I just want to commend you on such a good lecture. I am an ICU physician at an academic center and the PSV trick to see what the patient wants is exactly how we teach the fellows and residents. Keep up the good work.
Thank you SO SO SO SO SO SO much for all your videos. You explain things so well. Ending my first year of RT school soon, and I couldn't have done it without you!!! THANK YOU
You are short of amazing. You broke this down with clear explanation. I was so stuck and just couldn't click for me. Watching your videos have given me a better understanding tenfold. I'm am flabbergasted that you don't have more followers on your page. People are sleep, NOT ME. Thank you!
The way that you explain Mech vent, I just loveeeee it. Thank you for taking the time to go over respiratory. I really appreciate you! Where was you when I was taking mech vent?!!! Anyhow, Thank you so much.
Thanks, Jesse! Well, that would either be one my kids or my haters. I have plenty of both. LOL I do appreciate your kind comment!!! Go be great, Jesse!
Awesome video! Extremely detailed. I’m taking my TMC in about 2 weeks- I feel a little bit more confident now and feel I’m ready for those troubleshooting questions. Thank you very much!!
I just wanna say I really enjoy your videos. You explain things very thorough. I learned a lot from you my question is I notice a lot of your videos you took about volume control, I was wondering if you could do a video on pressure control and troubleshooting on the ventilator
@@RespiratoryCoach My concerns are the vent setting, alarms and knowing what everything means right now. It's confusing at time and there is a lot of stuff to know. I wanted to ask you if you know where I can find a sample oral presentation for a patient that is on a vent. We have a big project due in 9 weeks. We are assign a patient from our clinical instructor and have to get all the info and put it together, then present it to the class via powerpoint. I want to see how other people put their presentation together so I have a general idea. Any input would help thanks max
You are the best coach ever! I love you videos. Thanks for all your hard work and making this videos for us! Where are you located? I’m in California, Sacramento
Great Video!!!A very interesting tip that you mentioned about switching to PSV in order to help determine whether a patient is either flow or volume hungry is definitely a strategy that I want to apply. However, if my patient has really bad lungs like in ARDS wouldn't switching to PSV possibly lead to more VILI due to the concept surrounding Patient Self Inflicted Lung Injury (P-SILI). I was wondering if there are any ways or bedside tools we can utilize to help limit or prevent P-SILI. Also, when switching to PSV does it matter how much PSV we set? You mention to switch to a PSV 10, would there be a difference if I switch to a PSV 5??Thanks again for these awesome videos!!!!!
First, thanks for watching and commenting! To answer your first question, I don't overly concern myself with P-SILI, if my intentions are to watch my patient in PSV for 30-90 seconds. The risk of P-SILI have been linked to prolonged, vigorous spontaneous effort. That's not what I propose. My purpose for going into PSV is solely to observe the patient's spontaneous inspiratory flow. This gives me an idea of where to set the peak flow on my vent, in order to meet my patient's inspiratory flow and reduce their flow hunger. Which in turn, hopefully improves patient-ventilator synchrony and reduces/avoids vigorous spontaneous efforts. I believe that if I can make my vent breathe like my patient wants to breathe then my patient will spend less energy, rest better, and heal quicker while on the vent. I hope that makes sense. And yes, there would be a difference if you placed them on PS-5 vs PS-10. The PS-5 imposes a greater workload onto the patient, than PS-10. This could cause an increased level of respiratory distress, which would alter your patient's resting peak inspiratory flow. I'm only using PS-5 when assessing readiness for weaning during a SBT. Great question, BZM!!!
Thank you for the video. How would I fix a leak if the patient is supposed to be getting 350 Vt but is getting low to mid 200Vt and they have 3 chest tubes? How would I adjust my settings. The vent is giving the 350 but exhalation is approximately 220
Friend, when you take about flow hunger, you suggest increasing flow. The ventilators we use cannot control flow, so how would we increase flow? Should we decrease I/time ?
I have a question about the air trapping. If I do a expiratory hold, will that be any beneficial in reducing air trapping. I tried to do it any clinical the other day and it did not work. My Pt was in PRVC. My next option should have been to decrease the I-time right?
Hello, Alaawy! It all depends on the level of sedation. I assume when you say "fully" sedated, you mean sedated to the level that the patient isn't initiating any breaths. In this case, most asynchrony is eliminated. However, asynchronies such as auto-trigger and airtrapping may still occur. So it is safe to say that sedation helps to reduce the risk of p-v asynchrony, yet doesn't completely eliminate all asynchronies. Hope that makes sense. Thank you for watching and commenting with your question!!
My patient is asynchronizing, shes already on maximum sedation. Her tidal volume was set at 500 but she was just having tv of 200 to 350. RR was also higher than set (24bpm). Paralyzers been given before, but they are short terms if not given as infusion. What are my other options?
Need more info, but there's only four possibilities. 1. Airtrapping - look at your flow wavefore. If it's not returning to baseline... that's it! 2. Breath stacking - are your volumes alternating between small TV and large TV? If so...that's it. 3. Your patient is hitting there high insp pressure limit, which will terminate the breath before the full TV is delivered. 4. You have a leak - look at your volume waveform. If it's not returning to baseline, but your flow waveform is then ....that's it. Keep me informed. Would like to hear a follow up on this. Go be great!!!
What if the patient's TV has a lower and higher numbers showing concurrently while on BIPAP-PS, is it breath stacking? Sorry few info as I'm not an RT but we manage mech Vent
I would honestly have to go back and watch the video to see exactly what you are referring to, but the short answer is yes. Just understanding how variables and settings work in pressure control vs volume control is the key.
I hv 1 doubt,suppose ny patient on ventilatior,his pip was 15 and p plat was 9on day 1, nd suppose on 2nd day his pip is 45 and p plat is 20 wat shd we consider only airway resistance or high p plat or both
Great question. When you assess and compare day 1 values with day 2 values, you'll see that your airway resistance and static compliance have both worsened. So this case is an example of both an airway resistance and alveolar compliance concern. Hope this makes sense. Thanks for watching and asking, Roshan.
Hello Gela! Either your oxygen supply is low if you're running on a cylinder, maybe during transport? Or your oxygen supply tubing is not connected to the oxygen outlet. Or your patient is pulling a significantly greater inspiratory flow from the vent/niv, than what the vent/niv is providing. Any of those sound like the problem?
Maybe get a new mic? I have your volume low on the RUclips app and my computer and you are still hurting my ears. Anyway, I am loving the info. I am an older RT (49) student. I used to be an RT but due to personal reasons, stopped. After 10 years, I am going back in. It's harder to learn and I can't believe all that I forgot. Thank you for your videos and simple explanations. I need all the help I can get!!
Hi Stacey. I appreciate the punch in the mouth followed by the hug. 😂😂😂. That's probably more me not having an inside voice rather than the mic, but an upgrade in tech is coming soon. Seriously though, thanks for that feedback. Also, best wishes as you make your way back into the field. I'm here to help however that may be. Reach out anytime. Thanks for watching and commenting!
@@RespiratoryCoach Not a punch, just a little nudge. Lol. Oh, don't worry, I will probably inundate you with questions since I am doing this all from notes, Respiratory Therapy Zone questions, and yes, your videos. Thank you again! I'll be in touch for sure :) :) :)
I just want to commend you on such a good lecture. I am an ICU physician at an academic center and the PSV trick to see what the patient wants is exactly how we teach the fellows and residents. Keep up the good work.
Thank you SO SO SO SO SO SO much for all your videos. You explain things so well. Ending my first year of RT school soon, and I couldn't have done it without you!!! THANK YOU
You have no idea how helpful this was. Thank you so much for the lesson ❤
thanks! Would love more of these troubleshooting vids!
BRILLIANT! Thank you so much for helping me help my patients in London, UK.
You are a great teacher! It is very clear to me now! Thank you! 👏🏼👏🏼👏🏼🔝🔝🔝
So thankful for these videos 🙏🏽🙏🏽
This was so helpful, and I'm not even an RT! Aww I wish I'd seen your videos earlier. Well I'm gonna watch them ALL now. Thank you!
Thank you for the kind comment and for watching!
This is excellent information Joe. Thank you
Thank you so much! You are making my life much easier, sir.
One of the best channels on RUclips. Thank you so much, sir.
Wow, thanks! I appreciate that kind comment and you watching!
Awesome
Learning more every day from you. Thanks
THANK YOU!!! New ICU nurse here, this is VERY helpful!
Awesome! Congrats on your new ICU position. Love hearing from and interacting with nurses on the channel. Please comment anytime! Thanks for watching!
You are short of amazing. You broke this down with clear explanation. I was so stuck and just couldn't click for me. Watching your videos have given me a better understanding tenfold. I'm am flabbergasted that you don't have more followers on your page. People are sleep, NOT ME. Thank you!
Thank you for this kind comment and for watching. Glad you're AWAKE!!! Go be great!!!
Thank you sir, i found you is the best ever i came across❤
Thank you. This video was very helpful.
The way that you explain Mech vent, I just loveeeee it. Thank you for taking the time to go over respiratory. I really appreciate you! Where was you when I was taking mech vent?!!! Anyhow, Thank you so much.
Thanks for the kind comments. I appreciate you watching and commenting. Best wishes!!!
Your videos are really helpful!! Thank you
Amazing!! Thanks coach😊
WAAHHH THANK GOD I FOUND YOU RESPIRATORY COACH!! JUST A WEEK BEFORE MY RTLE
Hey coach. That bipap video was absolutely awesome thank you. I just subscribed and will be watching daily
Cool, thanks Ken! I appreciate your presence in our community, watching, commenting, etc! Thank you!
Excellent presentation ,thanks and regards sir .
Thanks so much. So much helpful
Again man.. you killed it!!! Thank you! Also, who the heck would thumbs down this??
Thanks, Jesse! Well, that would either be one my kids or my haters. I have plenty of both. LOL I do appreciate your kind comment!!! Go be great, Jesse!
Awesome video! Extremely detailed. I’m taking my TMC in about 2 weeks- I feel a little bit more confident now and feel I’m ready for those troubleshooting questions. Thank you very much!!
Glad it helped. Good luck on your TMC!
Awesome video, thank you!!!
so helpful!!!! thank you! i really like the shirt BTW!!
Coach
Wow your lecture is super awesome❤
I am sad that I didn't see these videos earlier.
Thanks for the video! I start my first RT job in a few weeks & I've been using your videos to brush up on my knowledge.
Congratulations! That's awesome. Go be great!!!
@@RespiratoryCoach thank you!
Love it 😍 Thank you so much. I would like you to do more videos like this.
Anytime! Thank you for the feedback.
This was so easy to understand thank you so much!!!!!
Cool! Thanks for watching and leaving that comment. Glad it helped!
I just wanna say I really enjoy your videos. You explain things very thorough. I learned a lot from you my question is I notice a lot of your videos you took about volume control, I was wondering if you could do a video on pressure control and troubleshooting on the ventilator
Thank you so much...it really helped!
Please do more videos about troubleshooting..
Will do, Prince! Glad it helped, and thanks for watching and commenting.
Thank u so much I really like this video and I appreciate the way u teach on how to troubleshooth a big 👍 2 u..😊
You are very welcome! Thank you for watching!
Thank you! ICU doctor here. I’m going to use ur talk for my presentation next week here in Oman.
Awesome! Let me know if you want me to join you!!! I appreciate your support!!
Awesome explanation thank you !!
Glad you liked it! Thank you for watching and commenting!!
I AM grateful for all you do to help us succeed in the life of being A GREAT RT!!! I Thank God for what he has placed within you
thank you, very helpful
second-year RT student, trying to listen to all your videos
You're very welcome! Congrats on making it to the down slope of RT school. Thanks for the kind comment and best wishes as you finish up.
@@RespiratoryCoach My concerns are the vent setting, alarms and knowing what everything means right now. It's confusing at time and there is a lot of stuff to know. I wanted to ask you if you know where I can find a sample oral presentation for a patient that is on a vent. We have a big project due in 9 weeks. We are assign a patient from our clinical instructor and have to get all the info and put it together, then present it to the class via powerpoint. I want to see how other people put their presentation together so I have a general idea. Any input would help
thanks
max
@@maxpla168 Send me an email @respiratorycoach@gmail.com. I don't know of a presentation available online, but I can help.
Love your videos bro.
Awesome, Andrew! I love the fact that you watched and commented!!! Thank you!!!
Always great content. Wheres your merch? :)
hi i was very impressed by your lecture byzewyi Msc student RT
I am a 3 Rd yr RT student and this cls was really help full 😁
Nice! That's the goal!
You are the best coach ever! I love you videos. Thanks for all your hard work and making this videos for us! Where are you located? I’m in California, Sacramento
Thank you for sharing these kind words and watching! Love from Texas!!
Thank you thank you thank you
Thank you
Great Video!!!A very interesting tip that you mentioned about switching to PSV in order to help determine whether a patient is either flow or volume hungry is definitely a strategy that I want to apply. However, if my patient has really bad lungs like in ARDS wouldn't switching to PSV possibly lead to more VILI due to the concept surrounding Patient Self Inflicted Lung Injury (P-SILI). I was wondering if there are any ways or bedside tools we can utilize to help limit or prevent P-SILI. Also, when switching to PSV does it matter how much PSV we set? You mention to switch to a PSV 10, would there be a difference if I switch to a PSV 5??Thanks again for these awesome videos!!!!!
First, thanks for watching and commenting! To answer your first question, I don't overly concern myself with P-SILI, if my intentions are to watch my patient in PSV for 30-90 seconds. The risk of P-SILI have been linked to prolonged, vigorous spontaneous effort. That's not what I propose. My purpose for going into PSV is solely to observe the patient's spontaneous inspiratory flow. This gives me an idea of where to set the peak flow on my vent, in order to meet my patient's inspiratory flow and reduce their flow hunger. Which in turn, hopefully improves patient-ventilator synchrony and reduces/avoids vigorous spontaneous efforts. I believe that if I can make my vent breathe like my patient wants to breathe then my patient will spend less energy, rest better, and heal quicker while on the vent. I hope that makes sense. And yes, there would be a difference if you placed them on PS-5 vs PS-10. The PS-5 imposes a greater workload onto the patient, than PS-10. This could cause an increased level of respiratory distress, which would alter your patient's resting peak inspiratory flow. I'm only using PS-5 when assessing readiness for weaning during a SBT. Great question, BZM!!!
.
Thank you sir
You are very welcome, Ajay!
Excellent presentation sir 👍
Can we have patient demonstration of various trouble shooting on venti display
Thank you. I'll see what I can do!
Thank you for the video. How would I fix a leak if the patient is supposed to be getting 350 Vt but is getting low to mid 200Vt and they have 3 chest tubes? How would I adjust my settings. The vent is giving the 350 but exhalation is approximately 220
🙌🏾🙌🏾
Would your PIP alarms go off from an obstruction in PCV, even though you are controlling the preset pressure?
Hi sir. can you do a video about T.pause,t slope and Its relations to other parameters and effects to the patient
always sob. wants volume volume volume. is it bad to increase it?
Friend, when you take about flow hunger, you suggest increasing flow. The ventilators we use cannot control flow, so how would we increase flow? Should we decrease I/time ?
I have a question about the air trapping. If I do a expiratory hold, will that be any beneficial in reducing air trapping. I tried to do it any clinical the other day and it did not work. My Pt was in PRVC. My next option should have been to decrease the I-time right?
Thanks for posting your question. Here's my response. ruclips.net/video/G8Pf0huiKco/видео.html Best wishes!
Thank you! - an RT student
You're very welcome! Thanks for watching and for commenting.
Sir can you explain about apnea backup and when this apnea is going to happen in which modes and how plz ??
On the list! Stay tuned!
Hi dear
Is the p-v asechrony happening in fully sedated pt?
Hello, Alaawy! It all depends on the level of sedation. I assume when you say "fully" sedated, you mean sedated to the level that the patient isn't initiating any breaths. In this case, most asynchrony is eliminated. However, asynchronies such as auto-trigger and airtrapping may still occur. So it is safe to say that sedation helps to reduce the risk of p-v asynchrony, yet doesn't completely eliminate all asynchronies. Hope that makes sense. Thank you for watching and commenting with your question!!
My patient is asynchronizing, shes already on maximum sedation. Her tidal volume was set at 500 but she was just having tv of 200 to 350. RR was also higher than set (24bpm). Paralyzers been given before, but they are short terms if not given as infusion. What are my other options?
Need more info, but there's only four possibilities.
1. Airtrapping - look at your flow wavefore. If it's not returning to baseline... that's it!
2. Breath stacking - are your volumes alternating between small TV and large TV? If so...that's it.
3. Your patient is hitting there high insp pressure limit, which will terminate the breath before the full TV is delivered.
4. You have a leak - look at your volume waveform. If it's not returning to baseline, but your flow waveform is then ....that's it.
Keep me informed. Would like to hear a follow up on this. Go be great!!!
What if the patient's TV has a lower and higher numbers showing concurrently while on BIPAP-PS, is it breath stacking? Sorry few info as I'm not an RT but we manage mech Vent
Does the same apply to pressure control?
I would honestly have to go back and watch the video to see exactly what you are referring to, but the short answer is yes. Just understanding how variables and settings work in pressure control vs volume control is the key.
What is the bi block that you mentioned?
Hi! A bite block is a device used to prevent the patient from biting the ETT.
I hv 1 doubt,suppose ny patient on ventilatior,his pip was 15 and p plat was 9on day 1, nd suppose on 2nd day his pip is 45 and p plat is 20 wat shd we consider only airway resistance or high p plat or both
Great question. When you assess and compare day 1 values with day 2 values, you'll see that your airway resistance and static compliance have both worsened. So this case is an example of both an airway resistance and alveolar compliance concern. Hope this makes sense.
Thanks for watching and asking, Roshan.
@@RespiratoryCoach ok thanks
it never goes off
wow. its not panning out.
What would cause low PIP?
Typically low pip is the result of leaks. Check your ett cuff first, and then work back from there. Best wishes!
Which alarm is inactive when the ventilator is turned off?
All of them! I feel like this is a trick question.
@@RespiratoryCoach omg sorry I misspoke, I meant, which alarm is active when the ventilator is off LOL
trapped lung?
What could be the problem if it says no o2 supply?
Hello Gela! Either your oxygen supply is low if you're running on a cylinder, maybe during transport? Or your oxygen supply tubing is not connected to the oxygen outlet. Or your patient is pulling a significantly greater inspiratory flow from the vent/niv, than what the vent/niv is providing. Any of those sound like the problem?
Hi respi coach! Your reply helped great. Thanks a lot. More power.
"More power"....I like that!!!
Maybe get a new mic? I have your volume low on the RUclips app and my computer and you are still hurting my ears. Anyway, I am loving the info. I am an older RT (49) student. I used to be an RT but due to personal reasons, stopped. After 10 years, I am going back in. It's harder to learn and I can't believe all that I forgot. Thank you for your videos and simple explanations. I need all the help I can get!!
Hi Stacey. I appreciate the punch in the mouth followed by the hug. 😂😂😂. That's probably more me not having an inside voice rather than the mic, but an upgrade in tech is coming soon. Seriously though, thanks for that feedback. Also, best wishes as you make your way back into the field. I'm here to help however that may be. Reach out anytime. Thanks for watching and commenting!
@@RespiratoryCoach Not a punch, just a little nudge. Lol. Oh, don't worry, I will probably inundate you with questions since I am doing this all from notes, Respiratory Therapy Zone questions, and yes, your videos. Thank you again! I'll be in touch for sure :) :) :)
Hey question, on the ventilator when we see the bird beak, I know we want that football shape. How can I manipulate the vent to fix over distention?
Thank you sir
You are so welcome! Thank you for watching!
Thank you
You're very welcome. Thank you for watching and kindly commenting.