Cyanosis : is a bluish discoloration of the skin and mucous membranes ,Cyanosis can be seen when the deoxygenated hemoglobin in the blood reaches between 4-6 gm/dl ,normally 80-87% oxygen saturation could give rise to clinically apparent cyanosis .in cases of anaemia cyanosis may be seen when oxygen saturation may be as low as 60%.
Ask about the onst of cyanosis did it happen suddenly or has it been appearing over a long period ? a sudden onset may be due to pulmonary emboli or severe asthma , Ask about any associated symptoms as dyspnea chest pain ,and cough , Ask about any past medical history of respiratory or cardiac disease .Ask about any medication that may cause abnormal hemoglobin ,Don,t forget occupational and smoking history.
Examination : Check the pulse and blood pressure if week and blood pressure is low ,there may be a circulatory shock .fever in case of pulmonary infection ,look for clubbing of fingers and growth retardation in children The combination of clubbing and cyanosis is frequent in congenital heart disease and may also occur in pulmonary disease ( lung abscess, bronchiectasis ,cystic fibrosis and pulmonary arteriovenous shunts ).Look for the tongue for central cyanosis Look for the neck for raised JVP in heart failure and working accessory muscles in severe asthma , Examine the chest : Note for barrel chest ,kyphosis,scoliosis,scars . Poor chest expansion in COPD and asthma ,unilateral reduced chest expansion with lobar pneumonia , dullness to percussion over an area of consolidation ,localised crepitations may be heared in lobar pneumonia wide spread crepitations in bronchopneumonia and pulmonary edema .bornchial breathing may be auscultated over an area of consolidation . (Q) What are the types of cyanosis ?
(A) (1) Central cyanosis : (a) cardiac causes : cyanotic or congenital heart diseases e,g fallot tetralogy ,transposition of great artries , and trancus arteriosus , (b) Respiratory causes : pulmonary edema , pulmonary embolism , high altitude sickness ,severe pneumonia ,severe asthma , COPD, ARDS (C) Causes in the blood : methemoglobinemia ,sulfhemoglobinemia and polycythemia .
in central cyanosis limbs appear warm to touch and cyanosis does not disappear on warming of the hands .
(2) Peripheral cyanosis : occurs with sluggish or slowing of circulation , may be seen in heart failure and shock ,exposure to cold temperature ,arterial vascular occulsion of one limb ,limbs appear bluish and cold to touch ,warming may resolve the cyanosis .
(A) Cyanosis and clubbing of the lower extremities with normal upper extremity nail beds it is diagnostic of patent ductus arteriosus with pulmonary hypertension.
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