By Dr Adam Michael

Here are some key takeaways: 

1. The right ventricle and left ventricle are very different and we have to consider potential right ventricular failure
2. “The things that we often do for the shocked patient, will make the situation worse, if right ventricular failure is causing the problem”. This often leads to the ‘Right Ventricular Spiral of Death’.
3. The right ventricle handles pre-load very well.
4. Blocked ‘pipes’ are one of three ways that right ventricular failure occurs and these blockages occur, by either a large vessel occlusion due to a PE or through pulmonary vasoconstriction (due to hypoxic/hypercarbic lungs).
5. To unblock the pipes we need to correct hypoxia and decrease CO2. We can consider using NItric Oxide or nebulised GTN.
6. Beware positive pressure ventilation, as it may increase pulmonary vascular resistance.
7. There are specific steps involved to intubating patients with right ventricular failure including: optimising oxygenation and blood pressure, avoid hypoxia and hypercarbia and avoiding high inspiratory pressures.