Approach
• Differentiate cyanosis that is central (mucous membranes, tongue, trunk, 2/2 right-to-left shunt) vs. peripheral (feet, hands, lips, 2/2 peripheral vasoconstriction)
Definition
• Acrocyanosis: Blueness in hands/feet only seen in newborns 2° perfusion of the extremities → nl & resolves w/i 1st few days of life
• Breath-holding spell: Prolonged period w/o attempt to breathe a/w intense crying from pain, anger, fright → benign, but Dx of exclusion
History
• Age of onset, central or peripheral, med ingestion, recent illness
• Change w/ crying: Improvement → respiratory etiology (↑ alveolar recruitment); exacerbation → cardiac etiology (↑ cardiac output)
Findings
• Appearance (ill or well), VS, respiratory distress, heart murmur
Evaluation
• Provide O2, obtain CXR, ECG
• Hyperoxygenation test: Compare ABG on RA & on 100% O2 for 10 min, PO2 of >250 excludes hypoxia 2/2 congenital heart dz
• Improvement in O2 sat w/ O2, lack of murmur, nl ECG → pulmonary process
• No change in O2 sat w/ O2, murmur, abnl ECG → cardiac cause → obtain echo (see 14-19)
Treatment
• O2, identify then tx underlying condition
• Consider PGE1 for pts <2 wk of age in circulatory failure
Disposition
• Admit any pt who is ill appearing, low O2 sat or PaO2
• Consult cardiology for any pt w/ suspected congenital cardiac dz