Reza

Relax, take it off.

And it's such a powerful paradox between numbers and symptoms.

And I think when

and you're early on in your training or you don't have medical training, you're definitely going to trust the numbers over the symptoms.

But gosh, when you have a little bit of time and experience under your belt, the symptoms trump the numbers all the time.

And so I'd be really curious as to how this person, especially if this hypoxemia is developing over the course of a short period of time,

What its significance is in the patient isn't feeling anything.

And it's not just feeling anything.

It's also the fact that the most common causes of hypoxemia, namely the problems with the alveolus, are markedly diminished by the fact that this person has normal lung sounds.

Aaron Berkowitz likes to share this pearl on VMR a lot, which is that if you cover up one piece of data and the entire case or argument for a diagnosis collapses, you should really scrutinize that data.

So I'm doing that exercise with you, and I encourage all of you to do that, which is to cover up the O2 set and ask yourself, what are you left with?

And I think you're left with an asymptomatic person with a normal lung exam.

And so what would I do?

I think that really have to scrutinize that piece of data.

And that piece of data probably would be best scrutinized by getting an ABG to really understand this patient's oxygen saturation.

I think if you're early in your training, you might wonder why an ABG over a VBG.

And this is to emphasize that the venous blood gas gives you the venous oxygen.

And the venous oxygen is actually a function mostly of tissue consumption.

So it doesn't give you an accurate estimate of how much is making it across the alveolar capillary membrane.

So I would totally understand anybody who decided not to do this.