to bind to O2
• Normal level >1.5%
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Methaemoglobinaemia Causes
Congenital • cytochrome b5 reductase deficiency • haemoglobin M disease
Acquired (toxin/drugs) • aniline dyes • benzene derivatives • chloroquine • dapsone • prilocaine • metoclopramide • nitrites (nitroglycerin, NO, sodium nitroprusside) • sulphonamides
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Methaemoglobinaemia Clinical Features
• cyanosis! • symptoms and signs of decreased oxygen
delivery • e.g. chest pain, dyspnea, altered metal state, end organ
damage • SpO2 reading 85-90% • blood samples typically have a chocolate
brown hue • Normal PaO2
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Methaemoglobinaemia Management
• High flow O2
• Stop precipitants (or avoid if congenital)
• methylene blue (1-2mg/kg over 5 minutes)
• provides an artificial electron acceptor to facilitate the reduction of MetHb via the NADPH-dependent pathway
• Alternatives:
• ascorbic acid (if methylene blue contra-indicated, e.g. G6PD deficiency)
• exchange transfusion
• hyperbaric oxygen
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How does a sats probe work?
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How does a sats probe work?
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Pseudocyanosis
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Summary• Cyanosis occurs when there is 60g/L deoxyhaemoglobin
• Hb 8 cyanosis at SpO2 60%; Hb18 SpO2 87%
• Causes include resp and cardiac causes of hyoxaemia
• TREAT THE CAUSE
• Don’t forget blue dye, abnormal haemoglobins and pseudo cyanosis
• Methaemoglobinaemia causes “cyanosis”
• Treat with Methylene blue
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What Questions do you have?