Respiratory Therapy - Practice TMC Question - How to fix ventilation? 

I agree. He makes me more confident to take this exam again for the 3 rd time.

same same same i'm studying for my boards and doing the same

GO GET THAT RRT!

@@RespiratoryCoach absolutely will, thanks again for putting all those videos on, they are so helpful.

Hell YES!!! Go get it, Peter!!!

Will do! Stay tuned!!

LOL Thanks for watching Darius!

You're so welcome! Thank you for watching and commenting!!

Perfect! That's the goal of these videos. Strong work!!

Appreciate that! Thank you for watching!!

My pleasure! Thank you for watching!!

Glad you think so!

Hi Nancy! Glad you found it helpful and thanks for watching!!

YES! Big props to your instructor!!!

Thanks for watching and kindly commenting!

Nah, that would be you! Thank you for watching andn commenting!!

What's up, Kit? How have you been? I don't think we've ever actually talked, but we've had multiple chats. We can change that!?! Always appreciate your comments! Thank you!!

@@RespiratoryCoach I really value your lessons which are most helpful in my work (ICU). Last years I shifted my activity to private dentistry (providing sedation), and your videos help me to maintain my RT knowledge. Thank you ones more)) 👍🙏

Thanks for watching JT. I appreciate your comment. Hope it makes sense.

Hi Kayla!! Makes sense now though?

Absolutely! GO BE GREAT!

Yes mam...go get it!!! Is this RTalk episode 3 Becca?

@@RespiratoryCoach Sure is 🤓

Thank you, Thomas! How you been?

@@RespiratoryCoach Your Welcome! I have been doing fine. Keeping busy in our small critical access hospital in Northern Indiana. This budget cycle we have purchased (2) V60s, a Hamilton T1, a Servo U, a CoughAssist. So, trying to keep my head above water to train the RT staff. Your videos are so helpful when I put together training courses. So, please keep up your work! You help me with mine!

@@tgaskill That's awesome, Thomas. I would love to have you join me on my RTalk segment of the channel.. Send me another email, respiratorycoach@gmail.com, if you're interested.

Hi, Ronzette!! Not an all inclusive "rules" video, for that would be an extremely lengthy video, but I try to infuse various rules within each relatable topic. Maybe one day I'll compile a list of rules and make it available. Thanks for the idea and for watching!!! I appreciate you!

One more year ☺️ getting prepared already.. great explanation. Thank you

Glad you found it helpful, Christine!!

Welcome 😊

Absolutely... Male 106 + 6(height in inches - 60) = IBW in pounds / 2.2 for Kg Female 105 + 5(height in inches - 60) = IBW in pounds / 2.2 for Kg Hope this helps. Thanks for watching and commenting!!!

The recommended tidal volume range is 6-8 ml/kg. I would operate from that mindset on Saturday. Best wishes!! Go kill it!!

Normal spontaneous tidal volume is 5-8 ml/kg, starting tidal volume during mechanical ventilation is 6-8 ml/kg. Can't speak to what Kettering or other review courses are teaching.

good point! are you from Canada, because I am also wondering how ~ 84kg was calculated, maybe U.S calculation is different?

Increasing the tidal volume will also help with the oxygenation too

Hey Matthew. The to the point answer is because TMC rules say that once tidal volume is in range then the next step is to adjust RR. Tidal volume was already in the 6-8 ml/kg range, so RR is the correct answer. However, you bring up a great discussion. This is actually the discussion that took place that lead me to post this question. So let's break it down. Anatomical deadspace for this patient is approx. 185 mL, now some of that is bypassed with the ETT, but then the ETT creates mechanical deadspace. So let's just go with 185 mL of deadspace. If we leave tidal volume at 600 and increase the rate to 20, then we'll achieve an alveolar minute ventilation of 8.3L. If we stay at 18 and increase the tidal volume to 650, we'll achieve an alveolar minute ventilation of 8.37L. Not a significant difference in regards to the deadspace conversation. To the other person that commented about tidal volume helping with oxygenation also,remember hypoxemia is responsive to adequate ventilation. This is different than a shunt. So either way we go here we'll increase alveolar minute ventilation to essentially the same level, which will decrease CO2, increase pH, and also increase O2. Remember the TMC rules when taking your test. Great conversation! Thank you for kicking it off!!

@@RespiratoryCoach Hey that makes sense in the context of the question, and I know what you mean in regards to the answer that test questioner makers are looking for! It's kind of an odd question because I would assume that each patient has unique considerations, and they don't give any information as to if this person has an obstructive or restrictive lung disease, or some other consideration like if they are breathing over the set rate...which is quite possible if they're in the hospital!!

​@@matty00926

I would have to re-watch the content of the video, but based on TMC rules, as long as tidal volume is within the 6-8 ml/kg range then respiratory rate is the answer when adjusting for ventilation impairments. Thanks for watching and commenting with your question.

I understand , Thank you so much!!

No, this changes the scenario. Raising the rate in AC will not increase minute ventilation, unless raised above the total RR. Great question!

The primary reason is because hypoventilation is a cause of hypoxemia. So in theory, fixing ventilation first may also correct the hypoxemia. Make sense?

@@RespiratoryCoach ah yeh got ya. Thanks

Hi Josee! That formula is 100% applicable. In demonstrating a rule, I didn't go down that route, but you are correct! Using the stated formula can help you target an appropriate RR to achieve a desired CO2. Absolutely!

They're usually emphasized in most review programs.

@@RespiratoryCoach make a videoof it... Please 😜

Thanks for watching and commenting. There is a difference between normal and adequate. GO BE GREAT!

@@RespiratoryCoach thank you ,do you have a video with explination how i can distinguish normal state from the adequate?

Sorry the answer is b i know but what i dont understand that 71 pao2 is high

​​@@RespiratoryCoach thank you so much sir , I have understand why are you saying about the seventy one is low oxygenation because pao2 of 60 to 79 is considered mild hypoxemia and pao2 40 to 79 moderate and pao2 less than 40 severe I didnt know before that blood oxygen level above 60 is consedered abnormal too

Decrease tidal volume or maybe peep if you're starting from a place of over-distention.

@@RespiratoryCoach so decreasing title volume I would have to obviously increase the minute ventilation or keep it the same by increasing the respiratory rate no? Also would I not augment flow or no it doesn't do anything

@@RespiratoryCoach is there anything else you can do because let's say you are at 12 of p 14 of peep and you have a high title volume cuz the guy's big but he's on a rate of like 28 30. I know on conventional ventilation that sweet spot on the respiratory rate is like around 3234 before you really start reversing the ratios or double stacking your breaths.