I'm studying to take my Step one next month and never understood this, after a youtube search on V-Q mismatch I stumbled upon this, thank you so much! It's so clear now, better late than never! :)
Thank you so much for all your videos. I'm in my third month as a first year pulmonary/CC fellow and have been using your videos to reinforce concepts that during residency I found very confusing. You have such a talent. Thank you
ur lectures go hand in hand with your picture - you explain so clearly that it is like you are spoonfeeding us the exam answers :) so glad to be subscribed.
I have stage IV COPD with VQ mismatch and PH and nobody ever explained what this meant to me. Thank you!! Now I realize why I must keep 02 on always and monitor with pulse oximeter.
I am a pulmonary hypertension patient and have to have a double lung transplant. This lecture really helped me understand what the docs are talking about when they say my pressures are at certain levels. Thank you
your lectures are great I finally understand so easy to follow... I have been to several lectures on VQ mismatch over the years and could not get my head around it... I listen to your lecture and bang I finally understand it. I'm glad our Uni lecturer suggested to watch your videos..
After reading over the same 3 paragraphs about 4 times in my text book, i bounced up this you tube explanation and i can finally read on. Thank you very much.
Hallelujah !!!!!!!!!!!!!!!! May God bless you million times million. I completely understood the concept, I was so lost before i watched this video. :') Thank you
Very helpful! But one suggestion: Khan's professors are great at using different colors to help organize paths ways or thought. I would have appreciated that especially in the beginning of the video.
Love the analogy of ' air goes in and out and blood goes round and round' - this is what I jokingly tell people my bachelor of paramedical science taught me. However, essentially keeping a VR and HR going is one very good end goal for treating acute patients, generally speaking. I'm sure you know where I am coming from. Peace
Payden Aronson Interesting...I have documentation stating VQ mismatch from a Cardiologist and a pulmonary team. Had 2 right heart cats done and one was a stress cath ... I am not contradicting you, I don't know enough about it to say who is correct.
Words cannot describe how grateful I am for this video! Dr. Seheult did an EXCELLENT job in breaking down the concepts. I am clearly able to grasp the concepts!!
See the whole series at www.medcram.com along with other top quality videos including reviews in pulmonary, cardiology, infectious disease, and hematology!
Very good tutorial, very well explained. One thing you do that is soo--o-o often done badly in medical tutorials/discussions is that you have made sure the basic terminology and concepts are explained along the way. Btw this video also taught me PE fundamentals better than anything I've read on PE!
+Simon Barry Good to hear- glad this helped in your understanding, and thank you for your topic suggestion. We look at all topic suggestions like yours in planning for new videos
Very Helpful!! I would love to you go through a few more examples of pathology that lead to V/Q mismatch for example when V/Q is low like in bronchospasm or something like COPD/Asthma that affects both lungs in their entirety.
Great video! Now (just to tie it all in) I gotta go find the one where you describe and explain "Shunt". I am a Trauma/Burn ICU RN who loves to understand the rationale behind what we do. Thank you!
Thank you for your video. I just have one question regarding pneumonia and pulmonary edema, i.e. In those states, is it that you have increased fluid in the alveoli resulting in impaired ventilation but normal perfusion, creating an intrapulmonary shunt? So why would supplemental oxygen improve oxygen status in this case? Thank you in advance.
Roger. Thank you for all the videos. Please keep them coming!! Very helpful for a respiratory therapist student that's just entering his/her clinical practice :D
@12:35 You said that blood will go from high V/Q to low V/Q area. But I think it should be opposite. Decreasing ventilation and increasing perfusion will cause the terminal arterioles constrict and redirect blood to the respiratory area where PO2 is high. Therefore, the blood should go from low V/Q area to high V/Q area.
+Shirley King Thanks for commenting. What I was trying to communicate was that when there is a physicial obstruction in the pulmonary artery, this is going to cause blood to go from that area to anywhere else it can. Because of this it will cause an area of low perfusion to the affected area (high V/Q) and an area of high perfusion to everywhere esle (low V/Q).
Great explanation! Just need some clarification. I was taught that: - in lobar pneumonia, a portion of the lung has gunk in it and therefore is effectively a partial shunt (for that part of the lung) - V/Q ratio is very low - in pulmonary embolism, a portion of the lung cannot not be perfused and therefore is effectively in dead space ventilation (for that part of the lung) - V/Q ratio is very high SO when you say breathing 100% oxygen will correct a decreased arterial PO2 caused by V/Q mismatch but NOT shunt, are you referring to the shunt as being a very large shunt that blocks off an entire lung like widespread "white out" pneumonia? Is there a gradient for when V/Q mismatch becomes a complete shunt or complete dead space when the V/Q ratio reaches extremes?
I believe the principle he is speaking to is blood flow through a shunt, either from a pneumonia (blocked alveoli with mucus) or physiologic (like deoxygenated blood from the lung parenchyma) will not be exposed to oxygen at all (very low V/no change in Q). Increasing the PiO2 will have no effect on shunted blood because it is never within diffusion distance of blood. Hope this helps.
My understanding of V/Q in the different Lung Zones. where the alveoli get smaller as its gets to the lower zones of the lungs are high V/ Q since the alveoli are smaller and easier to ventilate and perfuse but in the higher zones have larger alveoli has less V/Q since the alveoli are larger in the higher zones of the lungs. Your video showed me a total opposite of what I understand or think I remember with respect the V/Q in the Alveoli in the different Lung Zones.
Can someone tell me why at the 8:07 it says that the saturation at the upper part is98% because it has high V and low Q? i mean what’s the relation btwn saturation and the VQ?help meee
Why does VQ mismatch apply in Pulmonary Emboli? If there isn't any blood flow to that section of the lung shouldn't it be marked as dead space? Earlier in the video you said VQ mismatch works only for lung that is both perfused and ventilated (no matter the balance or mismatch between them).
this was incredibly helpful!! one topic of interest (may already be covered, havent looked to see yet) differentiating PA02 from Pa02 from percent saturation from Fi02, and the different pathologies impacting all of these values (CO poisoning, altitude sickness, methemglobinemia, etc)
One thing, V/Q mismatch doesn't necessary mean that part of lung has lower rate and other part higher than usual, it means that V/Q is different than normal for lungs. In pneumonia for example there aren't pulmonary segments with higher ratio. Only lower, and result is hypoxic blood.
Loving your videos, it made applications of medicine much more easier to understand! Also, just wondering, how does hypocapnia play out in the compensating of this situation?
Could you please explain why hypoventilation is not considered a type of a V/Q mismatch (low V/Q) if there is lowered alveolar ventilation (V) with normal perfusion (Q) in this condition ? (e.g. the alveolar ventilation 2,5 l/min and the perfusion 5 l/min -> V/Q = 0,5) This is the thing I cannot understand so i'd be grateful for some clarification on this matter. (sorry for posting this question under your hypoventilation lecture too :) )
Hi MedCram, I'm almost certain you get asked this all the time but what is the name of the whiteboard software are you running to create videos like this one?
What software do you use for the drawings? I feel like they would come really handy when studying and being able to draw out diagrams, ect. Great video by the way. Thank you!
best 14 minutes ever spent! your video summarized in 14 minutes what 2 hrs of ventilation lectures didn't at my school... THANK YOU!!!
+Jennifer Torres Glad the video was helpful- thanks for the feedback!
I'm studying to take my Step one next month and never understood this, after a youtube search on V-Q mismatch I stumbled upon this, thank you so much! It's so clear now, better late than never! :)
Jenny Gonzalez Glad we were able to clear up VQ mismatch for you- thanks for the feedback
wow, compared to the PhD teaching at my medschool............
this is pure gold.
You got a very rare talent that many people dont have..thanks a lot...
shakhir rt
Thank you so much for all your videos.
I'm in my third month as a first year pulmonary/CC fellow and have been using your videos to reinforce concepts that during residency I found very confusing. You have such a talent.
Thank you
ur lectures go hand in hand with your picture - you explain so clearly that it is like you are spoonfeeding us the exam answers :) so glad to be subscribed.
Came here to grasp it for nursing school... And DANG. This was fantastic! Exactly what I needed. Thank you!
ICU nurse here: hard to keep up with, but still very helpful. Thank you guys.
You are a god! Pulmonary Physiology exam coming up & this explained it so much better than my professors rambling!
I have stage IV COPD with VQ mismatch and PH and nobody ever explained what this meant to me. Thank you!! Now I realize why I must keep 02 on always and monitor with pulse oximeter.
Incredible illustration, Doctor. Bravo! The best I have ever seen. Crisp, eloquent and to the T.
I am a pulmonary hypertension patient and have to have a double lung transplant. This lecture really helped me understand what the docs are talking about when they say my pressures are at certain levels. Thank you
your lectures are great I finally understand so easy to follow... I have been to several lectures on VQ mismatch over the years and could not get my head around it... I listen to your lecture and bang I finally understand it. I'm glad our Uni lecturer suggested to watch your videos..
Jason MacAskill Thanks for the feedback- glad the video helped clear things up
After reading over the same 3 paragraphs about 4 times in my text book, i bounced up this you tube explanation and i can finally read on. Thank you very much.
Ruanne Lynch Good to hear the video made the textbook more readable- thanks for the comment
You are helping me get through nursing school. Thank you so much for these videos.
Hallelujah !!!!!!!!!!!!!!!! May God bless you million times million. I completely understood the concept, I was so lost before i watched this video. :') Thank you
Legend. If only you were my lecturer! So clear & easy to understand! THANKS A MILLION!!!
Blew my mind how simply it was explained! Loved the illistrations
Very helpful! But one suggestion: Khan's professors are great at using different colors to help organize paths ways or thought. I would have appreciated that especially in the beginning of the video.
Way of your explanation is matchless... A big applause for you
Thank you
Wow. ICU presentation today covering MOA hypoxemia. This was the only thing i had trouble explaining. Thank you!!
this is absolutely amazing. I've been trying to understand this concept for literally hours. i get ittttt
Thank you for watching!
Straight forward, concise and in layman's terms. Very well done, thank you for your time and effort.
Dude! You are a rockstar at explanations!!
Doc am grateful for all your materials.have learnt a lot
Anaesthestist resident in Nigeria
Love the analogy of ' air goes in and out and blood goes round and round' - this is what I jokingly tell people my bachelor of paramedical science taught me. However, essentially keeping a VR and HR going is one very good end goal for treating acute patients, generally speaking. I'm sure you know where I am coming from. Peace
I was just diagnosed with this today and my head was spinning. Thanks for an easy to understand tutorial.
You can not be diagnosed with v/q mismatch... You can be diagnosed with pneumonia or asthma or anything else but not v/q mismatch...
Payden Aronson Interesting...I have documentation stating VQ mismatch from a Cardiologist and a pulmonary team. Had 2 right heart cats done and one was a stress cath ... I am not contradicting you, I don't know enough about it to say who is correct.
Finally a well explain concise video with ways to apply this concept
Very good explanation of quite difficult topics for the USMLE step 1. Thank you Sir.
Thank you for helping me on my National Respiratory Therapist exam.
Words cannot describe how grateful I am for this video! Dr. Seheult did an EXCELLENT job in breaking down the concepts. I am clearly able to grasp the concepts!!
This is a really thorough and clear concise explanation of V/Q mismatch thank you so much!
Love this series! I may pass this exam after all!
Excellent for the biggner and really very talented explanation which makes easier
thank you for such a clear explanation of V/Q mismatch
Absolutely awesome! Why can't clinicians just explain it like this? Thank you ever so much for making study easier
See the whole series at www.medcram.com along with other top quality videos including reviews in pulmonary, cardiology, infectious disease, and hematology!
Very good tutorial, very well explained. One thing you do that is soo--o-o often done badly in medical tutorials/discussions is that you have made sure the basic terminology and concepts are explained along the way.
Btw this video also taught me PE fundamentals better than anything I've read on PE!
+Simon Barry Good to hear- glad this helped in your understanding, and thank you for your topic suggestion. We look at all topic suggestions like yours in planning for new videos
DR you are a genius.i know understand hypoxema better than after reading all those stuffy texts.thank you
you are unique at making difficult concept easier..god bless you
Wauw, this is soooo incredibly helpful! My test is tomorrow and I have higher hopes now haha! Thanks a lot!! X
Thank you so much. My professor didnt even let me know that Q was perfusion
Very Helpful!! I would love to you go through a few more examples of pathology that lead to V/Q mismatch for example when V/Q is low like in bronchospasm or something like COPD/Asthma that affects both lungs in their entirety.
+Jenna Israel Thanks for the comment and suggestion!
Fabulous! great visuals and clear instruction!
thank you! very informative!Please make a video also for respiratory failure.
Thank you so much.For the first time,I can say that I understand Hypoxemia.
Fantastic explanation. You are doing great job!
These have been great, thanks for posting. Everything is clearer now!
You have a great way of teaching. Simple and precise! Thank you!
Lifesaver please continue doing this!!!!
+JelliBaby780 Thanks! More videos coming soon
GREAT demo! Clear and informative!
Great video! Now (just to tie it all in) I gotta go find the one where you describe and explain "Shunt". I am a Trauma/Burn ICU RN who loves to understand the rationale behind what we do. Thank you!
Thank you for your video. I just have one question regarding pneumonia and pulmonary edema, i.e. In those states, is it that you have increased fluid in the alveoli resulting in impaired ventilation but normal perfusion, creating an intrapulmonary shunt? So why would supplemental oxygen improve oxygen status in this case? Thank you in advance.
You explained things wonderfully! Thank you for making this topic simpler for me.
Roger. Thank you for all the videos. Please keep them coming!! Very helpful for a respiratory therapist student that's just entering his/her clinical practice :D
You are my favorite, as usual!
@12:35 You said that blood will go from high V/Q to low V/Q area. But I think it should be opposite. Decreasing ventilation and increasing perfusion will cause the terminal arterioles constrict and redirect blood to the respiratory area where PO2 is high. Therefore, the blood should go from low V/Q area to high V/Q area.
+Shirley King Thanks for commenting. What I was trying to communicate was that when there is a physicial obstruction in the pulmonary artery, this is going to cause blood to go from that area to anywhere else it can. Because of this it will cause an area of low perfusion to the affected area (high V/Q) and an area of high perfusion to everywhere esle (low V/Q).
Great explanation!
Just need some clarification. I was taught that:
- in lobar pneumonia, a portion of the lung has gunk in it and therefore is effectively a partial shunt (for that part of the lung) - V/Q ratio is very low
- in pulmonary embolism, a portion of the lung cannot not be perfused and therefore is effectively in dead space ventilation (for that part of the lung) - V/Q ratio is very high
SO when you say breathing 100% oxygen will correct a decreased arterial PO2 caused by V/Q mismatch but NOT shunt, are you referring to the shunt as being a very large shunt that blocks off an entire lung like widespread "white out" pneumonia?
Is there a gradient for when V/Q mismatch becomes a complete shunt or complete dead space when the V/Q ratio reaches extremes?
I believe the principle he is speaking to is blood flow through a shunt, either from a pneumonia (blocked alveoli with mucus) or physiologic (like deoxygenated blood from the lung parenchyma) will not be exposed to oxygen at all (very low V/no change in Q). Increasing the PiO2 will have no effect on shunted blood because it is never within diffusion distance of blood. Hope this helps.
very good explanation.. V/Q mismatch isn't difficult again with this lecture..
great video and easy to understand!
please keep posting
Resp test next wednesday.......thank you from New Zealand :)
Very helpful thank you! Luckily I found this video. Have physiology test tomorrow :)
Beautifully explained.. Thank you
you did a better job than my patho teacher
My understanding of V/Q in the different Lung Zones. where the alveoli get smaller as its gets to the lower zones of the lungs are high V/ Q since the alveoli are smaller and easier to ventilate and perfuse but in the higher zones have larger alveoli has less V/Q since the alveoli are larger in the higher zones of the lungs. Your video showed me a total opposite of what I understand or think I remember with respect the V/Q in the Alveoli in the different Lung Zones.
great explanation! this made V/Q very easy to understand. thank you!
Can someone tell me why at the 8:07 it says that the saturation at the upper part is98% because it has high V and low Q? i mean what’s the relation btwn saturation and the VQ?help meee
Thank you so much for your clear explanation. I finally understand V/Q balance and imbalance, yay!
Roddy Gee Good to hear- Thanks for the comment!
Thanks, you made it very simple, my lecture was shocking in comparison
Great video has made it all a bit clearer!
Excellent video, very helpful
Manoj Regmi Thank you for the comment
@Tye, Aa refers to alveolar-arterial gradient and the concentration of oxygen of both areas.
Extremely helpful and concise. Thank you very much!
Glad it was helpful - thanks.
Great material, simple to understand.. thank you
Chris Jauregui Thank you- glad it was helpful
Very helpful, the explanation is very clear. Thanks!
firstly thanks so much for such a nice video . just one question is there chance of V/Q mismatch in case of hemothorax ?
Thank you! This is super helpful.
Why does VQ mismatch apply in Pulmonary Emboli? If there isn't any blood flow to that section of the lung shouldn't it be marked as dead space? Earlier in the video you said VQ mismatch works only for lung that is both perfused and ventilated (no matter the balance or mismatch between them).
Very clear explanation, thanks !
Thank you for the great and easy demonstration that was very interesting .. You made every's clear so far .. Thanks again
from the bottom of my heart..... thank you
this was incredibly helpful!! one topic of interest (may already be covered, havent looked to see yet) differentiating PA02 from Pa02 from percent saturation from Fi02, and the different pathologies impacting all of these values (CO poisoning, altitude sickness, methemglobinemia, etc)
Great lecture. Would like a topic "cardiopulmonary exercise testing Explained Clearly. Tq
That was great. Thank you for your time in explaining.
Great! Any cardio lectures?
Made it very easy to follow and understand. Thanks
D Long thanks for the feedback- glad the video helped
One thing, V/Q mismatch doesn't necessary mean that part of lung has lower rate and other part higher than usual, it means that V/Q is different than normal for lungs. In pneumonia for example there aren't pulmonary segments with higher ratio. Only lower, and result is hypoxic blood.
Thank you very much for these lectures - really helps!!
Loving your videos, it made applications of medicine much more easier to understand! Also, just wondering, how does hypocapnia play out in the compensating of this situation?
Could you please explain why hypoventilation is not considered a type of a V/Q mismatch (low V/Q) if there is lowered alveolar ventilation (V) with normal perfusion (Q) in this condition ? (e.g. the alveolar ventilation 2,5 l/min and the perfusion 5 l/min -> V/Q = 0,5) This is the thing I cannot understand so i'd be grateful for some clarification on this matter. (sorry for posting this question under your hypoventilation lecture too :) )
Can i ask one question ? about the last slide, u mention that the shunting is not responds to 100% oxygen therapy. is this mean V/Q
Hi MedCram, I'm almost certain you get asked this all the time but what is the name of the whiteboard software are you running to create videos like this one?
great videos! would be interesting to watch EVLP related topics
sofia uz Thanks for the suggestion
Very good video, but would APO be another cause of V/Q mismatch
Wonderful explanation ++ Thank you very much!! (from France)
+Yellobra Merci beaucoup!
it's wonderful explanation
thank u so much for this great explanation
What software do you use for the drawings? I feel like they would come really handy when studying and being able to draw out diagrams, ect. Great video by the way. Thank you!
FrontCam and SmoothDraw. Thanks for the comment
Thank you sooooo much.
Bless you.
I appreciated your simple & clear explanation.
+Vanessa James Thank you for the feedback