Hi, thanks for the question. ARDS is generally a shunt mechanism. Pulmonary edema if very severe can also be shunt, but mild pulmonary edema is usually V/Q mismatch.

Thank you @MEDCRAMvideos for the wonderful explanations and making concepts clear.

Great video. I'm an RT student doing a project on ARDS and I didn't understand the different ways the term shunting is used...until I watched your video. Thank you!

Best med educator in KZread 👏🏾👏🏾

That was the best explanation I've ever had! Thank you so much!!!

Great Job! This is great, short, concise, all that you need to fully understand the problem! I was wondering if you could make a lecture about inotropes in different cardiac pathology...

Excellent and easy to follow. I love the old fashion drawing e- learning methods

Extremely helpful video. Thank you.

Thank you so much, this is very helpful!

Excellent video, very clear, simple without oversimplify, and it goes straight to the point in very difficult topic, in addition, beautiful diction; my second language is English and I really appreciate a clean diction, thank you very much

thx for the clear explanation!!! my doubt was cleared^^

Simply Brilliant. Thanks and God Bless

CRT studying for RRT. This is excellent review.

Another great video! Thanks!

You are a legend! great vid!

Thank you for the video! Very helpful!

Finally it makes sense! Thank you!

beautiful and clear. thanks a lot.

Nursing student here in a critical care class. Thank you so much!!!

@Medcram

5 жыл бұрын

You are very welcome!

Thanks Proff marvelous explanations.......

This was excellent! Thank you

Very helpful for an aspiring Respiratory therapist like me. Thank you so much 🙏

@Medcram

9 жыл бұрын

Ingrid2955 Good to hear- best wishes with your RT career

excellent teacher. thank you

Thank you so much. that is very helpful. Very easy to understand and follow.

@Medcram

8 жыл бұрын

+Bonny Fok Good to hear- thank you

I never feel bothered to comment but man you make it easy to study. Thanks a bunch.

@Medcram

6 жыл бұрын

Thank you for commenting!

@markcarrensalazar

5 жыл бұрын

MedCram - Medical Lectures Explained CLEARLY

Thank you so much!!!!! 🎉🎉🎉🎉🎉

I clicked that advertisment because you rock ;)

Or you can get a mixed venous blood gas from pulmonary artery catheter to measure O2 Sat and PvO2. Then you get a regular ABG. And now you can get your shunt fraction and C(a-v)O2 difference.

It's tricky. yes, you are right. but on;y if there is absolutely no ventilation. ARDS causes this most often. PNA can too. but it can also cause V/Q mismatch. If you ever have to guess - always guess V/Q mismatch unless it's obvious that the O2 is not correcting with supplemental o2.

That was really good, thank you alot professor.

Great, thank you !

Awesome! Just awesome.

Hi, can anyone please explain what does R to L shunting in pulmonary embolism mean? Is it R to L cardiac shunting or pulmonary shunting?

THANK YOU!!

This is so helpful! Could you please post videos on HCM?

great video! thanks so much!

THANK YOU 👌👍 was very helpful

My go to videos during PA school. Keep up the good work!

@Medcram

8 жыл бұрын

+Derek Smith Good to hear and best of luck in PA school

great explanation

Thank you for the video. I do not understand why the Aa gradient is increased. There is nothing in the interstitial space like in diffusion.

Thks u so much~~ I can understand shunting now

thanks hugely

excellent vid, pls do hemodynamics, no one had done it on you tube.

This lecture helps me a lot. Thank you from Med students in South Korea

@Medcram

9 жыл бұрын

Lee Jinsoo Greetings to South Korea- glad the lecture helped

Can you explain why medications such as, Nitro, nipride, and cleveprex, would cause shunting?

this is great. thanks a lot

Thank you so much, you saved my physiopath :D Merci

@Medcram

6 жыл бұрын

+Nour Baya love it!

So by definition a hemothorax is one giant shunt, bipap with high epap would oxygenate better than 100% alone ?

Awesome explanation :)

Very good explanation

Very interesting and very helpful indeed. Thank you so much.

@Medcram

9 жыл бұрын

Tina Arena thanks for the feedback- glad it was helpful

Hi! Would appreciate if you could give a reply because I cannot seem to find an answer anywhere else. In shunts like ARDS, does PAO2 not decrease since there is no ventilation? Therefore, doesn't PAO2 and PaO2 both decrease and this lead to no change in the A-a gradient? thank you very much!

Dank u wel ! Groet uit Amsterdam

thanks you very much.. very nice presentation and clearly explained the topic..

@Medcram

9 жыл бұрын

DR RAJAT MOHANTY Thank you for the feedback

Your videos are great. They helped me get a A in all my nursing classes. I also have a respiratory degree and I am reviewing. I just have one question about his video. I may be wrong but don't you get a L-R shunt because the pressures on the L side of the heart are greater than the R side of the heart. (through the ASD and VSD) it still results with oxygenated blood on the left side mixing with unoxygenated blood on the right side? Just wondering. Thanks.

@YouAreLoved21

5 жыл бұрын

I have the same question about the mentioned R-L shunt, is it supposed to be L-R shunt for ASD,VSD and PDA?

thanks

Thanks a lot 👍

Really clear explanation! However just wanted to check, if pulmonary oedema causes pathological shunting, do the following also apply? pulmonary embolus, pneumonia, atelectasis, pneumo/haemothorax?

6:08 - If you can see math like this, you can become an absolutely amazing pulmonologst or anasthesiologist

Shunting is by definition no ventillation. PE affects perfusion, causing VQ mismatch

You are amazing 💖

Butifully explained.

I was told yesterday that I had a shunt, I do not know how to react, or if it was normal the reaction of my doctors, you can tell me the risks.

Can i please ask something? At first you were talking about shunting in the pulmonary artery but later when you described the RT to Lt shunt of ARDS, the shunting was happening in the heart. My question is does the pulmonary artery shunting happen in the lungs or somewhere else? also, where does the Rt to Lt shunting of blood due to ARDS happen, in the heart or lungs?

@yasmine4754

7 жыл бұрын

He only briefly mentioned the heart to explain, that shunting can happen in other places too, for example in the heart. Another word for shunting could be "bypassing", but the video itself is only about pulmonary shunting, blood continuing to flow without being oxygenated, ARDS is an example of shunting, so is pulmonary edema and pneumonia, think of a bus driving down a road, people standing at the bus stop to be picked up, but the bus never stops to pick them up, just continues to drive. : )

@marszalikm89

6 жыл бұрын

I think it's more like, the buses are coming, but no one is even there to be picked up.

@drrajurajan

6 жыл бұрын

More like no bus stop!!!

@MegaJunebug420

5 жыл бұрын

Anatomical shunt vs Physiological shunt

Hello, thank you for this video! My daughter has had 3 instances of crying/vomiting, then falling unconscious with her eyes open and not breathing. We were told she had a VSD at birth and it hasn't gone away (she's 15 months old). My mom's aunt had a RTL shunt - is it common to pass out/stop breathing with a RTL shunt? What's the reason for this? Thank you for any help! (P.S. - we are going to the cardiologist and have an echo scheduled.)

great!

Can ARDS and Pulmo Edema present as either VQ shunt or Diffusion limited, depending on the severity of the case? I see what your saying, but I see different diseases, like ARDS, fibrosis, presenting as different types of Hypoxia. Thanks for putting this topic is clear and simple terms. I was confused when during my profs lecture

thanks, good lesson for understanding shunting

@Medcram

9 жыл бұрын

ofebell thanks for the comment

MAGNIFICO

Awesome thanks 👍😀

What causes shunting during general anaesthesia?

Awesome!

Great video - thanks! One question: why is ARDS/pulmonary oedema considered a shunting problem, and not a diffusion problem? Or is it both?

@snoopytroops

8 жыл бұрын

Think I partly understand: the extra fluid causes alveolar collapse, rendering areas of lung non-viable. Therefore blood passing through these areas can't exchange gas, and is shunted back into the systemic circulation deoxygenated. Still think this sounds pretty similar to what happens in diffusion failure...?

What about the Bohr effect ?

I understood most of this. Thank you very much! But I do have one question though... If hypoxemia due to shunts does not improve well with 100% oxygen therapy, could that be used as a diagnostic tool? To identify the cause of the hypoxemia? Thanks in advance!

@Medcram

8 жыл бұрын

+Hagai Cohen Yes - absolutely. It also pops u[p on tests as well. I often see it in the ICU when a patient has ARDS. Turning up the FIO2 just doesn't seem to correct the hypoxemia. PEEP does. Look at the ventilator lecture for more info.

How can I download your very informative videos?

awesome video! i dont understand one thing however, if ARDS is considered a shunt then why isnt fibrosis considered a shunt? Or can ARDS be a diffusion problem too?

Excellent ....aziz

Right to left shunting, how would that affect this mechanism? Also isnt PDA Left to right shunting not what you mentioned?

You are amazing

Hi Dr. This was a great video. But I'm still a little confused. I had a USMLE question that said, Pulmonary Embolism isn't considered shunting, but it's more of a Deadspace problem. Why isn't ARDS considered a Deadspace problem, but more of a Shunting problem. Isn't it like of similar? Both situations Ventilation is normal, ..... is it because shunting has normal profusion, while Deadspace have no profusion?

@Medcram

8 жыл бұрын

+H ta da izo Pulmonary Embolism is actually V/Q mismatch. There is dead space in the fact that lung is being ventilated and not perfused or perfused rather poorly. ARDS clearly is a situation where the opposite is happening (Perfusion but no ventilation) The protein rish exudative lung secretions are preventing any oxygen exchange with the pulmonary capillaries --> effectively shunt.

@fatboy117

8 жыл бұрын

Hi dr. Medcram... thanks for the update. I got it!! pls more videos! =) and Happy new year best of luck.

@nicholasdesnoyer8505

8 жыл бұрын

So in this case, would pneumonia be a shunting of diffusion problem?

Thank you for your video and explanation But, I wanna ask about something Is it a normal thing in the healthy body?

@Medcram

7 жыл бұрын

+L7nee 9 yes but only if it is less than 1%. There are a few veins in the heart that can do this. Thesibian veins.

why high PaO2 blood in the normal segment dont increase SaO2 in shunted segment after joining each other?

@Medcram

6 жыл бұрын

+duc anh duong it does. But only a very small amount: o2 content = 1.34 x hgb x sat + pao2 x .003.

thank you for your videos. i have a question; can you please clarify the difference between anatomic dead space and shunting. Please. thank you.

@Medcram

8 жыл бұрын

+sandy123288 Thank you for the question. Dead space: all ventilation and no perfusion (Example: trachea) Shunting: no ventilation and all perfusion (example: alveolus filled with fluid)

@hausachemist5082

4 жыл бұрын

@@Medcram All in all, awesome explanation thank you so much.

Very illustrative but need to add shunt equation and methods of mesuring shunt.

Would it be accurate to say that a diffusion problem taken to its absolute limit would be a shunt?

Can COPD be a shunt problem?

thank u

I think it is very important to point out that this is only accurate if you are talking about a R to L shunt. Also you mentioned that a VSD and ASD would be R to L shunts but that is not necessarily correct most of the time (assuming your pulmonary resistance has dropped as it is supposed to) an ASD and VSD and PDA become L to R shunts. Am I correct?

yesm but they act differently. Look up "inert gas technique" to see ore technical and sometimes confusing information.

Where exactly does the shunted blood go then since it doesn't go to the lungs?

@TweetyBird4551

10 жыл бұрын

***** Start watching this at 10:00 and pay attention! Dr. Seheult covers this.

PLEASE HELP. In pneumonia you have alveolar infiltrates correct? In ARDS you have your alveola are filled. Doesn't that mean both situations have deceased ventilation and thus both are shunting.

@poonehbarati2494

5 жыл бұрын

Both of them can cause intrapulmonary shunts ;thus, you are right!

Atelectasis?

Where's Thomas?

amaz

ASD,VSD,PDA = Left to right shunt........ Tricuspid atresia, Tetralogy of fallot, Transposition = Right to left shunt..

isnt pulmonary arteries the ones with oxygen and veins the ones without?

@Medcram

5 жыл бұрын

+Aj no. Pulmonary artery has low oxygen. Then lungs give it oxygen then it goes back to heart via pulmonary veins.

I LOVE YOU

??? ... Isn't ARDS and pulmonary edema examples of wasted ventilation and having nothing to do with shunt ??? I have more questions then answers now ...

Also, her lips turned blue, that seems to be very important to add.