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this is literally the first time I have heard this explained as a dynamic physiologic process, in different stages throughout the metabolic process, as opposed to a stagnant "state of being". It makes soooooo much more sense now.
Right on man. Really glad this was able to help it click. Yeah its interesting how the changing physiology in the body causes these shifts depending where you are, but it makes sense!
Thank you so much! So many other channels who explain it just dump it on you and say they made it easy to memorise... You're one of the only channels who explained it with the physiology so that I could properly understand its relevance to clinical practice!
A as much I wanted to cry cause I couldn’t understand this concept. I want to hug you and thank you. May Allah bless you your explanation is perfect. You saved my life. Thank you ❤😭😍
I'm an RVT studying for anesthesia specialty boards, this was so helpful! Thought you might find it neat to know your videos are helping animal patients, as well as human patients :)
Brilliant, as ever. Have saved for when I become more intelligent!! For now me and my pulse ox have something to aim for! Many thanks as always, Roland UK
lol Roland! Good to see ya pop in and glad you enjoyed it. Its always a topic that was tough to grasp until I had it explained well to me. Hope I was able to help some.
Excellent vid once again and really helped get us listeners more depth on the curve. One thing if I could suggest it is (for us in the UK) it might be nice when talking about partial presures to also add the measurement in kPa as we don't look at it in mmHg. Might help someone but I guess it's not too hard to convert... Thanks again ICU Advntg...
Glad to hear the lesson was put together well for you and that you found it helpful. As for your suggestion, I think the problem may be that I often don't know these differences even exist as they aren't something that I use or deal with so they don't cross my mind as a possibility.
Mate, it's a very well put together and free video explaining a quite hard to understand process. Minimum effort to just do your own conversions to be honest.
@@ICUAdvantage I have listened to alot of your videos and it helped me study for my Adult Critical Care Specialist exam. Your topics are easy to learn when you explain it.
Hello! This is a great video, thank you! I do have a question for you. The first example made sense to me and I was able to guess the answer. In the second example I am having trouble understanding. You mentioned a patient experiencing metabolic acidosis, and you mentioned that they will have a left shift on this curve. In the context of just left and right shifts on this curve, a right shift would be more beneficial to this patient due to end tissue being more likely to receive oxygen right? I know there is more to the example than just the curve, so here are my further thoughts: You had mentioned that the patient would have a left shift (increase in O2 affinity) due to compensation for metabolic acidosis (so resp alkalosis - increased respiratory rate to increase the amount of CO2 exhaled, which would in turn cause more O2 to be inhaled) So is the increased O2 levels in the alveoli d/t increased RR what would increase the affinity for O2 and subsequently the left shift? Or is it because the lungs typically have a left shift? I feel as though there is something I'm not quite grasping.
Wait I’m confused with what you say at 14:14, so if a patient is in metabolic acidosis and we correct said acidosis, we would make it harder for tissue to get O2? But shouldn’t we still need to correct the acidosis?
it depends on the patient. sometimes they will allow what's called "permissive hypercapnia" in certain patients because the increased level of CO2 allows for them to perfuse better because oxygen is more readily available with higher partial pressure of CO2 or decreased pH. However, if the patient is extremely unstable because of their acidosis, it would not benefit them because hemodynamic instability will negatively impact their perfusion. So they might not have oxygen as readily available in a leftward shift, but they are able to utilize that oxygen that is bound more efficiently because they are hemodynamically stable. I hope that makes sense, I am not an expert so if I am wrong, someone else definitely chime in hahaha
So Kala is right on. I was merely mentioning about this scenario and the consequences of such. We certainly, and often do, allow a slight acidosis and usually don't correct past 7.2 as the body tolerates this well. That said, if they are 7.1, 7.0 or less, we are going to need to correct this back towards 7.2 but it is important to know there will be consequences too that will need to be accounted for. In one example, we may need to increase DO2 to compensate for this. Perhaps increased perfusion from more effective pressors in a less acidic environment might be enough to do this, but we may also need to increased FiO2 or PEEP being delivered. Sorry for the confusion, but I just gave a couple examples to know that there are "down stream" effects from the things we do and that we need to think of these to be able to anticipate other potential issues that come up. Sometimes we are damned if we do and damned if we don't.
I've just survived extremely low haemoglobin levels of 3.1g/dL or 31 g/L in the UK, where i am. I got released today and have been in since last Tuesday. My heart was failing, my ankles swelled right up and i could only walk a few steps before i was gasping for air. This has happened very slowly over the last 2 years, my GP thought it was my COPD getting worse, but sent me for a blood test for my liver function and a CT scan last December. I've just had another CT scan on Friday and all is clear, i'm waiting for a gastroscopy as an out patient. I might not of been up taking enough iron as i had 4 units of blood and an iron infusion and at my last blood test it was only at 8.9 g/dL or 89 g/L UK on Saturday as i'm very hard to get blood out of, i'm like a stone. They've put me on iron tablets and everything should go back to normal within the next week. I'm lucky to be alive as it was 1 of the lowest levels they've ever seen, 1 DR told me the only lower test they've seen was in a 96 year old who passed away at 2.6.
@@jouvertalandwa5337 Thanks, i feel loads better and can actually do stuff i couldn't for the last year, so hopefully i can get my life back and start doing things i used to do.
Wow, thanks for sharing and glad you are still here. Hopefully they get everything figured out for you. 3.1 is definitely one of the lowest seen, especially to survive.
Love how he's like "And increased presence of CO2 OBVIOUSLY means lower pH" as though everybody should know that by now hahaha. I mean, I did know that but it would be funny if some random person was watching this video and just heard that like 👀 lmao
I've always had a problem in understanding what exactly is PaO2. So if I'm correct it is the arterial content of O2, so the dissolved O2 seen as a pressure. It doesn't represent the amount of O2 on hemoglobin? We use PaO2 as 'the given amount of oxygen' on the X-axis, but how does a PaO2 decide the saturation, is it a kind of marker of how much O2 enters the body through the lung? I'm overthinking this, but I've always struggled with these basics.
Great question Kelsey. I think its probably less of a concern on the ear. I haven't seen much evidence though in the way of an inaccuracies with that or the forehead even. I know in personal experience the forehead has been tough to get to read with a finger sticky probe. I guess ultimately, if we have the equipment that is designed for that spot, use it, otherwise, if its all we have, well its all we have. And I'm sure we aren't going this route because things are working fine on a finger or toe lol. Whenever in doubt, wait until you have a good reading and a good pleth and then compare that to an ABG and that'll tell you if its accurate.
What role does dissolved oxygen(PaO2) play in the body? Does dissolved oxygen(PaO2) replenish and bind to the hemoglobin molecules that have already used their bound oxygen?
I'm a sickle cell patient looking to getting the new gene therapy that will reverse my hemoglobin to fetal hemeglobin and I don't understand this video in context of sickle cell
you are making a big mistake here , Oxygen saturation measures how much hemoglobin is currently bound to oxygen compared to how much hemoglobin remains unbound not how much oxygen is bound to the Hb simply it is the amount of Hb bound to oxygen not the amount of oxygen bound to Hb.
Blood memory, same binding contract, iron in blood makes current in vain, melted lungs sacks bags hardened, less, but more transfer of chemical exchanges, forahydrocarbon, agents, smirked in blood, separateation, levels in closed, bag, 5 min exchanges some gulp of air, mixes broke existence, seen real, the invisible to visible, while effects of ? The time shifting too me slow motion detection yous, not me quicker you think, but slower all time is different for kinds, ghost reading guess time shift not here or shadow images, 7D time, in blood separateation levels of blood separate, as void mixers, force of gravity, same in space instant death, gravity waves instant death, star shifts ,red star,blue star popular stats, hulls of Craft saturation of nebula, invisible kinds comings,,gases, deep sea maths scared me.
❤ Show your support with an ICU Advantage sticker! 👉🏼 adv.icu/support
💲 10% off EACH Month @ Nurisng Mastery membership: 👉🏼 adv.icu/mastery
NOTES for this lesson (and all previous lessons) are availably only to UA-cam and Patreon members. Links to join both here ⬇
► UA-cam: adv.icu/ym | ► Patreon: adv.icu/pm
this is literally the first time I have heard this explained as a dynamic physiologic process, in different stages throughout the metabolic process, as opposed to a stagnant "state of being". It makes soooooo much more sense now.
Right on man. Really glad this was able to help it click. Yeah its interesting how the changing physiology in the body causes these shifts depending where you are, but it makes sense!
Thank you so much!
So many other channels who explain it just dump it on you and say they made it easy to memorise... You're one of the only channels who explained it with the physiology so that I could properly understand its relevance to clinical practice!
A as much I wanted to cry cause I couldn’t understand this concept. I want to hug you and thank you. May Allah bless you your explanation is perfect. You saved my life. Thank you ❤😭😍
I'm an RVT studying for anesthesia specialty boards, this was so helpful! Thought you might find it neat to know your videos are helping animal patients, as well as human patients :)
This was a top tier explanation, i've never heard of this concept until studying for CCRN, and oh my god very very intriguing! THANK YOU!
This is awesome. Really glad to be able to help!
Broo i am in 11 class
And you just make me understand the whole concept
I wish that more teachers like you teach on UA-cam.
👍
What a clean breakdown man.
i ve been trying to understand this since may. i have an exam tomorrow. you just saved me . thank you
Woohoo! Hope the exam went well!
I love the absolute banger of an opening for a video about oxygen hemoglobin dissociation curve
Haha thanks! Hopefully you enjoyed the video 1/2 as much ;)
Thanks for the video! This REALLY helped my understanding of the oxyhemoglobin disassociation curve! Big help! Thanks again!
and the lightbulb moment happened! explained perfectly thank you
Yaah!! Love to hear this!
This is the best explanation. Totally makes sense now. Thank you 👍🙂
Awesome!! Glad to hear it!
thank you for teaching. sharing your knowledge help us to save the lives of others
Thank you so much ! I needed this for my accelerated nursing program. we just started on respiratory/ gas excchange.
Smoothest yet most useful explanation thanks !!!
Awesome! Thank you!
Thank you so much for making it truly easy to understand!!
Thank you for this video, it has been of great help😍
As an NNP student, thank you for the explanation!!
Awesome, glad you liked it!
Thank you for much for explaining this in ways that I am able to understand.
Awesome video king!
This video was excellent! Thank you so much for explaining this concept!
Really glad you liked it! Thank you!
thank you. studying for the ccrn and wanted to have a better understanding of this concept
Very cool! Best of luck on your CCRN and hope this helped!
Brilliant, as ever. Have saved for when I become more intelligent!! For now me and my pulse ox have something to aim for! Many thanks as always, Roland UK
lol Roland! Good to see ya pop in and glad you enjoyed it. Its always a topic that was tough to grasp until I had it explained well to me. Hope I was able to help some.
Excellent vid once again and really helped get us listeners more depth on the curve. One thing if I could suggest it is (for us in the UK) it might be nice when talking about partial presures to also add the measurement in kPa as we don't look at it in mmHg. Might help someone but I guess it's not too hard to convert... Thanks again ICU Advntg...
Glad to hear the lesson was put together well for you and that you found it helpful.
As for your suggestion, I think the problem may be that I often don't know these differences even exist as they aren't something that I use or deal with so they don't cross my mind as a possibility.
Mate, it's a very well put together and free video explaining a quite hard to understand process. Minimum effort to just do your own conversions to be honest.
Great Explanation! Thank you !
Such an amazing video! great explanations thank you
I had to go over this so many times for my CCRN but you made it so much easier to learn!! Thank you :)
So great to hear this! Glad I was able to break it down in a way that made sense. Appreciate you taking the time to leave a comment.
Awesome explanation Sir. ..thank u very much 👍
THANK YOU!
amazing explanation, very clear
You explain very well. I have an exam next week.I am just curious about how you look like. 😊Hope you read this haha. Kudos to you sir🎉🎉
THANK YOU!!!!!
Learning made easy 🎉thank you sir
Awesome and thank you!
Thank you so much. Well understood now.
This was fantastic thank you x
Awesome! Thank you!
Life saviour thank you
I actually get it now. Thanks!
Yay!!!
I was just reviewing this concept a couple days ago, haha. Thanks for helping solidify my learning with this vid 😃
Haha nice. I love it when the timing works out!
Thanks
thanks edie!
You're welcome!
So glad you covered this topic. I have a suggestion for a topic since you talked about this. Hypoxic Drive Theory Myth or Fact or a little of both
Glad you liked it Julia. Let me stew on that suggestion.
@@ICUAdvantage I have listened to alot of your videos and it helped me study for my Adult Critical Care Specialist exam. Your topics are easy to learn when you explain it.
So great to hear this! Thank you!
Super helpful
Breathe well taken
You just had a new subscriber ,lol thanks
Hello! This is a great video, thank you!
I do have a question for you.
The first example made sense to me and I was able to guess the answer.
In the second example I am having trouble understanding. You mentioned a patient experiencing metabolic acidosis, and you mentioned that they will have a left shift on this curve. In the context of just left and right shifts on this curve, a right shift would be more beneficial to this patient due to end tissue being more likely to receive oxygen right? I know there is more to the example than just the curve, so here are my further thoughts:
You had mentioned that the patient would have a left shift (increase in O2 affinity) due to compensation for metabolic acidosis (so resp alkalosis - increased respiratory rate to increase the amount of CO2 exhaled, which would in turn cause more O2 to be inhaled) So is the increased O2 levels in the alveoli d/t increased RR what would increase the affinity for O2 and subsequently the left shift? Or is it because the lungs typically have a left shift? I feel as though there is something I'm not quite grasping.
Wait I’m confused with what you say at 14:14, so if a patient is in metabolic acidosis and we correct said acidosis, we would make it harder for tissue to get O2? But shouldn’t we still need to correct the acidosis?
it depends on the patient. sometimes they will allow what's called "permissive hypercapnia" in certain patients because the increased level of CO2 allows for them to perfuse better because oxygen is more readily available with higher partial pressure of CO2 or decreased pH. However, if the patient is extremely unstable because of their acidosis, it would not benefit them because hemodynamic instability will negatively impact their perfusion. So they might not have oxygen as readily available in a leftward shift, but they are able to utilize that oxygen that is bound more efficiently because they are hemodynamically stable.
I hope that makes sense, I am not an expert so if I am wrong, someone else definitely chime in hahaha
So Kala is right on.
I was merely mentioning about this scenario and the consequences of such. We certainly, and often do, allow a slight acidosis and usually don't correct past 7.2 as the body tolerates this well. That said, if they are 7.1, 7.0 or less, we are going to need to correct this back towards 7.2 but it is important to know there will be consequences too that will need to be accounted for.
In one example, we may need to increase DO2 to compensate for this. Perhaps increased perfusion from more effective pressors in a less acidic environment might be enough to do this, but we may also need to increased FiO2 or PEEP being delivered.
Sorry for the confusion, but I just gave a couple examples to know that there are "down stream" effects from the things we do and that we need to think of these to be able to anticipate other potential issues that come up. Sometimes we are damned if we do and damned if we don't.
I've just survived extremely low haemoglobin levels of 3.1g/dL or 31 g/L in the UK, where i am. I got released today and have been in since last Tuesday. My heart was failing, my ankles swelled right up and i could only walk a few steps before i was gasping for air. This has happened very slowly over the last 2 years, my GP thought it was my COPD getting worse, but sent me for a blood test for my liver function and a CT scan last December. I've just had another CT scan on Friday and all is clear, i'm waiting for a gastroscopy as an out patient. I might not of been up taking enough iron as i had 4 units of blood and an iron infusion and at my last blood test it was only at 8.9 g/dL or 89 g/L UK on Saturday as i'm very hard to get blood out of, i'm like a stone. They've put me on iron tablets and everything should go back to normal within the next week. I'm lucky to be alive as it was 1 of the lowest levels they've ever seen, 1 DR told me the only lower test they've seen was in a 96 year old who passed away at 2.6.
Keep going. All will be well
@@jouvertalandwa5337 Thanks, i feel loads better and can actually do stuff i couldn't for the last year, so hopefully i can get my life back and start doing things i used to do.
Wow, thanks for sharing and glad you are still here. Hopefully they get everything figured out for you. 3.1 is definitely one of the lowest seen, especially to survive.
@@majmat try to eat a lot of green leafy vegetables drink herd tea google up iron tea a lot will Pop up
Thanks!
Of course Henrique! Good to see you.
Love how he's like "And increased presence of CO2 OBVIOUSLY means lower pH" as though everybody should know that by now hahaha. I mean, I did know that but it would be funny if some random person was watching this video and just heard that like 👀 lmao
Nice
Thanks
I've always had a problem in understanding what exactly is PaO2. So if I'm correct it is the arterial content of O2, so the dissolved O2 seen as a pressure. It doesn't represent the amount of O2 on hemoglobin? We use PaO2 as 'the given amount of oxygen' on the X-axis, but how does a PaO2 decide the saturation, is it a kind of marker of how much O2 enters the body through the lung? I'm overthinking this, but I've always struggled with these basics.
Does anyone know how to access the notes?
What are your thoughts about placing the finger pulse oximetry on the forehead or ear and potentially inaccuracies
Great question Kelsey.
I think its probably less of a concern on the ear. I haven't seen much evidence though in the way of an inaccuracies with that or the forehead even. I know in personal experience the forehead has been tough to get to read with a finger sticky probe.
I guess ultimately, if we have the equipment that is designed for that spot, use it, otherwise, if its all we have, well its all we have. And I'm sure we aren't going this route because things are working fine on a finger or toe lol.
Whenever in doubt, wait until you have a good reading and a good pleth and then compare that to an ABG and that'll tell you if its accurate.
Maybe a video on alcohol withdrawal next?? CIWA exam, why the symptoms occur and meds given for minor to severe DTs. 🙂
Thanks for the suggestions Amanda. 😊 I do have ETOH WD on the todo list, but not sure when I'm going to get to it yet.
What role does dissolved oxygen(PaO2) play in the body? Does dissolved oxygen(PaO2) replenish and bind to the hemoglobin molecules that have already used their bound oxygen?
Good
Thanks
I admit...
that I don't get it. It seems to me that this graph shows an "associative" curve. So how quick O2 binds to Hb.
ChatGPT suggest me this video.when I asked video on this topic
I'm a sickle cell patient looking to getting the new gene therapy that will reverse my hemoglobin to fetal hemeglobin and I don't understand this video in context of sickle cell
🙏🙏🙏
What is the program you use for making those wonderful videos
I use Adobe Photoshop, screencast to an iPad with Apple Pencil for the writing.
👍
TY
you are making a big mistake here , Oxygen saturation measures how much hemoglobin is currently bound to oxygen compared to how much hemoglobin remains unbound not how much oxygen is bound to the Hb simply it is the amount of Hb bound to oxygen not the amount of oxygen bound to Hb.
10:57 *2,3-BPG
Semantics depending on who is talking about it. BPG and DPG used interchangeably
typo in the thumbnail!
Ahhhh yes! Thanks for that. I need to get that fixed.
Blood memory, same binding contract, iron in blood makes current in vain, melted lungs sacks bags hardened, less, but more transfer of chemical exchanges, forahydrocarbon, agents, smirked in blood, separateation, levels in closed, bag, 5 min exchanges some gulp of air, mixes broke existence, seen real, the invisible to visible, while effects of ? The time shifting too me slow motion detection yous, not me quicker you think, but slower all time is different for kinds, ghost reading guess time shift not here or shadow images, 7D time, in blood separateation levels of blood separate, as void mixers, force of gravity, same in space instant death, gravity waves instant death, star shifts ,red star,blue star popular stats, hulls of Craft saturation of nebula, invisible kinds comings,,gases, deep sea maths scared me.
ƤＲＯ𝓂Ｏ𝕤ᗰ
Thanks!
Nice