I just wanted to say thank you for making these videos. I’m almost done with the didactic portion of RT school, and I’ve referenced your videos every single time I had a question about a concept. Thank you!
i will continue to make it known how amazing you are. You continue to break things down so well. We appreciate you so much. Blessings on top of Blessing for you and yours
Thank you sooooooo much for taking the time to make these videos . From my first semester in the program I've been struggling with this flow to VT concept 😩and I couldn't never get it and now I'm on my last semester, after reviewing your video a few times I finally understand it and ull never know how happy this made me. Because I want to be great respiratory therapist. I said it b4 and I'll say again I really wish you were my professor. Thank you
Hi coach...I'm from Brazil and discovered jst now your channel and your videos ...thank you so much for that, because, even in english, I can understand your teachings better than in portugueese, 'cause you make things clearer on your board hahah...thank you man...
I can’t find information my mother’ s Kyrgys language, second Russian language. But you are the best ! For me very useful as I have to study also English. As all your information are very , very important and useful! 🌹❤️❤️❤️🙏🙏🙏🤗🤗🤗
Excellent work! Can you do an exam orientated 30 -40 Q quiz session including scalars, loops, modes, asynchrony, capnograph, compliance and resistance?
Thank You! Should we take the RR set on our side on device, or the total RR (including patient non-assisted ones) into consideration for calculation of TCT?
elaborative explanation indeed .. well appreciated.. but I've a doubt ??.. from the formula for I time if we have a Vt of 500 ml , flow of 60 l/min then our I time comes out to be .5 sec .. and if we have set the respiratory rate at 15 l /min then our I:E ratio comes out to be 1:7 which we usually never do in routine practice .. I mean even for COPD max we go to 1:4 or 5 ... So how does this 1:7 value signifies our I : E TIME how can we use it for a practical purpose..
Thank you for this comment. The practical usage of the video is understanding the relationship between I time, E time, flow, volume, rate, etc. Why do you say 1:7 I:E is not routinely done?
Thanks sir .. I meant to say .. we generally don't go beyond 1: 5 esp when there is dynamic outflow obstruction e.g COPD .. so if it comes out to be 1: 7 then should we practically use this ratio in our day to day ventilation inside ICU ???
Hi coach, do you have a video about the variables relation in PCV ? ( tidal volume and , I time , E time, MV , mean airway resistance , ...... ) + thank you
Please with the flow, we have vents that have its flow unit in l/m, but we have other vents that have its flow unit in cmh2o. Please with this how do you calculate Itime
On my trilogy vents we set i time to determine the flow. If the eye time is not set correctly to the patient's efforts it will block their exhalations. Is it okay to go under 0.5
If that's what the patient wants, then yes. We get lost sometimes in trying to make the patient breathe like the vent. Completely wrong approach. Make the vent breathe like the patient!!! I love your questions!!
Why inspiration time depend on flow rate ...60lit per min or 1 lit per sec here insp time .5sec tcd is 4 sec........ .......30lit per min or 500ml per sec ....here to but i need 500ml per 4sec so easily i can get this at same insp .5 sec and tcd of 4sec ... ..how flow rate affect is
Correct. Increasing inspiratory flow will decrease inspiratory time in volume control. You can also reduce tidal volume, but that alters minute ventilation, which may adversely affect your blood gas. Some vents allow you to adjust insp time directly, but the same concepts are at play. Decreasing your set inspiratory time results in an increased flow. Makes sense. If you want to get there quicker, drive faster. Hope this helps!!
60 lit per min of what sir is it oxygen or mixed gas ....in oxygen flow what is the maximum flow given i.e we seen jn nasal nrm there is marking like 1 ,2 ,3,4lit per min like that ..for the we calculate fio2 by 20%+4%if 1 lit or 8% if 2lit ...so if i give oxygen at 8 lit per min in nrm fio2 is 20%+32% so 52% is the fio2... so to atain 100%fio2 max oxygen flow rate is around 20lit per min ....how can we give 60lit per min sir lungs will burst it seam ..so in one second 1lit gas is coming we dont know at which pressure this 1 lit is comming ...itseams in one sec my lungs will have 1lit of air ...i know im stupid hypothetical as mechine wont push that much air into my lung so ..what the role of inspiratory duration of .5sec( tcd is say 4sec) means ..it tell if i inspiration for .5sec(tcd 4sec) what will i achive 500ml per tidal volume.. so at 60lit flow rate and 14 rr to achive 500ml tv my inspiratory time is .5sec tcl 4sec)....so if my flow is say 30lit i can achive same 500ml tv at .5sec (tcd 4sec)...as ourTLC is 5lit and mv is 5lit and the flow of air is 30lit per min so much air is coming what happens to that excess 25 lit .....hope you help me
I had a really stupid question if patient comes in with an asthma exacerbation and we already tried 2x albuterol Tx, Iv solumedrol , Wob is increased and we know pip will be increased already, when we intubate and mechanically ventilate why would it be okay to start with either pc or Vc ? Either or? I would prefer pc over vc only because keeps from barotrauma and and prevents Pt asynchronony? I time would have to be lower or rate too allow for complete exhalation? I’m just confused why vc would be an viable option?
Sorry for the paragraph? I just can’t see myself putting a asthma exacerbated Pt on vc , because they are air hungry at this point from wob being increased , and want air in the air trapped won’t that increase pip so high and lead bars trauma or tension pneumonthorax? ( for example vc by set vt at 450 f at 10 so every 6 secs they get 450ml but air is still trapped in the lungs they trigger a breath again. I’m so annoyed by this
Yes, starting in PC would be acceptable for acute asthma, primarily for the reason you stated, to prevent barotrauma. However, PC doesn't necessarily prevent asynchrony, or airtrapping. Whether VC or PC, with a rate of 10, there'a another breath coming every 6 seconds. Status asthmaticus is a very difficult disease to mechanically ventilate. The key for me is proper sedation with a focus on adequate I:E ratio and minute volume. Hope that helps, and I like the way you are thinking about barotrauma, airtrapping, asynchrony, etc. Strong work!
Hello Martinia! Tidal volume is how much you are putting in to the patient's lungs. Flow is how fast you are delivering that set volume. If you decrease flow, the rate at which the volume is delivered, then it will take longer to deliver the set amount of tidal volume. If you increase flow, the set amount is delivered quicker. The time it takes to deliver the set tidal volume is I time. Thing about it like driving a car. If you drive 40 mph (flow) for 60 miles (tidal volume) your drive time (I time) will be longer, than if you were to drive 60 miles driving 70 mph. Does that help?
We typically don't concern ourselves with I time in Bipap, as the patient should be triggering spontaneous respirations. Therefore, we have little control over I time, TCT and the I:E ratio. In the case that the patient isn't breathing spontaneously, then we should probably be thinking mechanical ventilation, and then the substance in the becomes relevant. Hope this helps! Let me know if not!
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RT student here! This video was very helpful, explained a difficult concept so easily! Thank you
My goodness, you are an amazing teacher. I am so grateful for your incredible knowledge and the ability to articulate it so well to all of us.
I just wanted to say thank you for making these videos. I’m almost done with the didactic portion of RT school, and I’ve referenced your videos every single time I had a question about a concept. Thank you!
Awesome! Thank you for watching. Are you excited for your clinical portion to begin?
i will continue to make it known how amazing you are. You continue to break things down so well. We appreciate you so much. Blessings on top of Blessing for you and yours
Thank you so much for your kind words. I truly appreciate you taking the time to write this comment and watch. Thank you!!!
As usual, Sir, you made it so easy, marevelllllously. Hats off!
I got notification on your channel and I jump right into it to watch. I got another helpful lecture as usual. Thank you!
Hope you enjoyed it. And thanks for watching!
How do you get the notifications ?
I am incredibly thankful for your videos, they helped so much.
I am currently in the program right now I highly appreciate you for doing these videos very helpful
Well, I highly appreciate you for watching and commenting. Best wishes!
Thank you sooooooo much for taking the time to make these videos . From my first semester in the program I've been struggling with this flow to VT concept 😩and I couldn't never get it and now I'm on my last semester, after reviewing your video a few times I finally understand it and ull never know how happy this made me. Because I want to be great respiratory therapist. I said it b4 and I'll say again I really wish you were my professor. Thank you
You're very welcome! Glad it finally makes sense. Keep up the strong work!
Thank you so much! I have a midterm this week and this clarifies things for me! I look forward to your videos even if we aren’t on the same topic
Hi, Mayra! At some point it will be all the same topics. LOL Thanks for watching and commenting.
We need to get respiratory coach’s numbers up! Like, comment, subscribe; and share with peers.
you are good teacher and you make easy complicated things keep up it!
I appreciate that! Thank you for watching and kindly commenting!
Hi coach...I'm from Brazil and discovered jst now your channel and your videos ...thank you so much for that, because, even in english, I can understand your teachings better than in portugueese, 'cause you make things clearer on your board hahah...thank you man...
I can’t find information my mother’ s Kyrgys language, second Russian language. But you are the best ! For me very useful as I have to study also English. As all your information are very , very important and useful! 🌹❤️❤️❤️🙏🙏🙏🤗🤗🤗
Make Video on how to calculate Flow Rate and how to set flow rate as per patient needs
Got it on the list! Thanks for watching and commenting!
Excellent work! Can you do an exam orientated 30 -40 Q quiz session including scalars, loops, modes, asynchrony, capnograph, compliance and resistance?
booyah, come on sense! yup
thx a bunch man, you get right to it.
You're awesome dude. Legit THANK YOU for your information.
Hi, Patrick. You're legit for watching and commenting. Thank you!!!
Yes!!!!!! Oh thank you !!!!! I thought you forgot and just in the nick of time for finals !!!!!you are so helpful grateful for you !
You're welcome! I typically don't forget. Thank you for the kind comment! Hope it helped you with your finals.
thanks someone finally broke it down more
Thank you so much for such informative and interesting videos. 😀🙏
You're very welcome, Midoo! Thanks for watching and commenting!
Incredible!!! Thank you soo much!💯💯
Thank you for watching and commenting!
Thank you for your help , we appreciate you ❤
Nicely explained sir
Thank you for watching and kindly commenting!
its good presentation thank you!
I have been following your video, it's amazing, I learnt a lot. Thank you so much.
Thank You!
Should we take the RR set on our side on device, or the total RR (including patient non-assisted ones) into consideration for calculation of TCT?
Definitely need a graphic class
Thank you very much ❤🌹🙏🙏🙏
Thank you caoch
Thank you for watching and commenting!
Tqqqqqq now I am decided u r my respiratory teacher ......
Lol....sounds good
elaborative explanation indeed .. well appreciated.. but I've a doubt ??.. from the formula for I time if we have a Vt of 500 ml , flow of 60 l/min then our I time comes out to be .5 sec .. and if we have set the respiratory rate at 15 l /min then our I:E ratio comes out to be 1:7 which we usually never do in routine practice .. I mean even for COPD max we go to 1:4 or 5 ... So how does this 1:7 value signifies our I : E TIME how can we use it for a practical purpose..
Thank you for this comment. The practical usage of the video is understanding the relationship between I time, E time, flow, volume, rate, etc. Why do you say 1:7 I:E is not routinely done?
Thanks sir .. I meant to say .. we generally don't go beyond 1: 5 esp when there is dynamic outflow obstruction e.g COPD .. so if it comes out to be 1: 7 then should we practically use this ratio in our day to day ventilation inside ICU ???
That's so helpful thank you so much
Hello Coach, for the purpose of the TMC exam, if physician wants to change the I:E ratio of 1:2 to 1:3 what the RT should do? Thank you (:
Hi Coach,Would you do a video on ventilator loops, please? Thanks
Absolutely! Second request I've received for this, so watch for it soon! Thanks for watching!
Here you go! ruclips.net/video/ljl01egY0ps/видео.html
Thanks you so much.
Hi coach, do you have a video about the variables relation in PCV ? ( tidal volume and , I time , E time, MV , mean airway resistance , ...... ) + thank you
Probably not in that context. I'll put one up. Got it on the list. Thanks for watching and for commenting!
Thank you Respiratory Coach
Thank you for watching!!!
That helped so much
thank you this video was great!
Please with the flow, we have vents that have its flow unit in l/m, but we have other vents that have its flow unit in cmh2o. Please with this how do you calculate Itime
On my trilogy vents we set i time to determine the flow. If the eye time is not set correctly to the patient's efforts it will block their exhalations. Is it okay to go under 0.5
If that's what the patient wants, then yes. We get lost sometimes in trying to make the patient breathe like the vent. Completely wrong approach. Make the vent breathe like the patient!!! I love your questions!!
@@RespiratoryCoach thank u I did it today and it worked great thank u for ur help
So do we always divide our i and e times by .5 to get that ratio?
It depends on your I time
Hello I’m confused where u got the 3.5 from b cause .4-.5 is not 3.5?
Hi Tim. Without going back and watching the video. Did I say .4-.5 or 4-.5? The latter makes more sense and would yield a 1:7 I:E ratio.
Hello Joe, I need one of your shirts.
THANKKKK YOUUUUU!!!!!!!!!!!
Thank you!
Amazing
Why inspiration time depend on flow rate ...60lit per min or 1 lit per sec here insp time .5sec tcd is 4 sec........ .......30lit per min or 500ml per sec ....here to but i need 500ml per 4sec so easily i can get this at same insp .5 sec and tcd of 4sec ... ..how flow rate affect is
To reduce I time we have to increase flow???
Correct. Increasing inspiratory flow will decrease inspiratory time in volume control. You can also reduce tidal volume, but that alters minute ventilation, which may adversely affect your blood gas. Some vents allow you to adjust insp time directly, but the same concepts are at play. Decreasing your set inspiratory time results in an increased flow. Makes sense. If you want to get there quicker, drive faster. Hope this helps!!
@@RespiratoryCoach indeed sir
Ur every word helps
Thanks
60 lit per min of what sir is it oxygen or mixed gas ....in oxygen flow what is the maximum flow given i.e we seen jn nasal nrm there is marking like 1 ,2 ,3,4lit per min like that ..for the we calculate fio2 by 20%+4%if 1 lit or 8% if 2lit ...so if i give oxygen at 8 lit per min in nrm fio2 is 20%+32% so 52% is the fio2... so to atain 100%fio2 max oxygen flow rate is around 20lit per min ....how can we give 60lit per min sir lungs will burst it seam ..so in one second 1lit gas is coming we dont know at which pressure this 1 lit is comming ...itseams in one sec my lungs will have 1lit of air ...i know im stupid hypothetical as mechine wont push that much air into my lung so ..what the role of inspiratory duration of .5sec( tcd is say 4sec) means ..it tell if i inspiration for .5sec(tcd 4sec) what will i achive 500ml per tidal volume.. so at 60lit flow rate and 14 rr to achive 500ml tv my inspiratory time is .5sec tcl 4sec)....so if my flow is say 30lit i can achive same 500ml tv at .5sec (tcd 4sec)...as ourTLC is 5lit and mv is 5lit and the flow of air is 30lit per min so much air is coming what happens to that excess 25 lit .....hope you help me
30 liters flow tidal volume 450 what will be IT
Some MV with autoflow?
I had a really stupid question if patient comes in with an asthma exacerbation and we already tried 2x albuterol Tx, Iv solumedrol , Wob is increased and we know pip will be increased already, when we intubate and mechanically ventilate why would it be okay to start with either pc or Vc ? Either or? I would prefer pc over vc only because keeps from barotrauma and and prevents Pt asynchronony? I time would have to be lower or rate too allow for complete exhalation? I’m just confused why vc would be an viable option?
Sorry for the paragraph? I just can’t see myself putting a asthma exacerbated Pt on vc , because they are air hungry at this point from wob being increased , and want air in the air trapped won’t that increase pip so high and lead bars trauma or tension pneumonthorax? ( for example vc by set vt at 450 f at 10 so every 6 secs they get 450ml but air is still trapped in the lungs they trigger a breath again. I’m so annoyed by this
Yes, starting in PC would be acceptable for acute asthma, primarily for the reason you stated, to prevent barotrauma. However, PC doesn't necessarily prevent asynchrony, or airtrapping. Whether VC or PC, with a rate of 10, there'a another breath coming every 6 seconds. Status asthmaticus is a very difficult disease to mechanically ventilate. The key for me is proper sedation with a focus on adequate I:E ratio and minute volume. Hope that helps, and I like the way you are thinking about barotrauma, airtrapping, asynchrony, etc. Strong work!
Thank you
awesome....
i am confused about the I time with the tidal volume and flow
Hello Martinia! Tidal volume is how much you are putting in to the patient's lungs. Flow is how fast you are delivering that set volume. If you decrease flow, the rate at which the volume is delivered, then it will take longer to deliver the set amount of tidal volume. If you increase flow, the set amount is delivered quicker. The time it takes to deliver the set tidal volume is I time. Thing about it like driving a car. If you drive 40 mph (flow) for 60 miles (tidal volume) your drive time (I time) will be longer, than if you were to drive 60 miles driving 70 mph. Does that help?
@@RespiratoryCoach i think putting it in an equation will be better. going to look at video again. thank you
What about in bipap
We typically don't concern ourselves with I time in Bipap, as the patient should be triggering spontaneous respirations. Therefore, we have little control over I time, TCT and the I:E ratio. In the case that the patient isn't breathing spontaneously, then we should probably be thinking mechanical ventilation, and then the substance in the becomes relevant. Hope this helps! Let me know if not!
Thanks for sharing