nkhanch, ugh. Thanks for pointing this out. This is what happens when you don't have an editor double checking these things...very annoyed at myself! Adding an annotation to correct the error.
Sorry man, it was 10 years, 2 homes, and 3 computers ago. My notes from this era of videos are long gone. If I had to guess, one of the primary references was probably Marino's The ICU Book, supplemented with papers from the primary literature. These days though, there are better resources than Marino (no disrespect!). derangedphysiology.com is a wonderful resource to better understand respiratory physiology and pathophysiology.
Quick question: approximately how long after giving supplemental oxygen would one expect to find physiological equilibrium? That is to ask, about how long does it take until the ABG accurately reflects the change in FiO2?
In my experience, it takes less than 5 minutes. However, I have heard others cite 10-15 min (or more) as the length of time to wait after changing FiO2 before rechecking an ABG - which seems excessive to me unless they believe it takes that long to manifest the increased physiologic intrapulmonary shunting caused by high FiO2. To the best of my knowledge, the time course for this process hasn't been well measured.
Hello Dr Strong. I´m curious, during the pandemic in many hospitals with shortness of High flow nasal cannula they used a normal nasal cannula and a reservoir mask on top, both al full flow (6l/m and 15l/m). Does it have any impact on FiO2 and oxigenation of the patient? or would it be as in the graph presented?
A quick desperate question please that i've been struggling to get my head around: - why does supplemental O2 in Pulmonary oedema cause a further widening of the A-a gradient?
Simply because it increases the alveolar oxygen pressure (A) without causing a corresponding increase in the arterial oxygen pressure (a) . In case of pulmonary edema gas exchange is impaired in the affected alveoli & intrapulmonary shunt of blood takes place towards the intact ones . The shunted blood doesn't get adequate oxygenation by the intact alveoli even with supplemental oxygen !
Hi, doctor strong. In case 1 , doesn't the normal gradient formula calculate the upper limit of A-a gradient? So in this patient the gradient beyonds normal range?
Example 2: Someone with a RR of 30 does not qualify for a NC, shouldn't he be placed on a Venti mask to control how much O2 he is getting because he is hyperoxemic? Possibly at 28%?
Nkhanch, u might wanna check ur PrMask, THE RESERVOIR BAG SHOULD A VALVE while EXP ports shouldnt have any Valves to allow entrainment of ambient air into the appliance reservoir and pure O2 exiting the Valve of the Bag ONLY during INSPIRATION- sorry ^^
nkhanch, ugh. Thanks for pointing this out. This is what happens when you don't have an editor double checking these things...very annoyed at myself! Adding an annotation to correct the error.
Excellent video Dr. Would you mind if I asked for the references that you used on this video for further and more in-depth reading? Than you.
Sorry man, it was 10 years, 2 homes, and 3 computers ago. My notes from this era of videos are long gone. If I had to guess, one of the primary references was probably Marino's The ICU Book, supplemented with papers from the primary literature. These days though, there are better resources than Marino (no disrespect!). derangedphysiology.com is a wonderful resource to better understand respiratory physiology and pathophysiology.
@@StrongMed actual mvp! Thanks doctor!
Quick question: approximately how long after giving supplemental oxygen would one expect to find physiological equilibrium? That is to ask, about how long does it take until the ABG accurately reflects the change in FiO2?
In my experience, it takes less than 5 minutes. However, I have heard others cite 10-15 min (or more) as the length of time to wait after changing FiO2 before rechecking an ABG - which seems excessive to me unless they believe it takes that long to manifest the increased physiologic intrapulmonary shunting caused by high FiO2. To the best of my knowledge, the time course for this process hasn't been well measured.
Hello Dr Strong. I´m curious, during the pandemic in many hospitals with shortness of High flow nasal cannula they used a normal nasal cannula and a reservoir mask on top, both al full flow (6l/m and 15l/m). Does it have any impact on FiO2 and oxigenation of the patient? or would it be as in the graph presented?
Excellent lecture.thanks a lot.
A quick desperate question please that i've been struggling to get my head around:
- why does supplemental O2 in Pulmonary oedema cause a further widening of the A-a gradient?
Simply because it increases the alveolar oxygen pressure (A) without causing a corresponding increase in the arterial oxygen pressure (a) . In case of pulmonary edema gas exchange is impaired in the affected alveoli & intrapulmonary shunt of blood takes place towards the intact ones . The shunted blood doesn't get adequate oxygenation by the intact alveoli even with supplemental oxygen !
Hi, doctor strong. In case 1 , doesn't the normal gradient formula calculate the upper limit of A-a gradient? So in this patient the gradient beyonds normal range?
Example 2: Someone with a RR of 30 does not qualify for a NC, shouldn't he be placed on a Venti mask to control how much O2 he is getting because he is hyperoxemic? Possibly at 28%?
plz ventilator graphics series as the wonderful ABG series plz sir
hypoxemia in example 2?
amazing !
Nkhanch, u might wanna check ur PrMask, THE RESERVOIR BAG SHOULD A VALVE while EXP ports shouldnt have any Valves to allow entrainment of ambient air into the appliance reservoir and pure O2 exiting the Valve of the Bag ONLY during INSPIRATION- sorry ^^
brilliant again, ty
Does anyone know a good and simple book about ventilation and o2 therapy? Thanks
Thanks
OTHERWISE, THE BAG WONT INFLATE AT ALL because of a LOW FLOW Factor