PulmPEEPs 88. Fellows’ Case Files: NYU
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Oct 24, 2024 Dr. Jeremy Grossman, a second-year PCCM fellow at NYU, and Dr. Shari Brosnahan, an assistant professor focused on pulmonary embolism, delve into a complex case involving an 80-year-old patient with severe hypoxemia. They discuss the critical role of thorough history-taking and the differential diagnosis for hypoxemia in elderly patients. The dialogue highlights diagnostic insights, including echocardiographic findings and the importance of collaboration in care decisions. They also share valuable lessons on communication with families and the advantages of mentorship in clinical training.
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Understanding Hypoxemia Mechanisms
- Alveolar hypoventilation, caused by issues like neuromuscular weakness or COPD/asthma, is usually preceded by hypercapnia.
- Remember that diffusion limitation, often seen in ILD and pulmonary edema, worsens with increased heart rate.
Ruling Out Simple Hypoxia Causes
- Consider low FiO2 (e.g., unplugged oxygen) as a potential cause of hypoxia in the ICU.
- Also, check for leaks in ventilator circuits if applicable.
Interpreting Bubble Study Results
- When evaluating a bubble study for shunts, determine the timing of bubble appearance (early vs. late).
- Assess the quantity of bubbles (a few vs. steady stream) and consider provoking maneuvers.
