what's up frt community so I got a good one for you tonight I received an email I don't know maybe two days ago and the email was can you help break this down and when I looked at it I said man this is a good topic now it's not so much related to what you're gonna see on a mvrc exam because I'm not gonna ask you to do things like this but they're gonna ask lots of questions revolving around this entire exercise and so if you're a second-year student you're gonna want to stick around and watch all of this to the end of the video so that you can see all the ways that this plays it together now what we're talking about here is coming up with initial event settings when given just a little bit of information and so you can see I already have it here on the board I've already written it out what we have here is a 5/8 Mel is we want initial vent settings but we have this specification that we want to desire eye time of whatever it might be now I put in here 0.8 seconds now the email looked essentially just like this it wasn't point eight seconds it wasn't a five eight mil but I'm not here to do your homework for you I'm here to teach you how to do your homework and how to prepare you and how to know all of these things and how they link together so let's jump in it and let's figure out what our vent settings are gonna be with the desired I have a point eight seconds for this five eight mil now what we won't here is this this is what everything you should end up with you should end up with a mode a title volume a respiratory rate from there we're gonna give an eye time and E time an ite ratio and a flow setting and we only have two numbers to work with the only two numbers we have to work with right now is 0.8 seconds so we can go ahead and plug this in here 0.8 seconds so we want that so we know where you're starting whenever we put them in we want an eye time of 0.8 seconds now in pressure control this is real easy because you're just gonna set the peak inspiratory pressure and set the point eight seconds and you have your eye time set and there is no tidal volume set so that's gonna vary and that but we have here specifically being asked for a title volume which tells us that we're going to set that title volume now if we set the title volume then that tells us right off the bat that when it comes to mode we're dealing with volume control and you see they're gonna be AC or si and V now which is better and don't know the answer to that I don't like to answer this question what is the best mode of mechanical ventilation what I like to answer what I like you guys to think about is what is the best mode of mechanical ventilation for my patient well with this information we don't even know so right now you'll be safe answering AC or simv because we don't know anything else about the patient okay now we're talking initial bit settings so let's from the mode and from the I type let's talk about tidal volume okay and what I want to point out to you is that we know what the safe initial tidal volume ranges it's six to eight MLS per kilo okay so now I've already done the math here and a 5/8 mil ideal body weight is 154 pounds you've got to be able to get to ideal body weight so if I pull up my calculator here from pounds we have to get into kilograms because this range is in kilograms so we do 154 pounds divided by two point two kilograms equals 70 kilograms and we have it there okay now with that 70 kilograms we can come down here and say seventy we can multiply it times six which is going to be 420 we can multiply it times eight and we get five 60 milliliters so when we turn that into liters we're talking point four two liters up to 0.5 six liters okay now you've got to also be able to move between leaders and milliliters fairly easily in the field of respiratory therapy you have to understand that when you say well my patients on a rate of 20 with a tidal volume of 500 and that gives us a minute ventilation of 10 liters that you'll get confused by that because 500 times 20 is ten thousand milliliters we turn that into liters we talk about minute ventilation in litres most of the time we talk about tidal volume in milliliters but these formulas I'm going to show you revolve around tidal volume in liters so you have to be familiar with how milliliters translates into liters so we come up here and let's just go right smack in the middle let's just go with 0.5 liters that's what we're gonna set for our tidal volume okay how many races because we need this space so what I want you to understand now is now we have two numbers now we have tidal volume and I time what you must understand from a respiratory therapist stand point is is that if you have eye time and tidal volume then you can calculate flow if you have tidal volume and flow you can calculate eye time and guess what if you have eye time and flow you can calculate the tidal volume so there's multiple ways to do this you just have to know one formula and that one formula is that I time equals tidal volume over flow and this is in liters per second that's important because when we talk about flow we talked about it in liters per minute but in this case you have to turn it into liters per second and this is going to make sense think about it if you have somebody on 60 liters per minute a tidal volume doesn't last minutes a title volume lasts seconds and so when you think about it like that it makes sense that we turn flow into liters per second and this is really what the ventilator operates off of it operates in liters per second not liters per minute even though we set the liters per minute okay I know that's kind of confusing but you just have to wrap your brain around it and make it make sense okay now if we understand this formula then we understand that our eye time here is 0.8 seconds and that equals our tidal volume our tidal volume we chose 0.5 liters over X we want to know what our flow is right you got several things here you've got to solve and tidal volume and eye time will help you figure out your flow now when you do this you have to get X by itself so we're going to take and we're going to put it on we're going to multiply both sides by X this is going to give us 0.8 x equals 0.5 okay so when we do that we divide both sides by 0.8 so divide this side by 0.8 divide this side by 0.8 and what we get is X equals 0.5 divided by 0.8 equals and you're going to get a number that's point six two five now 0.625 doesn't sound like a flow does it the thing is is you have to remember that this is liters per second so to get it into liters per minute you have to multiply that times 60 and our answer here is thirty seven point five liters thirty seven point five liters per minute okay now if you're like me then you see that you go wait a second I thought starting flow was 40 to 60 liters for me and you would be right so we can come over here and we can change some things using this same formula we can say I type of 0.8 equals tidal volume X and let's say we want to go with a flow of 40 liters per minute then we say 40 liters per minute now remember we got to get that in two liters per second so we do 40/60 equals point six six six six six six six and we're going to call it point six seven okay so we're going to do point eight divided by X divided by point six seven and this is flow and liters per second now what is our title volume equal when we set these two things 40 liters per minute 0.67 liters per second all we have to do is multiply both sides by 0.67 this will cancel out point six seven over here and when we do a point eight times point six seven we get point five three six is what x equals I remember X is our tidal volume so we could easily come over here and say you know what if we put them on a flow of 40 we'll have a tidal volume of 0.5 36 now if you remember our tidal volume range was 420 to 560 so this point 536 means you're going to give a tidal volume of 536 milliliters so this is still in range and we can easily change this to 40 liters per minute which gives us in to our tidal volume range and we say you know what instead of 0.5 we're gonna go 0.5 3 6 and this is liters 536 milliliters okay so now we've got our tidal volume in an appropriate initial bit setting range six to eight emails per kilo 422 560 we also have our flow in a starting range of 40 to 60 liters per minute so now these things are making sense right now from here you have to figure out the rest of these numbers right well let's say how do we figure out a time well to figure out a time you have to know what your total cycle time is once you figure out your time you'll be able to figure out your IDE ratio you can't figure out either of these without knowing your total cycle time unless you're a time is given so if we were given any time then we could say okay how to use this if we were given any time we could calculate a total cycle time if you can calculate your total cycle time then you could calculate a respiratory rate and that's where my next part of this comes the next point I want after the first point which is tidal volume I time and flow are all related my next point is is that e time and respiratory rate are related okay so here's how total cycle time equals respiratory rate divided by 60 okay so let's just say we want to go with a starting range let's say we have a risk-free rate the starting range is 10 to 16 breaths per minute let's just say we want to go with 14 breaths per minute then total cycle time is going to equal I put this up here on I apologize 60 divided by rec the respiratory rate so total cycle time is 60 divided by 14 blue chose 14 so we're gonna put that at the bottom now what this is going to give us is a number 60 divided by 14 equals four point two eight now what that means is that the ventilator is going to give 14 breaths a minute and to do so it's going to give one breath every four point two eight seconds make sense right it doesn't give 14 breaths just breath breath breath breath breath and then stops and waits for a minute to go by it spreads them out over 60 seconds which is why total cycle time is 60 / breaths per minute so our total cycle time is four point two eight that means you have four point two eight seconds to get the breath in and then to allow it to come out in other words total cycle time equals eye time plus E time see where this is going we now can calculate our e time here based off of total cycle time and based off of our inspiratory time so I'm gonna erase this we know our total cycle time is four point two eight so if total cycle time equals eye time plus E time then four point two eight equals point eight plus X right so here's what we do you simply take away point eight from here and take away point eight zero from here and what you're left with is four point two eight minus 0.8 gives us three point four eight seconds and that equals our e time because you see of this four point two eight point eight of it is inspiration which means the other three point four eight seconds must be exhalation so we put three point four eight seconds on our inspiratory time I'm gonna run our expert ory time so you see how everything is coming together now we have one thing left to calculate and that's our IDE ratio now when you calculate IDE ratios you simply take your eye time in your a time and you put it in ratio format so you say 0.82 3.48 and what this tells you is is you're spending 0.8 seconds tonight I'm in three point four eight seconds in a time but a ratio brings everything back to a 1/2 a base of 1 so when you look at this you're going to actually divide both sides by 0.8 this will give us point eight divided by point eight equals one three point four eight divided by 0.8 equals four point three five and that's what our idea ratio is and what that says is for every one part of inspiration you're spending for point three five times in exhalation and that's what it is so your ID is one it's a four point three five and that's your answers guys one two four point three five now what I want to do is show you another way to get to this same answer okay so what I'm gonna do here is erase the one point fourth the one the ID ratio I'm gonna erase the e time and I'm gonna erase the breaths per minute because I told you that respiratory rate i time an e time are all linked together in calculating and developing your idea ratio so what if we said we don't want a one to four of one to four point three five what if we want a one two three let's see what we can we can easily come over here and say you know what I want to set in high time of one two three which means I want three times exhalation for every one part inspiration okay so if we have a one two three okay and our eye time is point eight seconds and all we have to do is multiply both sides times point eight and we will get is 0.82 2.4 now if you want to check yourself just divide it back he'll divide both sides by 0.8 and you'll get 1 2 3 okay so 0.8 to 2.4 so this means your icon is 0.8 which makes your expert ory time 2.4 seconds and that gives you an idea ratio of 1 2 3 okay so we can take this e time put it here 2.4 seconds and guess what remember what total cycle time formula was total cycle time equals pi time plus E time so guess what total cycle time equals 0.8 plus 2.4 this equals 3.2 okay so our total cycle time our TCT equals 3 point 2 now watch this remember how to calculate total cycle time not if you have I to e then you know you just add those two together the I time any time you get total cycle time but I also told you that to get total cycle time when you do 60 divided by the the respiratory rate right so if we know our total cycle time is 3 point 2 we can say 3.2 equals 60 over X when we do that we solve for X these sides will cancel out we multiply this time as X so we get 3.2 x equals 60 divide this side by 3.2 we'll get X by itself divide this by 3.2 and guess what you're going to get remember respiratory rate turned into X so when I do this I'm going to get 60 divided by 3 point 2 and the answer here is 18.75 sorry respirator now is 18.75 now of course you can't set a risk for a rate of 18.75 you're gonna go with 19 but you understand that that 19 is going to slightly affect your total cycle time and slightly affect your e time which will affect your idea ratio okay so I wanted to show you multiple ways to get these numbers because if I was a college professor which I am I would ask this in multiple different ways I would question you if you know how to get total cycle time in relation to respiratory rate I would ask you if you knew how to get total cycle time from an i time in any time I would ask you if you knew how to get a respiratory rate from an i time and an E time or maybe just an i time and an ID ratio what's the rate you can do all those things and it's absolutely amazing guys because there's nothing more than math you just have to know how to work the formulas so I know I did a lot here today I know I I showed you one way then I showed you another and Dean's changed but I just want you to understand that the in the answer here is 100% correct these initial vent settings are 100% correct for a 5 foot 8 ml with a nighttime of point eight seconds our tidal volume falls within our initial range our eye time is 0.8 seconds our IDE is one two three that gives us a two point four second e time these two numbers give us a rate of eighteen point seven five and all of that is driven by a flow of 40 liters per minute I hope this makes sense I hope you got to see this and go oh my gosh like that I see it and I see the way these formulas help us to come up with these values and you understand how flow affects I time how I time affects flow you see how a respiratory rate affects total cycle time which affects e time which IDE ratio that's my goal here if I did that give me a thumbs up if you liked this video and having already subscribed please hit the subscribe button if you're already subscribed but you don't get notifications turn the bell on so when I put a video up that might teach you just a little something that you weren't already aware of you know the videos there and most importantly hope everybody's having a great time learning how to be a respiratory therapist or working as a respiratory therapist best wishes guys