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 Community https://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 Website Explore 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

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“What did the council decide on item 42?” — answered with the speaker and the moment.

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