Name
CYANOSIS
DESCRIPTION
DETAIL
CAUSES : A. CENTRAL CYANOSIS 1. RESPIRATORY DISEASES - ANY SEVERE DIFFUSE LUNG DISEASE - CHR BRONCHITIS WITH EMPHYSEMA - PULMONARY EMBOLISM - PULMONARY EDEMA - PNEUMONIA - ALVEOLAR HYPOVENTILATION DUE TO ANY OBSTRUCTION TO THE AIRWAYS 2. CARDIO-VASCULAR DISEASES - LEFT VENTRICULAR FAILURE - CYANOTIC CONGENITAL HEART DISEASE * FALLOTS TETRALOGY * PULMONARY ATRESIA * PULMONARY STENOSIS WITH REVERSED INTERATRIAL SHUNT * EISENMENGER COMPLEX * TRICUSPID ATRESIA * TRANSPOSITION OF GREAT ARTRIES * DRAINAGE OF SUPERIOR & INFERIOR VENA CAVA INTO LT. ATRIUM * EBSTEIN ANOMALY OF TRICUSPID VALVE WITH REVERSED INTERATRIAL SHUNT * LARGE PULMONARY ARTERIOVENOUS MALFORMATION 3. PIGMENTARY CYANOSIS - CONGENITAL METHAEMOGLOBINAEMIA - ACQUIRED METHAEMOGLOBINAEMIA DUE TO ANILINE DYES , INGESTION OF OXIDIZING AGENTS LIKE NITRITES & CHLORATES, BY HIGH NITRATE CONTENT OF WATER, POT. CHLORATE POISONING, PHENACETIN - SULPHAEMOBLOBINAEMIA B. PERIPHERAL CYANOSIS MAY BE DUE TO THREE REASONS : 1. INCREASED RESISTANCE TO BLOOD FLOW : - EXTREEM COLD - RAYNAUDS DISEASE & PHENOMENON - ACROCYANOSIS - ERYTHROCYANOSIS - PHLEGMASIA CAERULEA DOLENS - FACIAL CYANOSIS DUE TO OBSTRUCTION IN SUPERIOR VENA CAVA 2. DECREASED CARDIAC OUTPUT - DUE TO ANY CAUSE 3. INCREASED BLOOD VISCOSITY - POLYCYTHAEMIA VERA -
TYPENOTES
GENERAL MEASURES β’ Care by experienced physician and team (respiratory therapist, nurse, nutritionist, physical therapist, counselor, social worker) β’ Goals are to prevent and treat respiratory failure and pulmonary complications β’ Postural drainage and chest physiotherapy - adjuncts include fl utter valve and CPT vest (expensive) β’ Pancreatic enzyme replacement; H2 receptor blockers can increase utilization of enteric coated enzymes β’ Regular exercises for fi tness β’ Press for adequate growth through good nutrition - supplements may be needed β’ Aerosol B2 agonists; consider ipratropium β’ Antibiotics - especially to target Pseudomonas , Staphylococcus β’ DNase: aerosolized mucolytic, 2.5 mg neb q day. Use pari-plus nebulizer cup. β’ Oxygen: when needed β’ Monitor sleeping O2 saturation β’ Hypaque or diatrizoate (Gastrografi n) enemas or surgery for unrelieved meconium ileus (newborn) β’ For fecal accumulation and intussusception in older children or adults - enemas of diatrizoate (Gastrografi n) or polyethylene glycol (Golytely) per NG β’ Early identifi cation of diabetes, and treatment with insulin β’ Assisted ventilation with BiPAP is acceptable and temporary. May be used nightly as a bridge to lung transplant. SURGICAL MEASURES β’ Surgery may be indicated for some complications β’ Organ transplants possible for lung, liver, pancreas ACTIVITY Physical conditioning to the extent possible for cardiorespiratory fi tness (does not improve pulmonary function) DIET β’ Allow liberal salting of foods per patient preference β’ High protein β’ High calories (1.5 x recommended for general population) β’ High fat (previously not recommended) β’ Vitamin supplements (double RDA) β’ May need supplemental feeds, oral or by gastrostomy
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
PERIPHERAL VESSELS DOPPLER, COMPLETE BLOOD COUNT, ECHOCARDIOGRAPHY, ECG, CARDIAC DOPPLER