Understanding Cyanosis: Definition, Differential Diagnosis, and Hyperoxia Test, Slides of Pediatrics

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Evaluation of the Cyanotic Infant

Outline

 Cyanosis - define and describe

 Terms (PaO 2 v SaO 2 v CaO 2 )

 Differential of cyanosis

 The hyperoxia test

 A few etiologies

 Take home points

 Evaluation and intervention Flowchart

Cyanosis Acro v Central

 Acrocyanosis

 part of normal transition  may last 72hr  beware APGAR of 10  hypoperfused  severe anemia

Cyanosis

RA v. O 2 - Saturations

Terms

 PaO 2  Arterial Oxygen Pressure  Measured on an ABG machine  Oxygen dissolved in plasma  0.003 ml O 2 /mmHg/dl plasma  SaO 2  Percent Oxygen Saturation  Measured by saturation monitor (pulse-Ox)  ~1.34ml O2/g Hb

Oxyhemoglobin dissociation

Terms

 CaO 2  Oxygen Content of the blood  bound to Hb + dissolved in plasma  100% saturated  Hb 18g/dl  90 mmHg in plasma  = [1.0181.34]+[0.00390]  = [24]+[0.25]  Physiologically, saturations much more important to oxygen content (0.003600 = 1.8)

CaO 2 Samples

HYPEROXIA

100%, Hb 18 PaO2 600 [1.0181.34]+[0.003*600] [24]+[1.8]= 26

CaO 2 Samples

ANEMIA

95%, Hb 10 PaO2 85 [.95101.34]+[0.003*85] [13]+[0.25]= 13

CaO 2 Samples

CCHD

75%, Hb 18 PaO2 40 [.75181.34]+[0.003*40] [18]+[0.12]= 18

CaO 2 Samples

CCHD-ANEMIA

75%, Hb 10 PaO2 40 [.75101.34]+[0.003*40] [10]+[0.12]= 10

Not enough oxygen in

 Apnea

 neurologic and pharmacologic causes

 Diffusion barrier

 RDS, aspiration, pneumonia

 Obstruction

 pneumothorax, head position

Oxygen “mal-absorption”

 Shunting lesions

 cardiac  non-cardiac (like PPHN)

 Hematologic

 methemoglobinemia  carboxyhemoglobinemia