November 14, 2024

80 year old man with a history of diabetes mellitus

By Med-Challenger · 1 minute read

An 80 year old man with a history of diabetes mellitus presents with acute pain, cyanosis and decreased temperature of the right lower extremity. Distal pulses are not obtainable via palpation or doppler. You suspect acute arterial occlusion.

80YO

Based on this assumption, which of the following statements is true?

Warming of the extremity is expected to improve cyanosis in this case.
The patient’s cyanosis is secondary to postobstructive vasodilation and venous stasis.
Supplemental oxygen is not expected to improve cyanosis in this case.
This degree of cyanosis is a clue to decreased arterial oxygen saturation being present in addition to the peripheral occlusion.
Systemic vasodilators such as calcium channel blockers may improve this patient’s cyanosis.

The correct answer is:

Supplemental oxygen is not expected to improve cyanosis in this case.

Peripheral cyanosis is defined as cyanosis of the extremities and nail beds. It can be caused by peripheral arterial occlusion (as in the above patient), vasoconstriction, decreased peripheral blood flow, or abnormally large extraction of oxygen from normally saturated arterial blood.

Cyanosis secondary to vascular occlusion (the above patient) is not expected to improve either with warming or supplemental oxygen because blood is still not perfusing that extremity. Vasodilators are also not standard treatment for acute arterial occlusion.

Both warming and vasodilators such as calcium channel blockers have been used in the treatment of Raynaud’s Phenomenon, a form of peripheral cyanosis secondary to vasospasm of small arteries.

References:

Fernandez-Frackelton M. Cyanosis. In Marx JA, et al. Rosen’s Emergency Medicine. 8th ed. 2014. Chapter 14, 129-134.e1.

Sarko J, Stapczynski JS. Respiratory Distress. In Tintinalli JE, et al Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7th edition. 2011. Chapter 65, 465-473.

This question appears in Med-Challenger Emergency Medicine Review with CME

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