Educational Objective:
Explain the limitations of warming and oxygen supplementation in the presence of cyanosis.
Key Point:
Cyanosis secondary to acute arterial occlusion is not expected to improve with warming or supplemental oxygen. Prompt evaluation and treatment are necessary to prevent tissue damage and loss of limb function.
Explanation:
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:
Walls RM, Hockberger RS, Gausche-Hill M, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2021.
Tintinalli JE, Ma OJ, Yealy DM, et al. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 9th ed. New York, NY: McGraw-Hill Education; 2020.
