Thanks for this great info! You are really making me excited to become a RRT. I graduate soon & I strive to be a dynamic & effective RRT and the info you provide is leading me in that direction! Keep up your awesome work! I have gained so much confidence just by reviewing your videos!
That's awesome, John. If I motivate one person to go out and be a great RRT, then I've fulfilled my purpose for making these videos. Go be great my man!!!
Hey Margo! Wish you were my student! Self studying to learn respiratory therapy seems like a hard situation to be in. Let me know if I can ever help. My email is in the video description. Thanks for watching!!
@@RespiratoryCoach busy as expected. Thanks for asking. I just hope my employer will switch to MDI on highly suspicious cases instead of waiting for positive cases
What a great video! I have only 1 question if you don't mind. I've seen your videos about respiratory acidosis and respiratory alkalosis, but according to those videos I thought Bicarb increases so pH can get to normal levels, but why, in this case, Bicarb stays the same and CO2 affects pH? Thank you!
Sodium bicarbonate therapy Sodium bicarbonate (NaHCO3) is a crystalline chemical compound commonly known as baking soda that can be produced industrially. It can bring the pH level in the human body to equilibrium, that is 7.35 pH 7.45. In [5], Engelking asserted "Sodium bicarbonate (NaHCO3) solutions are sometimes administered to patients with metabolic acidosis who have both a low plasma HCO3− concentration, and a low plasma pH (< 7.2). Since this salt is for the most part completely dissociated in aqueous solution, Na+, HCO3−, and H2O are effectively added to the extracellular fluid (ECF) compartment (Figure 1). Since Na+ molecules are being added without Cl−, and since HCO3− has a tendency to displace Cl− from ECF compartment, both effects contribute to increase the strong ion difference (SID), thus causing alkalinization. In addition, added HCO3− acts as a buffer to accept protons, and generate CO2 and H2O. Although the Pco2 rises by about 0.5 mmHg for each mEq/L increase in the plasma HCO3− concentration, assuming the lungs are normal, this excess CO2 should stimulate ventilatory drive, and thus expiration. If a NaHCO3 solution is administered rapidly, however, ventilatory drive may not be appropriately regulated"
Thk you so much for the wonderful class. I have a query that if a intubated pt have uncompensated Met. Acidosis, can we increase the RR and decrease the Ti to do hyperventilation to compensate the acidosis.
Hi. Yes, to help stabilize the pH, hyperventilation would be appropriate, but not at the expense of stressing the alveoli with excessive ventilation. As the metabolic acidosis corrects, minute volume should be decreased to not cause an alkalosis. ETCO2 is a great tool to help manage this. Great question and observation in understanding the RTs role in metabolic disturbances. Thank you for watching and contributing.
What do you think the long term effects of the coronavirus for parients who were in ARDS? Long term vent support? Do we have enough LTACs to support also do they have the staff?
Hi, Jihan. I'd be a wealthy man if I knew the answers to those questions. I suspect similar to other diseases and injuries that lead to ARDS and long term ventilation, which we know can range from normal to restrictive findings in regards to PFTs. No idea on the capability of our LTACs. Good questions, Jihan. Thanks for contributing and watching.
Thank you for useful video, I really enjoying and learning from videos.. and I try to discuss with doctors to give quality care for patients, I have question when there patient with acidosis blood gas (CO2 HIGH) and it already in high setting RR 35 and tidal volume also high .. and still the blood gas have HIGH CO2 as RT what i can to do ?
Permissive hypercapnia. In this situation, the need to focus on adequate, as opposed to normal, is a must. We can't always achieve normal, strive for adequate!!! Thank you for watching and commenting!!!
Hi Eduardo, did you see my latest video? Just posted today. Here's the link...th-cam.com/video/AC0gETwYhic/w-d-xo.html It's probably not as informative as what you are hoping for, but the purpose was to provide some really good resources for you to access and inform yourself with. Let me know if you have any questions. Best wishes, my friend!
Hi, Khalid. Well, it's either a fully compensated metabolic acidosis or fully compensated respiratory alkalosis. 7.40 is neither acidotic or alkalotic, so you would have to know more about the patient to correctly interpret this gas. Is it a DKA patient and the patient is Kussmaul breathing? What's the anion gap? Or is it a traumatic brain injury patient with chronic hyperventilation. Hope that helps!
Thanks for this great info! You are really making me excited to become a RRT. I graduate soon & I strive to be a dynamic & effective RRT and the info you provide is leading me in that direction! Keep up your awesome work! I have gained so much confidence just by reviewing your videos!
That's awesome, John. If I motivate one person to go out and be a great RRT, then I've fulfilled my purpose for making these videos. Go be great my man!!!
This was super helpful for grasping a better understanding of the material I am going over in class. Thank you so much!
You're very welcome, Alexia! Thank you for watching!
Thank you ! such a great explanation...my program is a self-study ..no help from professors .Wish you were my professor.
Hey Margo! Wish you were my student! Self studying to learn respiratory therapy seems like a hard situation to be in. Let me know if I can ever help. My email is in the video description. Thanks for watching!!
Informative as always!!! :)
Thanks coach for the great video 👍
Thank you, Khalid, for watching and commenting. Much appreciated!
Great video and very informative.
Thanks, Isaac! How are things going at your facility?
@@RespiratoryCoach busy as expected. Thanks for asking. I just hope my employer will switch to MDI on highly suspicious cases instead of waiting for positive cases
Thank you
Thank you for watching and commenting!
What a great video! I have only 1 question if you don't mind. I've seen your videos about respiratory acidosis and respiratory alkalosis, but according to those videos I thought Bicarb increases so pH can get to normal levels, but why, in this case, Bicarb stays the same and CO2 affects pH? Thank you!
Thank u i loved it
Sodium bicarbonate therapy
Sodium bicarbonate (NaHCO3) is a crystalline chemical compound commonly known as baking
soda that can be produced industrially. It can bring the pH level in the human body to
equilibrium, that is 7.35 pH 7.45.
In [5], Engelking asserted "Sodium bicarbonate (NaHCO3) solutions are sometimes administered
to patients with metabolic acidosis who have both a low plasma HCO3− concentration, and a low
plasma pH (< 7.2). Since this salt is for the most part completely dissociated in aqueous solution,
Na+, HCO3−, and H2O are effectively added to the extracellular fluid (ECF) compartment
(Figure 1). Since Na+ molecules are being added without Cl−, and since HCO3− has a tendency
to displace Cl− from ECF compartment, both effects contribute to increase the strong ion
difference (SID), thus causing alkalinization. In addition, added HCO3− acts as a buffer to
accept protons, and generate CO2 and H2O. Although the Pco2 rises by about 0.5 mmHg for
each mEq/L increase in the plasma HCO3− concentration, assuming the lungs are normal, this
excess CO2 should stimulate ventilatory drive, and thus expiration. If a NaHCO3 solution is
administered rapidly, however, ventilatory drive may not be appropriately regulated"
Hi Valerie. Thank you for this comment. We too administer NaHCO3, specifically in the presence of a non-gap (or normal anion gap) metabolic acidosis.
Love you man❤️
You are amazing
Thk you so much for the wonderful class. I have a query that if a intubated pt have uncompensated Met. Acidosis, can we increase the RR and decrease the Ti to do hyperventilation to compensate the acidosis.
Hi. Yes, to help stabilize the pH, hyperventilation would be appropriate, but not at the expense of stressing the alveoli with excessive ventilation. As the metabolic acidosis corrects, minute volume should be decreased to not cause an alkalosis. ETCO2 is a great tool to help manage this. Great question and observation in understanding the RTs role in metabolic disturbances. Thank you for watching and contributing.
What do you think the long term effects of the coronavirus for parients who were in ARDS? Long term vent support? Do we have enough LTACs to support also do they have the staff?
Hi, Jihan. I'd be a wealthy man if I knew the answers to those questions. I suspect similar to other diseases and injuries that lead to ARDS and long term ventilation, which we know can range from normal to restrictive findings in regards to PFTs. No idea on the capability of our LTACs. Good questions, Jihan. Thanks for contributing and watching.
Some nurses call for Bipap on metabolic acidosis stating that the pt. Is acidotic. Which way to approach it and do the best for your patient?
Thank you for useful video, I really enjoying and learning from videos.. and I try to discuss with doctors to give quality care for patients, I have question when there patient with acidosis blood gas (CO2 HIGH) and it already in high setting RR 35 and tidal volume also high .. and still the blood gas have HIGH CO2 as RT what i can to do ?
Permissive hypercapnia. In this situation, the need to focus on adequate, as opposed to normal, is a must. We can't always achieve normal, strive for adequate!!! Thank you for watching and commenting!!!
Coach, please make more videos on ARDS to help fight(Covid-19)
Hi Eduardo, did you see my latest video? Just posted today. Here's the link...th-cam.com/video/AC0gETwYhic/w-d-xo.html
It's probably not as informative as what you are hoping for, but the purpose was to provide some really good resources for you to access and inform yourself with. Let me know if you have any questions. Best wishes, my friend!
What the is interpretation for PH: 7.40 Co2: 25 HCO3: 13 it just popped out when you explained the last part can you please help 🙏
Hi, Khalid. Well, it's either a fully compensated metabolic acidosis or fully compensated respiratory alkalosis. 7.40 is neither acidotic or alkalotic, so you would have to know more about the patient to correctly interpret this gas. Is it a DKA patient and the patient is Kussmaul breathing? What's the anion gap? Or is it a traumatic brain injury patient with chronic hyperventilation. Hope that helps!
What can you do if pt on a vent on full support and they have Partially uncompensated metabolic acidosis and Is breathing over the vent ?
Where did you get your board?
I don't remember, but Staples or Office Dept will have them.
Can you drop a link to your anion gap video? Thanks!
Here ya go, Stacey. th-cam.com/video/WgdkuD5Qusg/w-d-xo.html
@@RespiratoryCoach Thank you! Watching it now. :):):)
If you only had the last blood gas than how do you know for sure its metabolic and not respiratory, sorry still not understanding