i've been an RT for 13 years, but at a facility that hasn't kept vents in 6-7 years (we set pt's up on them, but transfer to our mother ship :P ). As I'm boning up, you have been the most pertinent to understanding how to ventilate/manage these covid patients. There are others that i frequently visit, but as far as actually ventilating and the nitty gritty that we soon forget after passing boards- you're great, man! Keep up the great work! We appreciate it!!
Thank you for this kind comment. I truly appreciate the time you, and others, take to watch and then write a comment. I love hearing from licensed RTs. Especially those with 13 years under their belt. It's a testament to your dedication to continue learning as times change, and thank you for the work you are doing as well.
Thank you so much, can't get enough of your classic teaching. Sincerely has helped me accomplish so much more. Look forward to conversing with you soon. My students are grasping some of the difficult concepts by your examples. Thanks again!!
I'm glad to hear that, Jay. You're also an instructor, correct? Send me an email respiratorycoach@gmail.com. Let's talk soon. Would like to learn more about your students needs and what you are seeing as an instructor. Thanks for watching, Jay.
Hi, before anything, Thanks a lot for share your knowledges. you make me remember the quote...The more I learn, the less I know. Your amazing, go ahead
"If you can't explain it simply, you don't understand it well enough" .. I enjoy the clear explanation that it so much helpful for a fresh student to respiratory care. TY. Hopet to win a zoom session regarding managing acute asthma, status asthmaticus, acute COPD :)
Brilliant video. It has really helped me to understand PEEP, this is because you explain it in simple terms. Am really enjoying watching and learning from all your videos, only wish i had found your channel earlier.
Thank you for the information. My husband is on intubation right now and I want to better understand what his numbers mean and to reference understanding his healing.
Hi Coach, my name is Daniel Bolla from Hungary. I have just started following your channel but I have to tell you that the way how you teach is amazing. I so love it. So, basically I have been a Respiratory Physiotherapist since 2008 and in the last few years I have been working at the NHS in the UK. I have always worked on ICU with critically ill patients but in the last few weeks what I have experienced was something different. You now these patients with covid-19, it is sooo difficult to ventilate and oxygenate them. So, here is my question: our patients who were proned several times, on a PEEP of 15, ASB-15, FiO2 above 85% and still rubbish ABG, PaO2 around 50, Sat- around 85% or less, massive airtrapping, pH around 7.2 .....What would you do with these patients? I know it is very complex but just wanted to ask you how would you approach? Many thanks in advance, Dan
Hey, Daniel. Thank you for the comment. What mode are we in and what is your set RR? Sorry not familiar with ASB-15. I assume that's the mode and rate. So, with no other information, the first thing I would keep in mind with any patient difficult to ventilate and/or oxygenate is to not over stress the alveoli attempting to achieve normal values. Think adequate rather than normal. Also, was peep of 15 optimal peep? Or just a stab at it? Which is what most places do. We got to get better at fine tuning our vent settings. I'm talking to RRTs all over the world right now. Send me an email if you would like to so we can further discuss. respiratorycoach@gmail.com Here to help!
Hi coach, you've shared additional knowledge to us as a professional or students.thanks a lot.my question is if i have an ARDS patient and allowed for permissive hypercapnia to achieve Ve of
Great question. Some simple way to remember is Minute Ventilation is proportional to pH. Knowing that MV = RR x Tidal volume, either RR or Tidal could be manipulated to correct alkalosis or acidosis. I think Coach will give more information. HH equation can help with explanation too. Cheers!
I face a situation where the doctor accepted PO2 of 68 and above, pt was in his 70s and the setting was PRVC, Fio2 90% , peep 10 and spo2 94% , there was episodes of hypotension. I know that PO2 will be affected by the age and the disease for sure but how to know that I’m not putting the pt at a risk of hypoxemia ?
Hello, Hawazen. By monitoring your PaO2 and SpO2. Hypoxemia is different than hypoxia. When you talk about hypotension, your greater concern should be with hypoxia. Would need more info to really figure out what was causing the hypotension.
Another great video. I do have a question about nitrogen being replaced by oxygen contributing to atelectasis(at 11:40), though. I assume you are referring to absorption atelectasis but if the unabsorbed oxygen remains in the alveoli and does not cross AC membrane, wouldn't it provide enough pressure to hold the alveoli open?
In theory yes, but we have to remember that the PaO2 is an average of all pulmonary blood flow returning for systemic circulation. This means there may be regions of gas exchange where most of that O2 diffused across leaving very little behind. Great critical thinking about this concept. Thank you for watching and commenting. I appreciate the discourse.
Been watching this several times, It just hit my mind to ask, can P/F ratio be calculated on ventilated patients as well or this formula is used only for normal breathing persons? A million Thanks !
How to choose ventilator circuit size according to kg ? Among neonatal ,pedia and adult circuit?then is pedia circuit be on pedia level or can pedia circuit be run on adult level? Why not or why yes?thank you coach.
Hey, Ramona. By not allowing the alveoli to fully collapse. If we keep them stented open, then they are more compliant to receive volume. Think about a tiny balloon. You know, those ones that are initially hard to blow up. Once you get past that initial resistance, the balloon inflates fairly easy, right? Now imagine having to blow up that balloon 12 times every minute. It would be easier to achieve this task if you kept a little bit of pressure inside the balloon, instead of allowing the balloon to completely deflate before each breath. I hope this makes sense, and I really hope that's what you were asking. If not, let me know. Thank you for watching and posting your question.
I don't have one as of now, but this link will take you to the protocol. www.ardsnet.org/files/ventilator_protocol_2008-07.pdf This includes FiO2 and peep recommendations to ensure adequate oxygenation.
Hi, Cari. Primarily Respiratory students and RRTs, but also we do get nursing students and RNs, along with other healthcare professions at various times. Are you a student?
i've been an RT for 13 years, but at a facility that hasn't kept vents in 6-7 years (we set pt's up on them, but transfer to our mother ship :P ). As I'm boning up, you have been the most pertinent to understanding how to ventilate/manage these covid patients. There are others that i frequently visit, but as far as actually ventilating and the nitty gritty that we soon forget after passing boards- you're great, man! Keep up the great work! We appreciate it!!
Thank you for this kind comment. I truly appreciate the time you, and others, take to watch and then write a comment. I love hearing from licensed RTs. Especially those with 13 years under their belt. It's a testament to your dedication to continue learning as times change, and thank you for the work you are doing as well.
Brilliant! Thank you for sharing your knowledge with your fellow RTs. I really love videos!
Hi, Abdi. You are very welcome. I thank you for watching and supporting the channel.
Thank you so much, can't get enough of your classic teaching. Sincerely has helped me accomplish so much more. Look forward to conversing with you soon. My students are grasping some of the difficult concepts by your examples. Thanks again!!
I'm glad to hear that, Jay. You're also an instructor, correct? Send me an email respiratorycoach@gmail.com. Let's talk soon. Would like to learn more about your students needs and what you are seeing as an instructor. Thanks for watching, Jay.
Please keep it up, I am one your followers, I am really benefiting from your videos and I am applying it at work
That's awesome and exactly what I like to hear. Thanks for watching, Mohamed.
Hi, before anything, Thanks a lot for share your knowledges. you make me remember the quote...The more I learn, the less I know. Your amazing, go ahead
Thanks, Adrian. Never heard that quote, but I like it. Thanks for watching!
"If you can't explain it simply, you don't understand it well enough" .. I enjoy the clear explanation that it so much helpful for a fresh student to respiratory care. TY. Hopet to win a zoom session regarding managing acute asthma, status asthmaticus, acute COPD :)
And you did. Send me an email respiratorycoach@gmail.com. I'll respond with zoom session information. Thanks for watching, Margo.
Brilliant video. It has really helped me to understand PEEP, this is because you explain it in simple terms. Am really enjoying watching and learning from all your videos, only wish i had found your channel earlier.
Me too, but never late than never. Welcome to the channel. Thanks for watching and kindly commenting.
Not to mention that you're actually early to the channel compared to those yet to come.
Thank you for the information. My husband is on intubation right now and I want to better understand what his numbers mean and to reference understanding his healing.
Beat wishes to you and your husband!
Brilliant! Thank you for sharing this
Hi Coach, my name is Daniel Bolla from Hungary. I have just started following your channel but I have to tell you that the way how you teach is amazing. I so love it. So, basically I have been a Respiratory Physiotherapist since 2008 and in the last few years I have been working at the NHS in the UK. I have always worked on ICU with critically ill patients but in the last few weeks what I have experienced was something different. You now these patients with covid-19, it is sooo difficult to ventilate and oxygenate them. So, here is my question: our patients who were proned several times, on a PEEP of 15, ASB-15, FiO2 above 85% and still rubbish ABG, PaO2 around 50, Sat- around 85% or less, massive airtrapping, pH around 7.2 .....What would you do with these patients? I know it is very complex but just wanted to ask you how would you approach? Many thanks in advance, Dan
Hey, Daniel. Thank you for the comment. What mode are we in and what is your set RR? Sorry not familiar with ASB-15. I assume that's the mode and rate. So, with no other information, the first thing I would keep in mind with any patient difficult to ventilate and/or oxygenate is to not over stress the alveoli attempting to achieve normal values. Think adequate rather than normal. Also, was peep of 15 optimal peep? Or just a stab at it? Which is what most places do. We got to get better at fine tuning our vent settings. I'm talking to RRTs all over the world right now. Send me an email if you would like to so we can further discuss. respiratorycoach@gmail.com Here to help!
Wonderful explanations with good basic interpretation.👍👍👍
Thank you for watching and commenting!!!
Wow! that was a very nice of you.
Hi coach, you've shared additional knowledge to us as a professional or students.thanks a lot.my question is if i have an ARDS patient and allowed for permissive hypercapnia to achieve Ve of
Thanks for the comment, Adz. Stay tuned for more info. Thanks for watching my man!
Great question. Some simple way to remember is Minute Ventilation is proportional to pH. Knowing that MV = RR x Tidal volume, either RR or Tidal could be manipulated to correct alkalosis or acidosis.
I think Coach will give more information. HH equation can help with explanation too. Cheers!
@@willampteymd1276 Hey man, thanks for this contribution. Love seeing others helping others. Doesn't always have to come from me. Thank you, William.
I face a situation where the doctor accepted PO2 of 68 and above, pt was in his 70s and the setting was PRVC, Fio2 90% , peep 10 and spo2 94% , there was episodes of hypotension. I know that PO2 will be affected by the age and the disease for sure but how to know that I’m not putting the pt at a risk of hypoxemia ?
Hello, Hawazen. By monitoring your PaO2 and SpO2. Hypoxemia is different than hypoxia. When you talk about hypotension, your greater concern should be with hypoxia. Would need more info to really figure out what was causing the hypotension.
Beautiful explanation
Thank you! I appreciate your kind words.
Advise to NEW students. Start with Joe asap. I did late in the game and wish I would have started sooner.
I wish I saw this video in the time frame for the offer!!
Me too, Elizabeth. I'll do another and let you know. Thanks for watching!
Thank you, Coach!
This video was upload three days and why I did I got the notification today?
I honestly have no idea. That's odd. Hope you enjoy it though.
Thank you so much, great content as always 🙏🌹
Thank you, Khalid. And thank you for watching, as always.
Another great video. I do have a question about nitrogen being replaced by oxygen contributing to atelectasis(at 11:40), though. I assume you are referring to absorption atelectasis but if the unabsorbed oxygen remains in the alveoli and does not cross AC membrane, wouldn't it provide enough pressure to hold the alveoli open?
In theory yes, but we have to remember that the PaO2 is an average of all pulmonary blood flow returning for systemic circulation. This means there may be regions of gas exchange where most of that O2 diffused across leaving very little behind. Great critical thinking about this concept. Thank you for watching and commenting. I appreciate the discourse.
How can u explain these things so easily. 😊
Been watching this several times, It just hit my mind to ask, can P/F ratio be calculated on ventilated patients as well or this formula is used only for normal breathing persons? A million Thanks !
How does PEEP affect hypotension coach? Thanks a lot
In patient who have Severe brain injury for the first 24 hours.Is PEEP contraindicated due to increase ICP?How thank you
Sir please make a video of how to wean a patient in mechanical Ventillation
Here ya go, Doc! th-cam.com/video/Au6e3t6k0aM/w-d-xo.html Good to see you on the channel again. How are things going?
How does PEEPaffect hypotension coach? Thank you
How to choose ventilator circuit size according to kg ? Among neonatal ,pedia and adult circuit?then is pedia circuit be on pedia level or can pedia circuit be run on adult level? Why not or why yes?thank you coach.
How to fix ABG in SIMV pressure support?
Awesome video
The best!
How does PEEP raise volume of the alveoli?
Hey, Ramona. By not allowing the alveoli to fully collapse. If we keep them stented open, then they are more compliant to receive volume. Think about a tiny balloon. You know, those ones that are initially hard to blow up. Once you get past that initial resistance, the balloon inflates fairly easy, right? Now imagine having to blow up that balloon 12 times every minute. It would be easier to achieve this task if you kept a little bit of pressure inside the balloon, instead of allowing the balloon to completely deflate before each breath. I hope this makes sense, and I really hope that's what you were asking. If not, let me know. Thank you for watching and posting your question.
@@RespiratoryCoach Thank you so much for your answer!!
@@daianaramona6561 You're very welcome. Best wishes!
@@daianaramona6561 You are very welcome, Ramona.
Hey can u explain peep nd fio2 table of alveoli trial in ards.net
Hey Roshan! Got your request on the list. Stay tuned! Thanks for watching!!!!
If ny video on dat already der,plz send me link
Thanks
I don't have one as of now, but this link will take you to the protocol. www.ardsnet.org/files/ventilator_protocol_2008-07.pdf This includes FiO2 and peep recommendations to ensure adequate oxygenation.
@@RespiratoryCoach thanks sir
Why does increasing PAO2 mean PaO2 increasing ?
thank u (y)
Is everyone here respiratory students or also nurse students?
Hi, Cari. Primarily Respiratory students and RRTs, but also we do get nursing students and RNs, along with other healthcare professions at various times. Are you a student?
Respiratory Coach yes, I am a student.