A guide to the initial emergency department management of patients with pulmonary hypertension and right ventricular failure. It is very rare for my to write about pathophysiology, but understanding the pathophysiology of the right ventricle is essential to understanding the appropriate emergency management of these patients. In the normal state, the pulmonary circulation is a low-pressure, low-resistance system. Pulmonary pressures are increased in response to hypoxia, hypercapnia, and acidosis.

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