Cyanosis and Pulmonary Edema PDF

Cyanosis  Cyanosis ❑ Definition : It`s dusky blue skin discoloration , When the reduced form( deoxygenated) haemoglobin > or = 5 g/dl of Hb. ❑ In case of anemia , cyanosis appears only in the case of severe hypoxia , while in polycythaemia it occurs more readily. ❑ Cyanosis of two...

Cyanosis  Cyanosis ❑ Definition : It`s dusky blue skin discoloration , When the reduced form( deoxygenated) haemoglobin > or = 5 g/dl of Hb. ❑ In case of anemia , cyanosis appears only in the case of severe hypoxia , while in polycythaemia it occurs more readily. ❑ Cyanosis of two types : central of the lips and tongue and peripheral of the fingers.  Cyanosis ❑ Causes of central cyanosis : I. Lung diseases : inadequate O2 exchange as in luminal obstruction from any cause , pnemothorax , pneumonia , pulmonary oedema _ in these disorders the cyanosis is corrected increasing by the inspired O2.  Cyanosis ❑ Causes of central cyanosis : I. Lung diseases : inadequate O2 exchange as in luminal obstruction from any cause , pnemothorax , pneumonia , pulmonary oedema _ in these disorders the cyanosis is corrected increasing by the inspired O2. II. Cyanotic congenital heart diseases : which results blood admixture ,& in these disorders the cyanosis is not corrected by increasing the inspired O2.  Cyanosis ❑ Causes of central cyanosis : I. Lung diseases : inadequate O2 exchange as in luminal obstruction from any cause , pnemothorax , pneumonia , pulmonary oedema _ in these disorders the cyanosis is corrected increasing by the inspired O2. II. Cyanotic congenital heart diseases : which results blood admixture ,& in these disorders the cyanosis is not corrected by increasing the inspired O2. III. Rare causes : methemoglobinaemia , congenital or acquired red cells disorders. Cyanosis ❑ Causes of peripheral cyanosis : Peripheral cyanosis will occur also in causes of central cyanosis , but it may be induced by peripheral & cutaneous vascular systems changes in persons with normal O2 saturation ,e.g. exposure to cold , hypovolemia and arterial diseases. Cyanosis Pulmonary oedema  Introduction :- ❑ It`s one of the cause of acute dyspnea. ❑ It results in a terrifying experience with sensation of “fighting for breath”. ❑ Simply, it`s accumulation of fluid into the alveoli. ❑ Its one of the medical emergency that requires an immediate and aggressive treatment.  Causes of pulmonary oedema : 1. Acute left ventricular failure : post –MI or ischemic heart diseases , valvular heart ,and cardiomyopathies. 2. Acute respiratory distress syndrome. 3. Fluid overload : e.g. renal failure 4. Neurogenic :e.g. head injury  Pathophysiology (LV failure) : There will be increase in the left ventricular diastolic pressure.This will result in rising of the left atrium, pulmonary veins and capillaries presurres. When the hydrostatic pressure of the pulmonary capillaries exceeds the osmotic pressure of plasma, the fluids will move into the alveoli. Pathophysiology (RDS) : There will be normal left ventricular diastolic pressure.This will result in normal left atrium, pulmonary veins and capillaries presurres. The hydrostatic pressure of the pulmonary capillaries is normal ,but the fluids will move into the alveoli due to the increased capillary permeability(inflammation). Exacerbating factors of pulmonary oedema 1. Arrhythmias :e.g. AF 2. Infection. 3. Pulmonary embolism. 4. Increase the blood pressure. 5. Anemia. 6. Inadequate therapy / poor drug compliance / discontinuation of treatment. 7. Thyroid disease. 8. Drug induced : e.g. NSAIDS,Corticosteroid and Verapamil.  Clinical features : Symptoms ❖ Sudden onset of dyspnea at rest , that rapidly progresses to respiratory distress ❖ Orthopnoea and PND ❖ Prostration ❖ The precipitants cause is usually obvious in history,e.g MI,pneumonia. Also ask about any recent drugs use. ❑ Signs : ❖ The patient looks distress , pale and sweaty. ❖ He is usually sitting up and leaning forward, unable to lying down on the couch ❖ The vital sings : tachycardia or sometimes bradycardia , pulsus alternas,tachypnea. ❖ The JVP is increased ❖ Fine basal crackles /crepitation ❖ Gallop / triple rhythm ❖ Wheezing (cardiac asthma) Investigations :- o Chest x – ray : (important) cardiomegaly , sings of pulmonary edema (bilateral perihilar shadowing , small effusion at the costophrenic angles ,fluid in the lung fissure and kerley B lines ). o ECG : sings of the predisposing factor or the cause , e.g. MI ,or arrhythmia o Lab tests : electrolytes , cardiac enzymes , arterial blood gas analysis. o Echocardiography can be considered Normal chest X - Ray Bilateral perihilar shadowing fluid in the lung fissure (yellow) and kerley B lines (red) Treatment : (begin treatment before investigations) :- o Sit the patient in upright position o Oxygen o I.V access and monitor the ECG o Morphine : 2.5 – 5 mg slowly I.V o Furosemide : 40 – 80 mg slowly I.V o Nitrates : - GTN (systolic pressure is > 90 mmHg) : spray or sublingual , & - I.V infusion of nitrates (systolic pressure is > or = 100 ) is then started keeping the systolic pressure above 90 o If the patient is worsening : further dose of furosemide 40 – 80 mg , and consider assisted ventilation. o Treat any arrhythmia , e.g. atrial fibrillation. o If the pressure is below 100 mmHg , treat as cardiogenic shock.