Current Insights into Managing Hypoxemic Emergencies in the ED

An outbreak of EVALI in Bogotá produced rapid severe hypoxemia and ARDS in young adults — this article summarizes ED recognition and management, practical imaging approaches for COPD exacerbations, and key markers that distinguish neonatal hypoxemic conditions.

In a retrospective series of 25 patients, the EVALI cohort (Bogotá) demonstrates high rates of hypoxemia and ARDS; most required ICU-level oxygen support. The report outlines ED-relevant actions: early recognition, titrated supplemental oxygen, timely escalation to noninvasive or invasive ventilatory support, and consideration of systemic corticosteroids as an immunomodulatory strategy.

The cohort most commonly showed bilateral ground-glass opacities, frequently peripheral with subpleural sparing. In the outbreak context these imaging patterns help distinguish vaping-related lung injury from other causes of ARDS and should prompt inclusion of EVALI in the ED differential when vaping exposure is reported.

For COPD exacerbations, an immediate upright chest radiograph best excludes pneumothorax and lobar consolidation at presentation. If the radiograph is non-diagnostic or complications are suspected, selective low-dose CT offers higher sensitivity; bedside lung ultrasound provides rapid assessment of B-lines and focal consolidation to guide treatment. Escalate to CT when initial radiography does not explain the clinical picture or when instability or atypical features are present.

Congenital causes of neonatal hypoxemia often present with a differential between pre- and post-ductal saturations, poor oxygenation response to supplemental oxygen, and asymmetric cyanosis with exam clues such as murmurs or hepatomegaly. A bedside hyperoxia test pattern—limited improvement with 100% oxygen—along with targeted pulse oximetry checks helps separate cardiac from primary pulmonary or infectious causes and prompts early cardiology or surgical notification. Immediate ED priorities are stabilization, appropriate oxygen delivery, and rapid diagnostic triage.