VA ICU report: Dyspnea versus hypoxemia; approach to acute hypoxemia

Case Summary

Thanks the ICU team for presenting a fascinating case of an 86M with multiple myeloma who developed dyspnea and refractory septic shock.

Top pearls

1. Pulse oximetry [measures the %Sat] is usually very reliable in giving us a sense of the amount of oxygen dissolved in the blood.  See below for some scenarios in which it may be misleading.

2. Remember that there are many causes of dyspnea that do NOT lead to hypoxemia – e.g., COPD exacerbation, anemia, ACS.

3. In acutely hypoxemic patients, empiric management is often needed – see image below.

Pulse Oximetry


Acute hypoxemia

Acute dyspnea .png

Dyspnea versus hypoxemia



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