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Here's my rapid approach to shunt in the ICU.If a patient is on high FiO2 and still hypoxic, they are shunting (other forms of hypoxia respond to O2)Two options:1. Lung (most cases)2. CardiacIf normal chest x-ray, consider cardiac BUT remember that CXR is insensitive for consolidation and many patients have atelectasis and are just shunting through that.CXR→ Abnormal = treat lung→ Normal = go deeperBubble study→ Early bubbles = intracardiac shunt (e.g., Patent Foramen Ovale)→ Negative = proceedL
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