Respiratory Therapy - Hypoxic Drive Theory or Something Else?

[@codygenewilliams]

I have my RRT and I’ve been working in the field for a little over a year now. I still come back to watch your videos and I get so hyped when you give us new videos! I love what you’re doing with this channel, please keep them coming.

[@RespiratoryCoach]

Thank you so much for this comment, Cody. I appreciate you!

[@CS-bh4ur]

I totally agree with this

[@katieduong2873]

I agreed, been RRT for 10 yrs, still come back here to watch your videos to refresh

[@eminetbegeta4743]

PLEASE PLEASE AND PLEASE Dear Coach,
here we are some ppl who CANNOT survive without your videos. Cant get enough of them, CUZ I've learned so much, even more than how much I retained from my RT school.
I understand your business, but don't forget about us!!
May God bless all what is yours and all what you do🙏🏽🙏🏽🙏🏽

[@RespiratoryCoach]

I'm not going anywhere! Best wishes!!!

[@christinavaldez5884]

Thank you. Student here at weatherford. This was a great explanation

[@steves8860]

I think what people see, and confuse with knocking out the drive, is something like this:
A pt is in the 50/50 club.
These people's work of breathing would increase too much to keep a CO2 of 40. CO2 is allowed to increase.
They get pneumonia.
Now, their oxygen drops.
They breathe faster to get their O2 up. CO2 drops.
Maybe long enough that their bicarb normalizes.
An ABG is drawn.
We give O2.
Their O2 goes up.
They begin to be able to rest, which for them is a CO2 of 50.
Draw another ABG and think his drive has been knocked out.
Im not sure that I have never heard anyone consider this.

[@crazytogab]

You are a blessing to the world. I heard about your channel when my husband was in the hospital and the ventilator alarmed, and alarmed. Unpleasant situation let me tell you. I thank God that a respiratory therapist was on duty who knew his business. He stepped into the room knew what to do and made necessary changes to the machine. He had a fine vocabulary which I don't. He essentially said that my husband's body was interpreting what the machine was doing as a sign that he did not have to breathe. So, he didn't and the machine alarmed. My husband was transported out of that hospital, and is in a Long-Term Acute Care facility. I now fear that he may be experiencing the same sort of thing there, but the therapists there don't --see it. Yesterday, I noticed the respirations were getting low, while the saturation was high. I lifted the oxygen tube away from his trake and saw that the respirations would climb. This afternoon, my phone rang. The nurse informed me they were putting my husband back on the ventilator. --sad. As I spent time with him today, I again saw that oh so unlovely 100 for saturation and the respirations falling. Sure, the ventilator is now set and kicks in at 14, but I fear they are teaching his body not to breathe and he will ---die. so sad. I have asked to speak with the pulmonary doctor. I hope he can convince me I am wrong and he will save my husband, or that he will agree and order the changes that I suspect will keep him from dying. Thank you so much for the service you are providing. God bless you!

[@danielleg2616]

Prayer for you . Did be recover?

[@snafu8203]

As a patient who passed out in the emergency with an oxygen sat of 50, needing oxygen at 50-60% and waking up in ICU not knowing what happened, your channel has helped me understand some of the tests, some of my on going home oxygen treatment, some of my PFTs, etc. I don’t remember what happened but I do remember starting to get sick year Dec 2017, hospitalized 5 times beginning Feb 2018 with the last only 3 weeks in ICU/non-ICU and an additional 3 weeks in a SNF before finally being able to come home on 5L of oxygen, nebulizer treatments 2x a day, Vest treatments 2x a day and suctioning 2x a day. I also do 2 different inhalers and most recently have started speech therapy for vocal cord dysfunction. Your videos have helped me to understand more of what happened to me (I’m still figuring it out as there is a lot going on) and what my treatments are doing for me. I’ve had better appointment conversations with my pulmonologist, cardiologist, rheumatologist, ENT, speech and language, gastroenterologist, nephrologist, neurologist, endocrinologist, etc. I’ve been through the ringer. But your channel has/is slowly helping me piece it together and understand how the roller ball effect impacted what happened to me.
Additionally, my youngest brother contracted Covid-19, has been in ICU since end of October 2021 and just recently transferred to long term care. He’s been on a ventilator and not doing well but your videos have helped us understand his oxygen treatments/status. PEEP is the word we heard often. Thank you.

[@RespiratoryCoach]

What a journey through unknown land. I appreciate you so much for sharing your story, and wish the best for you and your brother. I'm glad this channel has helped you and your family with better understanding of things.

[@61loneviking]

Yep, oxygen is a drug and too often is given at too high a level. It drives me crazy when some of our COPD pts come into ER with low Sats and immediately get put on Oxy masks at 8, 10 12 liters. It’s often times a V/Q mismatch, that they’ve just made worse.
I think you’re right about the V/Q mismatch. I have COPDers come in, they come in with an exacerbation and they can’t breath. I put them on a V60, with neb txs, steroids, low Fio2, low I time, and in two to four hours they are better. During that time you can see the VT and VE increase, so you know that they were not ventilating the areas of the lung that they usually use. How do you know? Simple, they stop struggling to breath, they relax!
But if you use a high FIO2 with that Bipap, even with a low I time, even with high I/E pressure-often they just don’t do well and may need that Bipap for many more hours.
And this ‘hypoxic drive’ problem is on a spectrum. In my years as an RT, I’ve seen maybe two dozen patients that definitely had this problem.

[@RespiratoryCoach]

I agree 100%. Thanks for this insightful comment. I can't stand that "Oxymask". I fell like I'm blindly throwing oxygen at my patients. Thanks for watching and taking the time to share your relatable experience.

[@day_dreamer_-9732]

At my hospital they automatically go for 15L NRB, no matter how many times I try to explain, or another they put a simple mask at 5L or less "because they mouth breathe" annoys me so much...

[@JustBreathe30]

Got my RRT recently, and going to start working in the field soon. I appreciate all you do with your videos, and to explain each section. Planning on rewatching the videos to get me back on track. There is the NBRC way and then there is the real world way.

[@SmileyFaceOfRom]

Thank you so much for continuing to teach us, even as I still go through school. I appreciate everything you do!

[@sergekauzunovich533]

Just found you. You are my favorite now. Thank you for your time :)

[@marvl_87g56]

Hey RT coach, im about to start clinicals in my program and your videos have really helped to break down the processes of some of these diseases and respiratory concepts. Thank you and keep doing what you do sir!

[@RespiratoryCoach]

Fantastic! I hope you have lots of lightbulb moments during clinicals. Thanks for watching and kindly commenting. Enjoy the journey to RRT!

[@markthorne2156]

I use your video a lot when I am teaching my respiratory students.

[@Ortega35mf]

Dear Joe
Please make a video about this new Flow controlled Ventilation (FCV) mode...

[@johnvarvatoss142]

ur legend, been RRT for past 15 years and I learn a lot of new things from u.. Thx

[@RespiratoryCoach]

Hey John! Thanks checking out the channel. I appreciate you watching and kindly commenting!!!

[@user-es6cr3fm6m]

This subject can be so confused, Ty for sharing this subject again.

[@angelacurro2893]

coach, please write a study guide!

[@user-bf1eb1ip2m]

I apreciate all u did for us as a RT’s

[@scottcochran1848]

Maybe you could make a video on how to recognize a retainer..

[@JJtheRT]

Hey Coach! I had a conversation with Garry Kauffman recently and we talked about looking at topics and age old adages for redefining. I.E. what determines high flow? Is it the same for neonates as it is for pediatrics and adults? What do the texts say? Great stuff here brother!! Keep doing what you’re doing… it’s clearly making a difference!

[@RespiratoryCoach]

What's up JJtheRT! What a great conversation starter. So many things to consider and potentially reevaluate. Appreciate you watching and commenting.

[@kyriefromthe6ix438]

Hey Joe I want to say thank you so much for everything you have post I past my TMC and CSE and it's thanks to your help. Thank you Joe for helping me become a RRT

[@RespiratoryCoach]

Awesome, Kyran! BIG CONGRATULATIONS!!!! I'm so proud of you. GO BE GREAT!

[@gmi_sales]

Superb Explained_ long back on Board Now Digital...👍
I see all of your explanation its Eye opening...
♥️Love from India -Mumbai.

[@stonecookie]

Please add a glossary in the comments if possible.

[@AJeweler]

I just wanted to thank you so much for doing this
I've learned so much from you
Here where i live there is no RT as a job
Anesthesiologists set ventilators
And they have lots of surgeries and they manage all icus and setting all ventilators in other wards other than OR or icus
And they don't give good care to patients outside icu
They don't visit intubated patients every day.( We have many intubated in the wards and icus are almost always full)
And me as a nurse wanna know as much as i can with your help to take care of my patients if they didn't

[@Gnokhi]

Nice video ....
@8:04 Why does not the increasing FiO2 causes a rise in Ventilation in the hypoventilated alveoli ?

[@yasmanygarcia8257]

Thank you!!!

[@jarhedjohn1000]

I needed this, thanks

[@user-es6cr3fm6m]

I had COPD patients that stated they were oxygen home all day 7L N/C 😂, some stated 4L N/C. In my care their SPO2 stayed 97% -95% , should be appropriate titration their oxygen? It something that causes me confused , if they leave on 88-92 % SP02 and mortality showing anything above it, how can be done about inside the hospital for these patients? Follow their baseline oxygen levels at their home, or titrated their oxygen levels in hospital care with 88-92? Per stats ? Thank you

[@rtoutloud8772]

Love. Speaking to the evidence!

[@Marc_de_Car]

Thanks

[@rooseveltroche5851]

Nice illustration coach

[@RespiratoryCoach]

Thanks for watching and commenting!

[@itsssmenil7287]

Dude thank u for all your video!

[@RespiratoryCoach]

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

[@shanellestone4379]

Hi there, I love your videos! I was wondering if you had a video on how to interpret x-rays? Or if you had any videos you would recommend? Thank you!

[@RespiratoryCoach]

Not yet! But definitely in the works.

[@christineblue1980]

Been doing my clinicals at the hospital and will be starting internship soon and I LOVE IT but WOW! The things I have seen throws the NBRC way of doing things out the door. I get under certain circumstances you have to critically think and use your common sense but it's so contradictory its confusing. I don't want to take the TMC and CRT several times because of simple confusion. ... By the way, your awesome and should make your own program. You know?? like a study program similar to Lindsay jones or Kettering.

[@UMBUBA]

Thank you for great video!

[@osielalvarado1921]

EMS support comment 🤚

[@tkachenko503]

Great job. Cheers

[@talia8514]

Simple and clean 👌 ✨️ 🫡

[@landon94]

I’m graduating in May. Will you be doing another course for tmc/cse prep? I know you offered it last year and I was interested.

[@RespiratoryCoach]

Absolutely! Stay tuned for more information. Thanks for asking and watching, Landon!

[@landon94]

@@RespiratoryCoach thanks for all you do as well! You’ve made my RT school experience much easier.

[@RespiratoryCoach]

@@landon94 Love hearing that. I started this channel 3 years ago with that being the goal. Comments like this fuel the future growth of the channel.

[@landon94]

@@RespiratoryCoach well you’ve accomplished it! I’d love to hear your thoughts on jobs for new grads. I’m trying to decide between three different facilities and the stress from that might be the end of me lol.

[@user-ec3db8ul1l]

What is my targeting PO2 in COPD patients?

[@RespiratoryCoach]

It varies for each different patient based on their normal baseline, but per the video, research showed increased adverse outcomes when less than 88% and greater than 96%, and another study suggested 88-92%. These saturation lead us to an approximate PaO2 of 58-70mmHg, BUT proper administration should be tailored to each patient ultimately.

[@countermeasuresecurityengi9719]

Joe - you're RIPPIN IT amigo!
Carry on - excellent Brain Food - Keep feeding us Respiratory Piranhae

[@RespiratoryCoach]

LOL "respiratory piranhae" I appreciate you man!

[@saralinda6412]

Hi i wanted to know if you can do private tutoring? Also Can you talk about the TMC and NBRC. How should we prepare and study for it, what questions are they most likely to ask? Thank you!

[@annadelfoyo6962]

Hello Sara, I will be taking the TMS test on 2 weeks, are you in a similar situation?? I’m in Florida…

[@saralinda6412]

@@annadelfoyo6962 hi yes i graduate this may and i am suppose to take it right after I’m very nervous

[@annadelfoyo6962]

@@saralinda6412 I will be taking my test this month, do you want to be in touch??

[@annadelfoyo6962]

@@saralinda6412 I think that we can help each other sharing information, if you want it, of course, Im also very nervous too for me it would be nice to talk with somebody in my same situation

[@saralinda6412]

@@annadelfoyo6962 yes i agree i am all in for it, and I don’t mind at all sharing information with you. We should all help one another.

[@jestinjoseph4865]

Hi coach, am an RT currently working in Dubai, I did my respiratory degree from India, I have a doubt which is with Indian respiratory therapist degree am I eligible to work in the US if I clear in NBRC exams

[@RespiratoryCoach]

Hello Jestin. To sit for the NBRC exam you must be a graduate from a COARC accredited program here in US or hold a Canadian RRT credential. I would reach out to the NBRC to be certain that there is not another option you might qualify for.

[@jestinjoseph4865]

Thank you coach

[@peaceforall1592]

u are amazing

[@RespiratoryCoach]

Thanks for watching and leaving an amazing comment!!

[@rebeccalowe188]

Any study guide information for tmc?

[@annadelfoyo6962]

Hi! Rebecca, I’m in Florida and i will be taking the TMC exam in 2 weeks, are you in a similar situation?

[@rebeccalowe188]

@@annadelfoyo6962 yes...what study material are you using?

[@annadelfoyo6962]

Hi!! Thank you for answer me. I’m using the Kettering (I have everything from them) and I’m using also a wonderful book by Gary Persing. What study guide are using you?
I don’t feel confident giving you any personal information through here, (like my number, or email) but if you have any idea how can we get in touch I can help you in any way you need, besides I would love to share information or knowledge if you want.

[@rebeccalowe188]

@@annadelfoyo6962 hello...I am in el Paso tx...long story short...I have been an rt for 21 year...I let my license lapse by accident 🤐.....and now I am having to retake the tmc exam...I also have only the Kettering book and am using there website for practice test...also I just bought a subscription to resp cram...but to make matters worse I just took the test Saturday and failed...yea..so back to the book...

[@xjunkz7445]

This guy RT's

[@RespiratoryCoach]

Thanks for watching and commenting Joseph!!!