Is Cyanosis an Emergency?
If you’ve recently been on a first aid course, chances are you’ve heard the term Cyanosis. But what exactly is Cyanosis and why is it important in first aid?
Is it an Emergency?
First off, Cyanosis can be caused by many different conditions, some of which may be an indication of a serious medical condition. It is important to determine the cause of Cyanosis in order to understand if this symptom is an emergency and how urgently you should seek medical attention. MostBut if you see a sudden change, like an adult or child suddenly turning blue, then please seek medical attention immediately.
What is Cyanosis?
Cyanosis is a blueish/purple tinge to the skin caused by tissues receiving a poor supply of oxygen rich blood. It is a pathologic sign, otherwise known as a symptom, and not a disease in and of itself. Generally speaking, a patient with underlying conditions that cause the deoxygenated hemoglobin level to raise to 5.0 g/dl or more will display Cyanosis. Cyanosis can be observed most apparently in areas of the body with high vasculature, which is why it is common to see Cyanosis of the lips and gums.
What are the three types of Cyanosis?
There are three different types of Cyanosis: central, peripheral, and circumoral (perioral). Central and Peripheral Cyanosis
Central Cyanosis is caused by arterial hypoxia − where there is a low level of oxygen in the red blood cells leaving the heart. This is a late sign in trauma but can also be caused, for example, by congenital heart defects or lung failure, which can lead to both slow blood flow and low oxygen in the blood. It is important to seek medical attention immediately.
Peripheral cyanosis is rarely a life-threatening emergency, and is most commonly caused due to the reduction of blood flow in the peripheral circulation. This blue skin can be due to vasoconstriction caused by cold or shock, where not enough oxygen rich blood is reaching the extremities, but leaving the heart normally perfused. Peripheral cyanosis is found in the distal extremities (hands and feet, fingertips and toes). The picture in this post shows an example of peripheral cyanosis.
Circumoral (Perioral) Cyanosis
This is bluish discoloration of the mouth or the lips, and other mucous membranes. It is most commonly caused by constricted blood vessels in response to cold temperatures. However, blue discoloration of the lips on an infant can be a sign of a blocked airway, which is an emergency that may require immediate medical treatment. On dark-skinned patients, Cyanosis may be harder to detect, in which case Circumoral Cyanosis may be the most apparent symptom.
Cyanosis Causes in Adults
Some common causes of cyanosis in adults may include:
- Respiratory Problems: conditions affecting the ability of the lungs to enrich oxygen in the blood through carbon dioxide exchange. These may include Emphysema, Pneumonia, Asthma, Chronic Obstructive Pulmonary Disease (COPD), or even a blood clot in an artery of the lung.
- Airway Problems: such as choking, swelling or inflammation of the airway.
- Cardiovascular Problems: these may include congestive heart failure or a heart attack, both of which affect the body’s blood flow and ability to deliver oxygen rich blood
- Blood Disorders: any condition that interferes with the body’s ability to transport oxygen in the blood, like sickle cell anemia.
- Exposure to Substances: exposure to gold and silver salts may cause cyanosis
- Other causes: these may include but are not limited to blood flow that is limited by tight clothing, seizures, medications used to treat high blood pressure, and drug overdose.
Cyanosis Causes in Newborns
Some common causes of cyanosis in newborns may include:
- Respiratory Distress: a newborn that has difficulty breathing may have a bluish tinge to the skin and mucous membranes
- Congenital Heart Defects: problems with the heart that are present at birth
- Anemia: if the infant has a low bed blood cell count, lowering oxygenated blood flow
- Infections: Sepsis or meningitis may both alter the newborns ability to deliver oxygen rich blood
- Cold Exposure: this may cause peripheral cyanosis or circumoral cyanosis in newborns
How to Detect Cyanosis
An absence of cyanosis does not indicate that the patient is not hypoxic − for example, low light levels and some artificial lights can simply make cyanosis hard to detect. A pulse oximeter can be used to more accurately assess the whether a patient is hypoxic or not.
Cyanosis may be apparent on your physical examination and assessment of the patient and can be caused by a number of medical emergencies. It is important for first aiders to be able to spot cyanosis and hand over this information to emergency medical staff.
It’s important to identify the cause of Cyanosis before treatment can be administered. This can entail administering oxygen, addressing any metabolic issues, performing surgery, or administering medications to treat particular medical disorders. Sometimes, making lifestyle adjustments like giving up caffeine or smoking can be beneficial. Depending on the severity of Cyanosis, treatment in a hospital or other medical facility may be warranted.
- Oxygen support: if the cyanosis stems from an issue with the lungs or heart, the person may need to be given oxygen through a nasal cannula or assisted ventilator (a machine that helps them breathe).
- Correction of metabolic abnormalities: If the cyanosis is caused by more general problems with the body’s metabolism (the way it processes substances like sugar and minerals), the person may need to be given medications to correct these problems. Hypoglycemia and hypocalcemia in particular should be corrected before other treatments are given.
- Treatment of specific health conditions: If the cyanosis is caused by a specific health condition like a heart defect, the person may need to see a specialist (like a cardiologist) and receive treatment such as surgery or medications.
- Lifestyle changes: In some cases, making longer-term changes to the person’s lifestyle (like quitting smoking or avoiding caffeine, which both constrict blood vessels) may be helpful in reducing cyanosis.
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