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Cyanosis in children (Aetiology (Respiratory Vascular: PH of newborn …
Cyanosis in
children
Definition
Central blue discolouration
due to reduced blood and
thus oxygen supply to tissues
Pathophysiology
Peripheral
Poor perfusion of peripheries
Blue hands/feet
Caused by cold, general unwellness
Central
Indicates reduced arterial oxygen saturation
Multiple causes
Aetiology
Respiratory
Vascular: PH of newborn
Infection: meconium aspiration
Congenital: RDS (surfactant), pulmonary hypoplasia
Systemic
Infection: sepsis
Metabolic: acidosis/shock
Cardiovascular
Congenital: cyanotic congenital heart disease
e.g. R-L shunts (TOF, TGA) or common mixing
(AVSD, complex disease), Eisenmenger syndrome
Clinical
presentation
SOB
(AVSD, complex,
resp disorders)
Shock
(sepsis etc.)
Cyanosis
Diagnosis
Examination
Cardio
Cyanosis, any SOB, any murmurs,
signs of HF, signs of shock
(reduced vol pulse, pallor, cold, low GCS)
Resp
Air entry, crackles (HF)
Investigations
Bloods
Cap blood gas, FBC, U+E
Imaging
ECHO
CXR
Bedside
Obs (sats, RR, HR, BP, temp)
ECG
Specialist tests
Hyperoxia (nitrogen washout): shows presence of
heart disease in cyanosed nonate
History
PMH
Growth and development
Vaccinations
Known medical conditions
FH
Heart/lung disorders
Cosanguinuity
POH
Antenatal (scans, bloods, growth, complications)
Perinatal (gestation, delivery, weight, complications)
Postnatal (complications)
DH
Current/past meds
Allergies
PC/HPC
Cyanosis: onset, character (peripheral, central),
radiation (spread), associated symptoms (breathless, shock/collapse), timing (intermittent, worsening) exacerbating/relieving factors
SH
Living arrangements
Management
Initial ABCDE
Oxygen, sit upright,
may need ventilation
Definitive
Conservative
Indentify and manage cause
Medical
Prostaglandins
Indication: ASAP
E.g. alprostadil
MOA: maintains duct in a duct-dependent circulation
SEs: flushing, hypotension, jittering, seizures, apnoea