Monday Apr 28, 2025

Acute Hypoxic Respiratory Failure Basics - Approach Using An ABG and Chest X-ray | Clinical Medicine

In this podcast we discuss a clinical approach to hypoxemia, or low oxygen levels in the blood, that requires just an arterial blood gas and chest x-ray!

Low Aa Gradient with a high carbon dioxide level (PaCO2 from your ABG!) suggests hypoventilation, such as COPD, OHS, opioid overdose, and etc. Low Aa Gradient with a normal pCO2 suggests things like high altitude.

High Aa Gradient is then divided into vascular and alveolar pathologies. Chest X-ray negative makes vascular pathologies more likely. This is then divided into oxygen responsive and oxygen non-responsive. Oxygen responsive conditions include things like pulmonary embolism, whereas oxygen non-responsive conditions tend to be shunts, such as cardiac or pulmonary shunting.

High Aa Gradient with chest x-ray findings suggests alveolar pathologies. This is then divided into filled, collapsed, or loss. Filled suggests conditions like pulmonary edema, pneumonia, bleeding, acute respiratory distress syndrome, and more. Loss implies conditions like COPD. Collapsed may be mucous plugging, pneumothorax, and more!

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