Case File: Shocking out with severe hypoxia

Clinical Vignette: 36 year old presented in acute respiratory distress, hypotension (BP 70/40 with HR 120), and severe hypoxia (SpO2 80s with partial rebreather). Thoracic auscultation was normal though the heart sounds were masked by her breath sounds.  The jugular venous pulse (JVP) was grossly distended with no leg edema.