0071643192.pdf

DIFFERENTIAL

Pseudocyanosisfrom heavy metals or drugs (amiodarone, phenothiazine);

skin does not blanch with pressure

DIAGNOSIS

■ Conduct a systematic diagnostic and therapeutic evaluation for the cause

of cyanosis.

■ The presence of clubbing suggests a chronic hypoxemic state.

■ If central cyanosis is present, the presence of an abnormal form of hemo-

globin must first be ruled out by co-oximetry.

■ Other tests that may be helpful include a CBC and CXR.

TREATMENT

■ Administer supplemental O 2 , although this will not improve cyanosis in

hemoglobinopathy, cyanide poisoning, and anatomic shunt.

■ Treat underlying cause.

Hemoptysis

Defined as the coughing up of blood from the lower (below larynx) respira-

tory tract. Hemoptysis can range from blood-streaked sputum to life-

threatening bleeding. Massive hemoptysis carries a high mortality and is

defined as the coughing up of>100–600 mL of blood in a 24-hour period.

Bronchitis, bronchogenic carcinoma, and bronchiectasis are the most com-

mon causes of hemoptysis (see Table 10.3),but up to 30% of patients have no

identifiable cause even after extensive evaluation.

THORACIC AND RESPIRATORY

DISORDERS

TABLE 10.3. Causes of Hemoptysis

MOSTCOMMONCAUSES OTHERCAUSES

Bronchitis Infection

Lung neoplasm Pneumonia

Bronchiectasis Aspergilloma

Lung abscess

TB

Autoimmune disorder

Goodpasture syndrome

Wegener granulomatosis

Cardiovascular

Pulmonary embolism

Arteriovenous malformation

Mitral stenosis

CHF

Arterial-tracheal/bronchial fistula

Bleeding disorder

Trauma

Cystic fibrosis