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

[@jamlisa4696]

I am a lung physiotherapist working in intensive care in Europe. I am learning so much from you. You are an excellent teacher. Thank you🙏🏾

[@markthorne2156]

I really enjoy the way Coach explains mechanical ventilation!

[@aileenhernandez1495]

Thank you!! I was always taught to ALWAYS fix ventilation first. I have a better understanding after this video, this makes so much more sense 🙌🏼

[@fishingsouls4christceoofgi614]

Binge watching, all of your content multiple times. Watching a 10minutes video I have learned so many concepts that I never grasped from a 2-3 he lecture. THANKYOU FOR BREAKING THIS DOWN to the point. I appreciate your slow voice of tone when you are saying something….Thankyou for repeating important concepts. Thankyou for teaching the nation and the world towards being the best RRT we can be!

[@atiyapowell6968]

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

[@shaydelre1898]

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

[@shaydelre1898]

Studying for my boards! Thank u so much!

[@melissaakers8752]

Wow! This video just blew my mind 🤯. It’s like I know that Vt and RR are for ventilation and PEEP and FiO2 are for Oxygenation, but I was getting questions wrong because I wasn’t picking the best answer. Your videos have made a world of difference for me understanding all this and I just graduated! And 🥴🥴I’m guilty of the “coarse” charting because NO ONE ever said don’t do that.

[@josesaldana6224]

I loved the video, learned so much from it. I wanted to add to the first scenario with the given settings RR 18 Vt 600 the Ve comes out to 10.8 L. Increasing the RR to 20 we now get a Ve of 12 L which will help correct the CO2 and bring the pH up. Increasing the Vt to 650 we get a Ve of 11.7 L slightly less than the first option. Great video as always, what I learned was to use the IBW formula when the weight, height, and sex is given. Initially when doing the problem I just used the kg given, and ignored the other information.

[@thezenithfarm3695]

Great discussion!! Atelectasis was the twist !! Thank you !!

[@cassandraguillory7526]

Thanks . Love your teaching videos, they help me understand respiratory so much and shows me all the information that I was missing and didn’t learn in respiratory school.

[@nancycreollo5114]

Good morning from Hawaii! Thank you for making this clear. I am 4 weeks in to MV and I was so lost 😞 you are inspiring! Makes me stay in the program.

[@RespiratoryCoach]

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

[@landon94]

Great video. Makes me feel good getting the right answer because I realize how good of a job my teacher has been doing. Thanks to her and you for always improving my knowledge.

[@RespiratoryCoach]

YES! Big props to your instructor!!!

[@RebeccaBurcher]

Hey Coach! TMC here we come! Great video and well broken down. It's so much easier to eliminate the wrong answers by asking yourself first, "Is this a problem with oxygenation or ventilation?" Thanks for the great insight! And love the merch 😁 -Becca

[@RespiratoryCoach]

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

[@RebeccaBurcher]

@@RespiratoryCoach Sure is 🤓

[@jt7794]

Joe, thank you for breaking down this question. When I paused the video in the two options to increasing the Ve I increased the Vt because it gave me the lowest Ve by increasing the rate the Ve is 12L. That is the reason I opted for increasing the Vt. Once again thank you for make it clear for everyone. Happy Easter to all and stay safe.

[@RespiratoryCoach]

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

[@washed-trickle]

Thank you for breaking this down, Keep these videos coming!!!!

[@RespiratoryCoach]

Will do! Stay tuned!!

[@barbarasmith7197]

We love your videos ! Our respiratory class found your videos and we watch them. We are just starting our 2nd year . Big thank you to all your videos.

[@pabbate87]

Let’s get it!! taking my way exit exam in a little more than two weeks!!

[@RespiratoryCoach]

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

[@melissazuniga951]

I love your videos. Thank you I’m currently in my last term of school and practicing for TMC and CSE ❤

[@patriciavalencia64]

Thank you soo much Respiratory Coach. I love watching your videos to refresh my RT knowledge.

[@RespiratoryCoach]

My pleasure! Thank you for watching!!

[@ggr_light809]

4 Critical Life functions 1. Ventilation 2. Oxygenation 3. Circulation 4. Perfusion. :)

[@RosemaryR2728]

Thank you. This confirmed what I know. The second question added to my knowledge! You’re the best

[@kitpesec1536]

Another great video)) Not only for exams but for refreshing RT knowledge)) Thank you so much))

[@RespiratoryCoach]

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!!

[@kitpesec1536]

@@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)) 👍🙏

[@FelixGregorianMedInventor]

You are truly awesome. Excellent presentation Reasoning and teaching components all in one

[@RespiratoryCoach]

Thanks for watching and kindly commenting!

[@sharonmori4833]

Great explanation, so glad I purchased your TmC boot camp, as I prep for my exam coming up soon.

[@RespiratoryCoach]

GO GET THAT RRT!

[@sharonmori4833]

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

[@shibunair9880]

Great video. Thanks for the explaination. Keep posting.

[@kebo7579]

This was very helpful! Thank you!

[@leishajohnson9686]

Thank you for teaching me the why!

[@delomcoker]

Thank you very much, now I understand this method better

[@RespiratoryCoach]

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

[@andrew8188]

This info really pertains to a test I just took. Thanks for clearing the air on that!

[@TheBishopDon]

man....I kept saying COME ON PASTOR!! LOL, thanks for the help man!!

[@RespiratoryCoach]

LOL Thanks for watching Darius!

[@kaylapopke5956]

I was wrong and picked vt. Thank you for explaining!

[@RespiratoryCoach]

Hi Kayla!! Makes sense now though?

[@bukolaogunnaike5621]

Thank you for making this easy.

[@sibella3]

Thank you so much for great tutorial 🙏

[@physiomedicine]

You are greaaaaaaat ❤❤hypercapnia is while the co2 high ph low causing hypoventilation,if this include oxigenation problem i must fix ventilation first

[@RespiratoryCoach]

Absolutely! GO BE GREAT!

[@christinesullivan5195]

THANK YOU! This video and the test taking tips were so helpful. I had some trouble tackling these questions in the past since there can be a lot of issues going on, but you break down each part and make it so easy to understand and solve. I'm so glad you're breaking down TMC questions before a lot of us take our exams!!

[@RespiratoryCoach]

Glad you found it helpful, Christine!!

[@izzyninalara5732]

This was very informative thank you for sharing great knowledge ♥️

[@fishingsouls4christceoofgi614]

Thankyou for making MV digestible 🙏🏽

[@ronzettejackson1055]

Hey, Joe do you have a video on the TMC rules on how they would like the questions answered ? If not I think that would be very helpful. Great job, love the videos!

[@RespiratoryCoach]

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!

[@akandela]

Thank you. Great teacher 👌

[@akkdancer99]

Soooo many of these on the TMC!!!

[@The357royal]

Awesome teaching

[@JohnWick-vs4vd]

Very helpful assessment. 🙌

[@RespiratoryCoach]

Glad you think so!

[@casiboehm9472]

Hi Joe, thank you for all of the TMC videos, they have been very helpful when preparing for the exam. I was wondering if you could post the equation for IBW for men as well as women?

[@RespiratoryCoach]

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!!!

[@wegahtatafla6876]

Great info! Thank you coach!

[@RespiratoryCoach]

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

[@nermsraborar1749]

Great lecture, as always! Thank you Coach! Keep shining ✨

[@hannahlartey6918]

Helpful and awesome. Tnx

[@acaprig27]

Great vid as always!

[@RespiratoryCoach]

Appreciate that! Thank you for watching!!

[@chavacar.1314]

You're the best!

[@RespiratoryCoach]

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

[@shaneang1]

So helpful!! Thank you!!

[@josephkimanthi2273]

Thank you.

[@haleighvidalaz9541]

I love your videos thank you for taking the time to share your knowledge! I have a question, I’ve been studying in my Kettering book , is setting the tidal volume range 5-10ml/kg then picking a numbers that’s typically in the middle of that 5-10 , is that acceptable as well ? That’s what the Kettering book was stating so I am just a little confused . This might be a stupid question because a range of 6-8 would kind of be “ in the middle “ of the 5-10 ml/kg that Kettering states to use . Sorry if this is confusing. I take my TMC test on Saturday 😳

[@RespiratoryCoach]

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

[@13l91]

Very helpful thank you for your time! I’m the 3rd semester In RT school do you advice if I start studying( preparing ) for the TMC exam ?

[@Lazyeyefitness]

much appreciated!!

[@meloucabugsa6320]

Do you have a comprehensive NIV video talking about advanced NIV settings?

[@tgaskill]

Great video and explanation!

[@RespiratoryCoach]

Thank you, Thomas! How you been?

[@tgaskill]

@@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!

[@RespiratoryCoach]

@@tgaskill That's awesome, Thomas. I would love to have you join me on my RTalk segment of the channel.. Send me another email, [e-mail], if you're interested.

[@felixgoga7330]

Thanks alot respiratory coach, for the second case by what range should we increase the tidal volume?

[@dtmfool789]

When I do the math I get 80kg even. If I use the online calculator I also get 80. IBW= 50(2.3x13)

[@matty00926]

Why not just increase the Vt to 650 which is within range still? doesn't a higher rr bring dead space issues into play? Or bring the potential for synchrony issues? Interesting practice question for sure!

[@rebelliousink9085]

Increasing the tidal volume will also help with the oxygenation too

[@RespiratoryCoach]

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!!

[@matty00926]

@@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!!

[@annexyrelle]

​@@matty00926

[@nv5606]

Hey Joe! I have a doubt; Let’s say that the Vt would be in the low side range, for example 510 ml instead of the 600 ml that the patient is receiving. Would changing the rate still be the correct answer? Thank you so much in advance !!

[@RespiratoryCoach]

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.

[@nv5606]

I understand , Thank you so much!!

[@khadijabelqas]

We just finished our Kettering Seminar and we were told that normal range for VT is 5-10 ml/IBW

[@RespiratoryCoach]

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.

[@Cindy-dr7zj]

This video helped me a lot! Your videos are what’s helping me get through RT school right now! 1 more year to go! Hoping to take your boot camp next year before taking the boards!

[@ginasophie500]

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

[@ruqayajaff3935]

Love ur videos

[@quintonwynn6471]

Question 1 increase rate

[@kimberlyhouseworth4711]

I haven't watch yet where you give the answer.... but when I do the calculation 650 VT is still in the normal range and since this is volume A/C I am going with 650 VT. Now let's see if I am correct.

[@kimberlyhouseworth4711]

boo I was so close to being correct!!!!!

[@jaysick9481]

Great vid great channel. But I got 80kg (79.9kg) as IBW. 50 + 2.3(60-73) = 79.9? Either way I would of chose D. Bc with an IBW of 80kg's, 650ml Vt would be out of the 6-8ml/kg range. Thus eliminating B.

[@joseepion3775]

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

[@suman788]

your videos are really helping me....just one question though, inspiratory crackles could also indicate underlying heart failure, then assuming similar situation in clinical practice what if I opt for increasing both PEEP and Respiratory rate? will it be correct?

[@lisarios8677]

Hello, just wondering if you have any videos for clinical sims or study guide.

[@joseepion3775]

I understand that the TMC rules state that if you are within the 6-8mls/ kg range then you should adjust the Rate first, however I am curious, I was taught a trick that if you do the rate multiplied by the current PCO2 divided by the next wanted CO2, that you get your approximate required rate. for example, in this case if I wanted to decrease to a PCO2 of 50 I would do (56 x 18) / 50. and the rate required would then be 22. so changing the rate to 20 wouldn't be sufficient to change the PCO2 to an acceptable level. I suppose it is better to just follow the TMC rules when answering these questions, but just wondering if you ever use this calculation, and is it possible that it is actually applicable to my clinical practice and will it yield accurate results?

[@RespiratoryCoach]

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!

[@riyanbamurdah7479]

I kinda disagree with the second question, cuz increasing Vt will not do recruitment of the altelactic alveoli , in my opinion increasing PEEP would be optimal answer cuz once you recruit the closed alveoli your Vt ( which still in normal range ) will do the trick . What do u think ?

[@jeannettemiranda8884]

Thank you!

[@garyprn2000]

I was taught the IBW formula for males is 50kg + (2.3 kg * inches above 5ft (in this case it is 13)). It appears that you used 2.6. I understand that roughly 3kg is not a huge difference in the long run. I am just wondering where the 2.6 came from. Thanks.

[@ozzya9977]

Can you please explain why you fix ventillation first instead of hypoxaemia?

[@RespiratoryCoach]

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

[@ozzya9977]

@@RespiratoryCoach ah yeh got ya. Thanks

[@nursinglikeaboss5611]

Thanks 😊

[@RespiratoryCoach]

Welcome 😊

[@ladaciaphillips7072]

Good Evening, I am interested in listening to the tmc bootcamp review for test takers. Is there a link I need to follow, I'm already subscribed to you page

[@Jatishwar]

But if it is a ILD pt, who will also have fine crepts,and the pt having stiff lung, increasing TV or increasing RR will be the correct option??

[@thebr0dy]

Hey Joe-- are these TMC Rules written out anywhere? i feel really comfortable in the hospital but the real life moves and the TMC moves don't always line up, and it leaves me lacking confidence on practice exams.

[@rozamajed3027]

I’m a little confused. I’m studying for the TMC exam and I have been told that they have changed the normal range for Vt to 5-10ml/kg. If that’s the case, it’s going to change the answer right? Or should I stick with 6-8/kg

[@nigel5009]

Hey coach If the patient is breathing above the set rate of 18, would you still increase the rate instead of the tidal volume .

[@RespiratoryCoach]

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

[@sej7593]

Thankyou ❤️

[@mahienaslewegena1292]

Great video for break down,,, how can I contact you , I need a tutor , thanks in advance

[@tiltflare3132]

Do you got Clinical Simulation breakdown videos

[@polokidzgohard93]

Do you have these for oxygenation?

[@physiomedicine]

Greaaaaat i have many questions from my university , can i send all of them to your email?🙂

[@physiomedicine]

Question 1 the answer B, and you are not correct when you say that o2 71 is reduced because the normal value higher than sixty .

[@RespiratoryCoach]

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

[@physiomedicine]

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

[@physiomedicine]

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

[@physiomedicine]

​​@@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

[@mondego]

Where can find a summary of those rules?

[@RespiratoryCoach]

They're usually emphasized in most review programs.

[@mondego]

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

[@tarikrafiq1846]

IDEAL body weight here is 76 kg not 84 kg . anybody agrees with me?

[@chexthis]

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?

[@RespiratoryCoach]

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

[@chexthis]

@@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

[@chexthis]

@@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.

[@paulapaula7817]

Thank you😃