WBM Emergency & Critical Care

Pulmonary physiology is essential for understanding hypoxemia, respiratory failure, oxygenation, V/Q mismatch, and shunt physiology. In this episode, we review ventilation-perfusion relationships, V/Q mismatch, pulmonary shunting, and the key differences between these mechanisms of impaired oxygenation.
Topics covered include:• Ventilation and perfusion basics• Normal V/Q relationships in the lung• What V/Q mismatch means• Low V/Q physiology• High V/Q physiology• What pulmonary shunt means• Right-to-left shunt physiology• Intrapulmonary and intracardiac shunts• How V/Q mismatch causes hypoxemia• How shunting causes hypoxemia• Response to supplemental oxygen• A-a gradient and oxygenation assessment• Difference between V/Q mismatch, shunt, and dead space• Common clinical examples• Pneumonia, pulmonary edema, ARDS, atelectasis, COPD, asthma, and pulmonary embolism• Practical application in respiratory failure and critical care
Watch the full video on YouTube:https://www.youtube.com/watch?v=gPrdV99D2qs
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⚠️ Educational Disclaimer:This content is intended for educational purposes only and should not be used as a substitute for clinical judgment, institutional protocols, specialist consultation, or individualized patient care.Full disclaimer: https://whiteboardmedicine.com/disclaimer

Hepatopulmonary syndrome and portopulmonary hypertension are two important pulmonary vascular complications of liver disease and portal hypertension. In this episode, we compare hepatopulmonary syndrome with portopulmonary hypertension, focusing on pathophysiology, clinical presentation, diagnostic evaluation, hemodynamics, treatment, and liver transplant considerations.
Topics covered include:• What hepatopulmonary syndrome is• What portopulmonary hypertension is• How liver disease and portal hypertension affect the pulmonary circulation• Intrapulmonary vascular dilatations in hepatopulmonary syndrome• Pulmonary vascular remodeling in portopulmonary hypertension• Hypoxemia, platypnea, and orthodeoxia• Pulmonary hypertension symptoms and right heart strain• Pulse oximetry and arterial blood gas testing• Contrast-enhanced echocardiography and bubble study• Transthoracic echocardiography screening• Right heart catheterization and hemodynamic confirmation• Differentiating hepatopulmonary syndrome from portopulmonary hypertension• Oxygen therapy and supportive care• Pulmonary vasodilator therapy• Liver transplantation considerations
Watch the full video on YouTube:https://www.youtube.com/watch?v=OfN0gn4qavc
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⚠️ Educational Disclaimer:This content is intended for educational purposes only and should not be used as a substitute for clinical judgment, institutional protocols, specialist consultation, or individualized patient care.Full disclaimer: https://whiteboardmedicine.com/disclaimer

Spontaneous bacterial peritonitis, or SBP, is a serious infection of ascitic fluid that occurs in patients with cirrhosis and portal hypertension. In this episode, we review the pathophysiology, clinical presentation, diagnostic evaluation, treatment, albumin use, and prophylaxis of spontaneous bacterial peritonitis.
Topics covered include:• What spontaneous bacterial peritonitis is• Why SBP occurs in cirrhosis and ascites• Bacterial translocation and ascitic fluid infection• Clinical presentation and symptoms• When to perform diagnostic paracentesis• Ascitic fluid cell count and PMN threshold• Ascitic fluid culture and diagnostic testing• Differentiating SBP from secondary bacterial peritonitis• Initial antibiotic treatment• Cefotaxime, ceftriaxone, and antibiotic selection• Albumin therapy and prevention of kidney injury• Repeat paracentesis and treatment response• Primary and secondary SBP prophylaxis• Norfloxacin, ciprofloxacin, and trimethoprim-sulfamethoxazole• Practical management considerations in cirrhosis
Watch the full video on YouTube:https://www.youtube.com/watch?v=bXhdupsucHM
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Join a growing emergency medicine, critical care, and resuscitation education community built around high-yield clinical learning.
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🌐 WhiteBoard Medicine WebsiteExplore our growing library of critical care and emergency medicine content:https://www.whiteboardmedicine.com
⚠️ Educational Disclaimer:This content is intended for educational purposes only and should not be used as a substitute for clinical judgment, institutional protocols, specialist consultation, or individualized patient care.Full disclaimer: https://whiteboardmedicine.com/disclaimer

Hepatorenal syndrome is a serious kidney complication of advanced liver disease and portal hypertension. In this episode, we review the pathophysiology, diagnostic criteria, clinical evaluation, differential diagnosis, and treatment of hepatorenal syndrome.
Topics covered include:• What hepatorenal syndrome is• The relationship between cirrhosis, portal hypertension, and kidney dysfunction• Splanchnic vasodilation and reduced effective arterial blood volume• Renal vasoconstriction and decreased kidney perfusion• HRS-AKI and HRS-NAKI terminology• Diagnostic criteria for hepatorenal syndrome• Differentiating HRS from prerenal azotemia and acute tubular injury• Initial evaluation of AKI in cirrhosis• Albumin challenge and volume assessment• Holding diuretics and nephrotoxic medications• Terlipressin, norepinephrine, midodrine, and octreotide• Role of albumin therapy• Renal replacement therapy considerations• Liver transplantation as definitive therapy• Practical management considerations
Watch the full video on YouTube:https://www.youtube.com/watch?v=1x1nxyuwXVs
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Join a growing emergency medicine, critical care, and resuscitation education community built around high-yield clinical learning.
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🌐 WhiteBoard Medicine WebsiteExplore our growing library of critical care and emergency medicine content:https://www.whiteboardmedicine.com
⚠️ Educational Disclaimer:This content is intended for educational purposes only and should not be used as a substitute for clinical judgment, institutional protocols, specialist consultation, or individualized patient care.Full disclaimer: https://whiteboardmedicine.com/disclaimer

V/Q mismatch and pulmonary shunt are two major physiologic mechanisms of hypoxemia, but they affect oxygenation in different ways. In this episode, we compare ventilation-perfusion mismatch with pulmonary shunt physiology, focusing on how each develops, how they differ clinically, and why their response to supplemental oxygen is different.
Topics covered include:• What V/Q mismatch means• What pulmonary shunt means• Ventilation and perfusion basics• Low V/Q physiology• High V/Q physiology• True shunt physiology• How V/Q mismatch causes hypoxemia• How pulmonary shunt causes hypoxemia• Response to supplemental oxygen• A-a gradient and oxygenation assessment• Common causes of V/Q mismatch• Common causes of pulmonary shunt• Pneumonia, pulmonary edema, ARDS, atelectasis, COPD, asthma, and pulmonary embolism• Practical comparison for respiratory failure and critical care
Watch the full video on YouTube:https://www.youtube.com/watch?v=zfly57Y8COA
📚 Join the WhiteBoard Medicine Patreon Communityhttps://www.patreon.com/WhiteBoardMedicine
Join a growing emergency medicine, critical care, and resuscitation education community built around high-yield clinical learning.
Patreon members get access to:• Comprehensive Study Guides• Bedside One-Pagers• Clinical Reviews• Mini-Courses• Practice Questions• Ad-Free Videos• Structured Topic Collections
🌐 WhiteBoard Medicine WebsiteExplore our growing library of critical care and emergency medicine content:https://www.whiteboardmedicine.com
⚠️ Educational Disclaimer:This content is intended for educational purposes only and should not be used as a substitute for clinical judgment, institutional protocols, specialist consultation, or individualized patient care.Full disclaimer: https://whiteboardmedicine.com/disclaimer

Pulmonary shunt is an important physiologic mechanism of hypoxemia and respiratory failure. In this episode, we review what a pulmonary shunt is, how shunt physiology affects oxygenation, how it differs from V/Q mismatch and dead space ventilation, and why shunt physiology often responds poorly to supplemental oxygen.
Topics covered include:• What pulmonary shunt means• Normal ventilation and perfusion relationships• Right-to-left shunt physiology• Intrapulmonary versus intracardiac shunt• How pulmonary shunt causes hypoxemia• Why shunt responds poorly to supplemental oxygen• Difference between shunt, V/Q mismatch, and dead space• Low V/Q physiology versus true shunt• Alveolar collapse and atelectasis• Pneumonia, pulmonary edema, ARDS, and consolidation• A-a gradient and oxygenation assessment• Clinical examples of shunt physiology• Practical relevance in respiratory failure and critical care
Watch the full video on YouTube:https://www.youtube.com/watch?v=dQGNjMO8JpQ
📚 Join the WhiteBoard Medicine Patreon Communityhttps://www.patreon.com/WhiteBoardMedicine
Join a growing emergency medicine, critical care, and resuscitation education community built around high-yield clinical learning.
Patreon members get access to:• Comprehensive Study Guides• Bedside One-Pagers• Clinical Reviews• Mini-Courses• Practice Questions• Ad-Free Videos• Structured Topic Collections
🌐 WhiteBoard Medicine WebsiteExplore our growing library of critical care and emergency medicine content:https://www.whiteboardmedicine.com
⚠️ Educational Disclaimer:This content is intended for educational purposes only and should not be used as a substitute for clinical judgment, institutional protocols, specialist consultation, or individualized patient care.Full disclaimer: https://whiteboardmedicine.com/disclaimer

Portopulmonary hypertension is an important pulmonary vascular complication of portal hypertension and advanced liver disease. In this episode, we review the pathophysiology, clinical presentation, diagnostic evaluation, hemodynamic criteria, and treatment of portopulmonary hypertension.
Topics covered include:• What portopulmonary hypertension is• The relationship between portal hypertension and pulmonary arterial hypertension• Pathophysiology of pulmonary vascular remodeling• Clinical presentation and symptoms• Screening with transthoracic echocardiography• Right heart catheterization and diagnostic confirmation• Hemodynamic criteria for diagnosis• Differentiating portopulmonary hypertension from hepatopulmonary syndrome• Severity assessment and risk stratification• Pulmonary vasodilator therapy• Oxygen, diuretics, and supportive care• Liver transplantation considerations• Practical clinical considerations in advanced liver disease
Watch the full video on YouTube:https://www.youtube.com/watch?v=e02CbywSFQM
📚 Join the WhiteBoard Medicine Patreon Communityhttps://www.patreon.com/WhiteBoardMedicine
Join a growing emergency medicine, critical care, and resuscitation education community built around high-yield clinical learning.
Patreon members get access to:• Comprehensive Study Guides• Bedside One-Pagers• Clinical Reviews• Mini-Courses• Practice Questions• Ad-Free Videos• Structured Topic Collections
🌐 WhiteBoard Medicine WebsiteExplore our growing library of critical care and emergency medicine content:https://www.whiteboardmedicine.com
⚠️ Educational Disclaimer:This content is intended for educational purposes only and should not be used as a substitute for clinical judgment, institutional protocols, specialist consultation, or individualized patient care.Full disclaimer: https://whiteboardmedicine.com/disclaimer

Hemoptysis is an important clinical presentation that can range from minor blood-streaked sputum to life-threatening airway and respiratory failure. In this episode, we review the causes, initial evaluation, severity assessment, diagnostic approach, and management of hemoptysis.
Topics covered include:• What hemoptysis is• Differentiating hemoptysis from hematemesis and upper airway bleeding• Common causes of hemoptysis• Bronchitis, pneumonia, bronchiectasis, malignancy, pulmonary embolism, tuberculosis, and diffuse alveolar hemorrhage• Massive versus non-massive hemoptysis• Airway assessment and stabilization• Oxygenation and ventilation considerations• Initial laboratory and imaging evaluation• Chest X-ray and CT angiography• Role of bronchoscopy• Reversal of anticoagulation and coagulopathy• Bronchial artery embolization• Surgical consultation and definitive management• Practical emergency and critical care considerations
Watch the full video on YouTube:https://www.youtube.com/watch?v=aju1pgnTIXE
📚 Join the WhiteBoard Medicine Patreon Communityhttps://www.patreon.com/WhiteBoardMedicine
Join a growing emergency medicine, critical care, and resuscitation education community built around high-yield clinical learning.
Patreon members get access to:• Comprehensive Study Guides• Bedside One-Pagers• Clinical Reviews• Mini-Courses• Practice Questions• Ad-Free Videos• Structured Topic Collections
🌐 WhiteBoard Medicine WebsiteExplore our growing library of critical care and emergency medicine content:https://www.whiteboardmedicine.com
⚠️ Educational Disclaimer:This content is intended for educational purposes only and should not be used as a substitute for clinical judgment, institutional protocols, specialist consultation, or individualized patient care.Full disclaimer: https://whiteboardmedicine.com/disclaimer

V/Q mismatch is one of the most important physiologic mechanisms of hypoxemia and respiratory failure. In this episode, we review the physiology of ventilation-perfusion matching, high V/Q states, low V/Q states, shunt physiology, dead space ventilation, oxygen response, and the clinical relevance of V/Q mismatch.
Topics covered include:• What V/Q mismatch means• Ventilation and perfusion basics• Normal V/Q relationships in the lung• Low V/Q physiology• High V/Q physiology• Shunt physiology• Dead space ventilation• How V/Q mismatch causes hypoxemia• Response to supplemental oxygen• Common clinical causes of V/Q mismatch• Pneumonia, pulmonary edema, COPD, asthma, and pulmonary embolism• Practical interpretation of oxygenation problems• Clinical relevance in respiratory failure and critical care
Watch the full video on YouTube: https://www.youtube.com/watch?v=lHEzgqx33HI
📚 Join the WhiteBoard Medicine Patreon Communityhttps://www.patreon.com/WhiteBoardMedicine
Join a growing emergency medicine, critical care, and resuscitation education community built around high-yield clinical learning.
Patreon members get access to:• Comprehensive Study Guides• Bedside One-Pagers• Clinical Reviews• Mini-Courses• Practice Questions• Ad-Free Videos• Structured Topic Collections
🌐 WhiteBoard Medicine WebsiteExplore our growing library of critical care and emergency medicine content:https://www.whiteboardmedicine.com
⚠️ Educational Disclaimer:This content is intended for educational purposes only and should not be used as a substitute for clinical judgment, institutional protocols, specialist consultation, or individualized patient care.Full disclaimer: https://whiteboardmedicine.com/disclaimer

Acid-base interpretation and blood gas analysis are core skills for evaluating metabolic acidosis, metabolic alkalosis, respiratory acidosis, respiratory alkalosis, anion gap disorders, mixed acid-base disorders, ABGs, and VBGs. In this episode, we review a structured approach to acid-base physiology, anion gap interpretation, delta gap analysis, and blood gas interpretation.
Topics covered include:• Acid-base physiology and core definitions• Metabolic acidosis• Metabolic alkalosis• Respiratory acidosis• Respiratory alkalosis• Arterial blood gas interpretation• Venous blood gas interpretation• ABG versus VBG interpretation• Anion gap calculation and interpretation• Albumin correction for the anion gap• High anion gap metabolic acidosis• Normal anion gap metabolic acidosis• Delta gap and delta ratio analysis• Mixed acid-base disorders• Compensation and expected respiratory response• Practical acid-base problem solving
Watch the full video on YouTube:
https://www.youtube.com/watch?v=bC90uByQpcc
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⚠️ Educational Disclaimer:This content is intended for educational purposes only and should not be used as a substitute for clinical judgment, institutional protocols, specialist consultation, or individualized patient care.Full disclaimer: https://whiteboardmedicine.com/disclaimer