Respiratory Therapy - Aerosol vs Humidity Devices

[@debilee4332]

i am an icu nurse and have watched many of your videos because your delivery is fantastic

[@adamt3013]

A passover without heat is worthless. Cool mist aerosol is the standard for a reason.

[@chooseurkarma]

Great explaining

[@stephaniekelly7113]

you are amazing!!!!

[@ventilator98]

My question is when a patient's body is performing the humidification, the temperature of the humidification is body temperature, and then when there's a trach patient who's on a trach collar, or T-Piece, they're wanting to administer COOL MIST. I believe Cool mist shouldn't be used for the trach patient, but HEATED, AND ONLY HEATED HUMIDIFICATION SHOULD BE USED! So why are people wanting to use cool mist for THE TRACH patient who isn't on the ventilator.

[@taye3986]

Thank you!! You are awesome...

[@non-mm28877]

Thank you that’s really help me study for the midterm

[@arwa7564]

thank you so much this was so helpful.

[@mjd9412]

I would formally like to offer you my Respiratory Therapy Fundamental teacher's position, please seriously consider my offer. Thank you.

[@RespiratoryCoach]

I accept!!! Thanks for watching and kindly commenting!

[@cyrillerosec.sumadia6007]

thank you sir.

[@RespiratoryCoach]

You're so welcome! Thanks for watching!

[@shmilyx007]

Thank you so much for the video..great explanation!

[@RespiratoryCoach]

You are welcome! I see you watching, Effie!! Thank you!!!

[@amandatorres4744]

Hi, love your videos! I was wondering if you could go over how we’re supposed to choose the best treatment options per the situation? Going further into case studies & not feeling confident in how to choose which nebulizer/medication.

[@hoganel79]

The way we learned Bland Aerosol, it includes both sterile water and hypertonic saline solutions for sputum induction. Is that the way it's always classified?

[@martiniasmith1446]

you rock

[@robgooner]

M Gf i

[@MDbros301]

You are seriously a lifesaver!! THANK YOU SO MUCH!!!

[@xodanny2955]

What’s amplitude ? Flow? Turn up the watts ? How do u increase USN output ?😊

[@Sam_1964]

Excellent presentation

[@acaprig27]

I would have loved for you to be one of my professors!

[@walaaalasari6662]

Thank you the best

[@taesarauw8374]

THANK YOU!!!!!!! Your page is the BEST!

[@RespiratoryCoach]

Hey Tae, you're too kind!!! Thanks for the question that prompted this video.

[@tiffanidazzo9468]

I am a lead therapist at a subacute facility in the Bay area and it is my first job. I would like some advice on The setup of the patients. I feel like we could greatly optimize their outcome if their care is properly set up. They are all long-term trade patients.

[@MacoyCafe]

Hi Tiffani, some of the things I might suggest you may already be doing if not then consider my recommendations. 1. Back up trach tube should always be cuffed even if the patient is currently using an uncuffed trach tube. In an emergency you will need to insert a trach tube that has a cuff so you can inflate it during ambu bagging. Add syringe 2. I would discourage the use of fenestrated trach tubes. Tissue inside the trach wall of the patient grows or swells into the fenistration holes when inner cannula is left out. Patients will refuse to have their pmv valve taken off at night. This is when you will run into that problem. When you change the trach tube the tissue is plugged up in the holes and will tear off the patient if your not very careful. I solved this by taking the wood end of a long q-tip and carefully fishing out the tissue. Do not replace with another fenestrated trach tube or the same thing will happen. 3. Know your patients who have diabetes, anemia and CHF. Knowing if they have diabetes is easy because they're g-tube feeding will be glycerol or something to that effect. If that patient starts having trouble breathing it is probably their blood sugar. With anemia patients they will have trouble breathing and no matter how much oxygen you give them or how high their saturation is they are still starving for oxygen because they're hemoglobin is 6 or 7. Encourage nursing to get them ferrous sulfate (iron), Epogen, blood transfusion if you suspect anemia. If you suspect CHF through visualizing sweating pitting edema request nursing to give lasix. 4. If you have a patient that has a ridiculous amount of secretions and you've tried everything else ask doctor to prescribe the drug Robinul. 5. Just because a patient can be weaned off of a trach tube doesn't mean they should be weaned off or switched to a cuffless trach tube. The doctor may want a cuff trach tube for future surgery of the patient. 6. When you encounter a patient with inner tracheal scarring and the suction catheter has trouble passing consider an extra long trach tube that passes the scarring or narrowing of the trach. The surgery to remove that scarring or narrowing costs $250,000. 7. If you're ventilator has an internal backup battery overtime the internal backup battery will completely lose its charge. When the facility checks the backup generator and turns the power off and then back on the ventilator with the non-functioning backup battery will fail and not turn back on. You will need to manually push the on button of the ventilator to turn the machine back on. Replace machine with a working backup battery. 8. If you have a patient with a fresh trach and stitches are present wait at least 10 to 14 days before considering removal of the stitches. Of course this is a rule of thumb and always examine the tissue first to make sure it's healing properly. This may not be your job but the job of the treatment nurse. Find out who's responsibility this is. 9. When a patient is decannulated and you have trouble getting the trach tube back in go one size smaller. Feed suction catheter into and through the trach tube. Now feed the suction catheter into the stoma finding the hole. Once the suction catheter is in the hole advance the tracheostomy tube over suction catheter. The suction catheter acts as a guide into the correct placement of the trach tube. 10. I hope this helps. Congratulations on your job.

[@MacoyCafe]

All of the subacutes I know have abandoned cool aerosol due to the production of way too many secretions. When I started respiratory therapy in 1998 all subacutes used cool aerosol machines. Most patients do much better without aerosol if they are not using wall oxygen. Wall oxygen is much drier than oxygen from an oxygen concentrator. If you have Wall oxygen continue using aerosol. If using oxygen concentrators provide humidity with an oxygen humidifier bottle. If you have a patient who has really thick secretions reserve the cool aerosol machine for them. Consider using cool aerosol on patients with pmv. This will help prevent thick secretions from accumulating in the trach tube when the inner cannula is removed during pmv therapy. In other words it will make it a lot easier to place a new inner cannula after pmv therapy. One more thing I forgot to mention in the previous post. The outer diameter of a shiley size 8 is equivalent to a portex size 9. A shiley size 6 outer diameter is equivalent to a portex size 8. This is very important if your facility switches everybody over to portex tubes. This is also important in case your facility runs out of shiley or portex and you need to replace your patient's tube with an equivalent size. I have also worked with Hudson tracheostomy hme's. They are okay but most facilities do fine with just oxygen humidifier water bottle.

[@MacoyCafe]

I just realized how unscientific it sounds to say we stopped using cool aerosol because of increased secretions. The fact of the matter is that many patients were not sleeping day or night due to coughing up excess secretions caused from cool aerosol delivery. The patients are given plenty of water through their g-tube. This water keeps the patients very hydrated including hydration in their lungs. Very interesting to note over time you will be able to know which nurses are giving more water in the g-tube on their shift. The patient will show it by increased secretions. Many patients that have bed sores will be given more water by the nurses because hydration promotes healing of the damaged tissue.

[@argga2]

Can you do a video on saline vs sterile water and when we would use either during aerosol therapy?

[@sinclair657]

Thank you so much for this information about the addition of the SVN flow to the readings on the vent. I now know how to approach situation moving on. Please explain why the Hydronamic/Hydrosphere nebulizer is most suitable to use with the NRM?

[@yamlevaharon934]

Hey! You make everything consolidate (haha) so much !!! Love your videos!! We had a question on the exam which one is more likely to spread infection LVN or SVN? Please helpppI Im thinking LVN?

[@RespiratoryCoach]

Hi Yam! Yes, LVN is more susceptible to infection due to the larger aerosol particles. The larger the particles the greater the ability to carry pathogens. LVN for the answer all day long!

[@thebr0dy]

man you're teaching more than my actual program. thank you.

[@RespiratoryCoach]

That's unfortunate, but I'm glad you found the channel. Thanks a bunch for watching and kindly commenting!!

[@nancycreollo5114]

Thank you !

[@raesworld9140]

How are you so concise!!! Omg ! Thank you

[@anitaarinze1842]

Very clear. Well done sir

[@RespiratoryCoach]

Thank you for the feedback, Anita!

[@kathyr7156]

My son has a trach that after a case of covid he needs oxygen. They are recommending warm mist , so that he doesn’t get dried out. The machine is a Fisher& Paykel MC 500 humidifier to warm the mist. Have you worked with this before? Any advice? Thank you🌷

[@moyedzl-dn5115]

you are just amazing, I don't even study RT but came here to broaden my knowledge, thanks

[@RespiratoryCoach]

Sweet! What do you study?

[@josheniajohnson252]

Thank you

[@RespiratoryCoach]

Hi Joshenia!!! You're very welcome. Thank you for watching and commenting!!

[@shaimaa6780]

best RT evveeeer

[@RespiratoryCoach]

Yes ma'am, you most definitely will be!! Speak it and act on it and it will be. Thank you for watching and commenting!!!!!

[@tera1333]

You truly have a gift in teaching 🙏. My teachers are OK at it but you make it make sense lol

[@RespiratoryCoach]

Thank you, Tera, for the kind comment! I appreciate your kindness!

[@dvannepatton4852]

You are such a great teacher. Everything you record i understand so much better than when I read or listen in class. You are a saint

[@ICUAdvantage]

I always appreciate your take on this info. Funny, but I don't know if I ever knew what "SVN" actually stood for. I'm sure over the years I've heard it, but certainly couldn't have told you if you asked!

[@RespiratoryCoach]

Hey Eddie!! Crazy the lingo we hear, but never truly understand. You could probably do the same and blow my mind. Appreciate you watching and sharing your thoughts.

[@ashleystrader9671]

I’m currently learning this in RT school and your teaching just Sticks so well!! Thank you, thank you!!

[@RespiratoryCoach]

Awesome! Glad it helps!

[@LordPalm1]

We're learning about aerosol in first semester of my program and this is soooo helpful!

[@RespiratoryCoach]

Fantastic! It only gets more fun from here!

[@henrythatrtguy6448]

You’re brilliant and an inspiration. Always learn something new from your videos!

[@RespiratoryCoach]

Hi Henry! Thank you for sharing those kind words, and I'm glad you find the channel helpful. Thanks for watching!!

[@ruqayajaff3935]

I learned in this video more than my book, thanks

[@holarobertoreyes]

Bro!! This video is awesome thanks! subscribed and liked!

[@terusate]

Thank you so much coach!!🙏🏼🙏🏼🙏🏼

[@HaiTran-gl6zz]

Honestly your very helpful. I had trouble with this topic even though it sounds so simple, but yet can be confusing for me !! Thank you!!! Wish me luck becoming an future RT this year!! Greetings from Southern California!!!

[@JDuBBaLiiCiiOuS]

Can you explain the relationship between temperature and humidity level? Does increased temperature cause more or less humidity and how so? Thanks, love your channel I recommend it to everyone.

[@MacoyCafe]

Increased temp = increased humidity in the air. We see this in our environment in the summertime when the air gets humid. If the air gets cooler in the evening water drops out of the air on the grass.

[@Frankifourfingers]

Thank you for excellent content. Could you provide comment on the role of Nebulised Normal Saline using an SVN as a mucolytic agent in patients with cough and acute respiratory distress not requiring mechanical ventilation. *normal saline vs hypertonic saline

[@alialzahrani2531]

You are the best 🙏🏽🙏🏽🙏🏽🙏🏽

[@RespiratoryCoach]

Thank you for leaving this kind comment and for watching! I appreciate you!

[@Don-xj3uo]

Total VALUE! All summer I will be watching and reviewing with your videos.... Thank you!

[@carolashelford7855]

Hello . I work as a paramedic . My firehouse just placed hme ( aero stat 2) on the ambulance to protect use from the covid . Will the hme protect use ?

[@RespiratoryCoach]

The HME will provide some level of filtering of expired gas, but will it fully protect you? I don't know the answer to that question. It seems like in an ambulance, the intubation process alone will present the greatest exposure risk. Once intubated, utilize the HME and avoid breaking the circuit at all cost. Do you utilize closed system suction catheters? If not, that would be worth looking into to help reduce having to break the circuit.

[@christinagraham6778]

I stumbled along and found your channel before doing my Classmate assignments.. and WOW you have just acquired an RT student!! This topic is explained beautifully, thanks so much

[@RespiratoryCoach]

Very cool! Welcome to the class. Be sure and share with your classmates. Thank you for watching and sharing this kind comment.

[@lisasalgado167]

Super helpful as always thank you!!

[@brandieboswellrealtor]

What a great video Coach!!!!!!! Thank you. I hate questions pertaining to the humidifiers but now I have such a better understanding.

[@orange_eee]

The information you given in 30m video is exactly what I learn myself 57 page in my textbook plus a bunch of slice of the PowerPoint 😊 love how you explain every detail

[@samhassy3526]

Which book did u study

[@almaabdulaziz2635]

this is so helpful thank you so much!

[@munyrahxz1540]

Hey, thanks for your video, it’s very useful, I have question.. what best for medication delivery for patients with MV MDI or SVN? And why?

[@RespiratoryCoach]

Hello. I don't the statistics to support which is superior during MV. I do know that the major factor probably comes down to proper administration with a MDI, and remembering to perform a mechanical breath hold. It must be actuated just prior to the inspiratory phase. That seems obvious, but you'd be amazed. With SVN, obviously much easier to administer, but still there are things to consider. HME must be removed. Placement of SVN. Type of SVN. Additional flow added to the circuit. I think the key is knowing the indications for the medications you wish to deliver, and then assess outcomes with the various medication delivery devices.

[@munyrahxz1540]

Respiratory Coach thanks for replying my question 🙏🏻

[@mskrh640]

Thank you so much sir. You are the best.

[@RespiratoryCoach]

You are very welcome, and thank you kindly for watching and commenting!

[@reginaisaac0826]

Thank you so much for explaining things the way you do!! Very helpful!!

[@RespiratoryCoach]

You're very welcome, Regina! Thank you for watching and commenting!

[@roshu4557]

What about high flow nasal cannula, is it also same as bubble nc?

[@RespiratoryCoach]

High flow nasal cannula, such as Airvo, uses a passover humidifier.

[@nermsraborar1749]

Great lecture Coach! Thank you.

[@cyriljum5182]

Thank You! Clear explanation, this is the best!

[@RespiratoryCoach]

Glad it was helpful! Thank you!

[@courtneynorth5263]

definitely subscribed . i really needed this information. due to this covid-19 of course campus classes have been replaced with online. Its much harder for me to learn and this video really helped me out. Thank you keep them coming please.

[@RespiratoryCoach]

Will do, Courtney! Definitely a challenge for students adjusting to distant learning during these times. Hope you find the channel a valuable resource to supplement your online classes. Thank you for subbing, watching and kindly commenting!

[@lizl.6874]

I've seen this before, I just wonder if the vent has the passover humidifier already, should we still put HME on the expiratory limb? what is the main difference of the green over the yellow HMEs? Thank you for these gold teachings!

[@RespiratoryCoach]

Perhaps maybe a filter should be placed on the expiratory limb, but not a HME. A HME is only indicated to provide heated humidification to the airways. If you have a heated passover in use then the need for a HME is eliminated. Plus, the function of a HME is negated by placing it on the exp limb, as there is now no inspiratory flow coming back through the HME to pick up the expired heated moisture. I'm not familiar with the green vs yellow HMEs to tell you the difference. If you have time and the desire, feel free to send me a picture of each to my email and I'll take a look for you. [e-mail]

[@lizl.6874]

@@RespiratoryCoach I've got my head around it now. Thanks a million! I was confused between the filter (yellow) and the HME(green), as you may know im not an RT but nurse manipulating ventilator.

[@annfillali3820]

You made it simple and easy to remember. Thank you for all your work 😊😊

[@RespiratoryCoach]

That's the goal! Thanks for commenting and watching!

[@mohamedhabibberhanu6553]

I really appreciate, you made it so clear Thank you so much coach

[@RespiratoryCoach]

Awesome, Mohamed! Glad you enjoyed it. Thank you for watching and commenting. I appreciate you!

[@Wasabiii23]

I’m in my first semester of RC school and I’m so thankful to have found your page! You really make it easier to understand the concepts of why we are doing certain things. I appreciate you putting in time to make these videos:)

[@jemihaeujeune1423]

Hi, did you graduate? If so how do you like working? Any tips for RT school? I’m also in my first semester.

[@Wasabiii23]

@@jemihaeujeune1423 yup I graduated this past May! Took my board exams a week after graduating and passed both exams. Got a job right away. Some tips I would give to a new student is to… -Watch respiratory coach lol. -When going to clinicals make sure to make a good impression and get contact information from each site that you may want to work at in the future. It’s always good to have connections. -Take advantage of study guides if teachers give them out. As soon as they release them for exams, finish it early and start studying them a little every day. -Last thing and the most important for school and clinical… Always ask questions if you don’t understand. I was that person who asked a lot of question. You’re there to learn, don’t be afraid of making mistakes. It will be better to learn from mistakes as a student rather than an employee! Take advantage of that! You guys got this! Things may be new and scary but you will get more comfortable with more repetitions! Good luck:)

[@shemaaali5237]

@@Wasabiii23 Thank you for that information! Samething here, I am on the first year of RC, and next semester I will do clincial education. Again, I really appreciate that!

[@shemaaali5237]

@@jemihaeujeune1423 Thank you so much!

[@lizl.6874]

Gold!

[@RespiratoryCoach]

Hey Liz!!! Actually, this comment is GOLD!!! Thank you for watching and commenting!

[@Sirp875]

hi sir, in administering nebulization using an oxygen, do we need to put a saline in a bottle that is attached to it?

[@RespiratoryCoach]

Hello, Edwin. No. We only need to add saline when diluting a concentrated dose of medication or attempting to induce a cough for sputum sampling. The gas source driving the nebulizer has no effect on the content of what is being nebulized. I hope I understand that question correctly. Let me know if not. Thanks for watching and asking, Edwin.

[@Sirp875]

@@RespiratoryCoach it's clear now for me, thank you for replying👍🌺