This is a patient with hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome) and both bleeds have been caused by telangiectasia throughout her upper airways and GI tract. In some cases GI bleeds can be caused by arterial-vascular malformations (AVM’s). Of note, the patient has issues with hepatic encephalopathy due to AVM’s in the liver. Sometimes, these patients get hypoxia. Any guess as to why?