Latest / WhiteBoard Medicine - Emergency And Critical Care
#201 Refractory Hypoxemia Explained | Pulmonary Embolism With Right-to-Left Cardiac Shunt (ED/ICU Case)
Refractory hypoxemia that does not improve with supplemental oxygen should immediately raise concern for a right-to-left shunt. In this ED and ICU case review, we walk through a patient with acute pulmonary embolism causing severe hypoxemia due to intracardiac shunting, reviewing the underlying physiology, diagnostic approach, and management considerations. We break down: • Mechanisms of refractory hypoxemia • Pulmonary embolism physiology and RV failure • Right-to-left shunt (including PFO physiology) • Why oxygen and ventilation may fail • ED and ICU diagnostic pearls • Management…
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