# Cyanotic face?



## VirginiaEMT (Nov 30, 2012)

I was a team-member on a code last night. The patient was in his low 30's, overweight but by no means the largest I've ever seen. The original call was for an unresponsive breathing patient but was changed to non-breathing about 3 minutes from the scene. 

The patient's wife said that he was alive when she got home from work but collapsed in front of her. So from the time he stopped breathing until we got there would have been 3-3.5 minutes. He was asystolic the entire code.

When I walked in I remember being amazed at how blue this patient's face was, nothing else, just the face. The wife stated that the patient had chest pain the day before but wouldn't go to the doctor. He also had difficulty breathing and was gasping when she came home, before he collapsed. We were able to place a King with good ETCO2 so my choking theory was dismissed. I thought maybe he had a dissected aorta, but it looks like blood would have pooled in his back and extremities since he was in the supine position, not his face which would have been the highest point on his body. I thought maybe a P.E but he had good ETCO2 and the medical examiner said if that was the case he would be blue from the chest up, which I know is not always the case. Then we're dealing with why he was in asystole. Maybe he just had an M.I and died. But I've got to satisfy my curiosity about why his face would have been so blue. You can't be anymore cyanotic than this guy was, so quick.

Any ideas?


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## Veneficus (Nov 30, 2012)

VirginiaEMT said:


> I was a team-member on a code last night. The patient was in his low 30's, overweight but by no means the largest I've ever seen. The original call was for an unresponsive breathing patient but was changed to non-breathing about 3 minutes from the scene.
> 
> The patient's wife said that he was alive when she got home from work but collapsed in front of her. So from the time he stopped breathing until we got there would have been 3-3.5 minutes. He was asystolic the entire code.
> 
> ...



in a pseudoaneurysm (formerly called dissecting aneurysm) blood does not actually have to leave the vasculature. 

The blood can pool in the space created by the seperation of the wall. 

If the arch or the acending aorta is involved, it can cause acute aortic valve failure. 

That would be different from a ruptured aneurysm where the blood would pool in the lowest area and perhaps appear clinically as a bruise. 

There are also conditions that cause a reverse flow through the basilar artery in the brain. 

But of all the many things we may speculate, it sounds like a vascular issue.


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## mycrofft (Nov 30, 2012)

An area *congested* with deoxygenated blood can appear blue (I think of it more as dark maroon/magenta), such as with a hanging/strangulation. My experience with true cyanosis is the basic skin looks normal or actually a pallorous.

Then there are those with methaemoglobinaemia or argyrism.


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## MSDeltaFlt (Dec 1, 2012)

There's a distinct possibility that the COD could be either TAA DeBakey I or II (I doubt a DeBakey III being that far down) or an embolus effecting the carotid arteries as (or after) they branch out from Aortic Arch.  Being obese it's even money, but being sedentary can leave one susceptible to emboli.


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## TheLocalMedic (Dec 3, 2012)

I've seen this happen a few times now on codes and I've wondered about it as well.  I've seen people who exhibit cyanosis starting at the chest and neck but also just in the face.  So far the only guess that has made sense to me was the PE.  Had one woman who coded right in front of us (went from mild chest pain over 2 days to apneic in about 3 mins, yikes!) who was only cyanotic in the face and neck, and autopsy later determined that it was a PE that had cause her death.  She was in A-fib when we first got to her, with no prior hx, so it sounds like a mural thrombosis.


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## the_negro_puppy (Dec 4, 2012)

I attended a VF arrest 46 y.o M chest pain after mowing, collapsed. Was in VF when we arrived. 6 shocks etc no rosc. His head was dark purple by the end of it.


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## Locklear (Dec 4, 2012)

Cape cyanosis due to pulmonary embolism. I've seen this once- person in apparent good health was speaking to his wife, suddenly turned blue and fell dead at her feet. CPR was begun immediately, to no avail.


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