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Cyanosis

  • Common ddx

    • congenital heart disease, methemoglobinemia, hypoxia, Raynaud's, COPD
  • Serious ddx

    • arterial occlusion
  • Labs

    • pulsox
    • consider ABG
    • EKG
    • CXR
    • spiral CT if PE
    • hemoglobin study if hemoglobinopathy
    • echo if congenital heart dz
    • PFTs if COPD
  • Congenital heart dz ddx

    • tetralogy of fallot, truncus arteriosus, transposition of vessels (neonate), tricuspid atresia, total anomalous pulm venous return, PDA
  • Pediatrics ddx

    • croup (seal-bark), epiglottitis (drooling), pertussis (cough), foreign body, breath holding spell
  • Localized cyanosis ddx

    • Raynaud's, arterial occlusion (unilateral), vasoconstricting drugs, epinephrine, lidocaine, acrocyanosis, PVC (erythromelalgia)
  • Cardio ddx

    • CHF, valvular heart dz, rheumatic carditis (murmur)
  • Pulm ddx

    • airway obstruction (choking), PE, pneumothorax, pneumonia, COPD, asthma exacerbation, restrictive lung dz, pulm fibrosis
  • Heme ddx

    • methemoglobinemia, sulfhemoglobinemia, CO poisoning
  • HPI

    • onset
    • aggravates, alleviates
    • location: localized vs generalized
    • quality and severity of cyanosis
    • associated pains
  • ROS

    • fever, weight loss
    • cardio: chest pain
    • pulm: dyspnea, cough
    • GI: nausea, vomiting, diarrhea
    • neuro: paresthesia
  • PMH

    • methemoglobinemia
    • Raynaud's
    • asthma, COPD
  • FH

  • SH

    • tobacco
    • CO exposure
  • Meds

    • new meds, sulfa drugs
  • Allergies

  • Px

    • vitals
    • general impression
    • skin: description and location of cyanosis
    • cardio: murmurs, JVD
    • pulm: work of breathing, wheezing
    • abd
    • extremities: perfusion, color, tenderness, edema, strength, sensation

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