Initial ABW Made Easy

Initial abw

hey future respiratory therapist or current respiratory therapist or new grads or whatever you are watching this video hopefully you learned something here answering another question now remember when I answer these questions that I can get shout out some credit to the person asking the question so you just don't think that I'm over here thinking of these questions on my own these are real-life questions these videos come from you so if you have a question and you want me to address it send it to me you can email it email is in the description you can send it to me through my Instagram or you can just simply reply to this video with your question or concern or topic that you need clarification on it and I'll do my best to break it down for you now normally one from Saudi Arabia wants to know about either body weight tidal volume and initial vent settings okay so I'm gonna do my best to answer that question now now secondarily to that I received an email from Kyle who's also currently a respiratory therapist student and he wanted to know the same thing so I get two questions kind of about the same concept in understanding how to calculate either body weight and and then going into tidal volume and other initial vent settings now the easiest thing to tell you about this is that there's no shortcut okay now I will tell you there is a shortcut out there on calculating ideal body weight you're estimating on your body weight I just don't know it because I just always do the formula so you can probably ask around and and seek out from experience risks right there because that know if you if you start here and then take I think it's something like 2 kilos for every inch or something over if you know the formula put it down if you know the shortcut it's really not a shortcut it's just another rule formula it's just another way to do it okay so so I don't I just know the one formula to calculate the body weight and that's the one I use this on when I teach ok so here we go we're gonna talk first about ideal body weight now to understand ideal body weight you need to know your patients X and you need to know their height everything is based off of that okay so here's the two formulas there's one for females and there's one for males so we're just going to go females here equals 105 plus 5 the height - 60 okay and for males it's 106 plus 6 times the height minus 60 okay so those are your formulas for idea by the way now to calculate that you have to know how tall your patient is so if you say let's just say we have a let's just say we have a we see this we're going to go with the female first okay so let's say we have a five foot seven inch female okay then the first thing you got to do is turn this into inches now once you realize that you're going to subtract 60 from this then it kind of simplifies it because when you know five foot seven the first thing we're gonna do is turn this into inches so five feet times 12 12 inches and a foot so five times 12 is 60 and in an additional seven inches equals sixty seven inches so we're gonna take that number and put it up here so 67 minus six T this brings us to 105 plus five times sixty seven minus 60 is seven okay now what I just said once you realize that this part of the formula is basically multiplying five times however many inches over 60 then you realize or over five feet then you realize you can really just say 105 plus five times the seven okay so that's kind of the only really trick I really do know when it comes to doing this formulas how many races gonna need more room here okay so remember we're five foot seven so then we just do the formula 105 plus 5 times 7 is 35 105 plus 35 is 140 now remember this is in pounds okay that's not a hashtag that's pounds okay so then to get it into kilograms you need to do 140 divided by 2 - so when we do that and pull on my calculator here we're gonna get 140 divided by 2.2 and our answer is sixty three point six kilograms is your ideal body weight in kilograms now ideal body weight in pounds is 140 both of these are important you're going to use the sixty sixty three point six kilograms to calculate your initial vient setting you're going to use your pounds to understand as a representation of your patients anatomical dead space anatomical dead space is approximately okay one ml for every pound of ideal body weight so if somebody has neither body weight of 140 pounds then estimated they have approximately 140 ml of anatomical dead space okay we all have it we all have anatomical dead space okay so that's why this number is important where it comes into play as an estimation of anatomical dead space this sixty three point six is the number that we're going to use to calculate this person's initial tidal volume range okay so that's the female alright so let's do one more let's say we have a female that's five foot four inches okay then we go 105 plus five this is 64 five times over 60 plus four so this is going to be 64 here so 64 minus 16 is four so 105 plus five times forward or remember I told you can just take this number over five foot and plug it in there okay and then what we have is 105 plus 20 equals 125 125 125 divided by two point two is 56.8 that's in kilograms okay that's important that's how we do for females so let's do one for males now okay so I remember males are slightly different okay so let's just go with a five-foot for male remember melt is 106 plus six times height minus 60 so we're gonna do 106 plus 6 this is 64 by foot 4 is 64 inches minus 6 again this 4 is what's gonna translate down there okay so now we have 106 plus 24 equals 130 130 130 divided by 2 point 2 equals 59 kilograms okay 59 kilograms now what we're gonna do here is one more all right but I'm going to make it to show you why you can't always just plug that number in okay to that one area so this is high minus 60 so let's say we have a six foot four male okay well you can't plug this 4 into there because this total height six times 12 is 72 72 plus four is 76 so when we write our formula this is going to be 76 minus 60 okay so this is 106 plus 6 this is 16 okay 106 plus 6 times 16 is 96 96 plus 106 is lacs 196 so this will be holy preference I can usually do this in my head but I'm struggling with this one so 106 plus 96 is 202 202 so two divided by two point two is 91 so 202 divided by two point two is ninety one point eight kilograms okay so obviously you see the trade here as as individuals get taller their ideal body weight depending on sex increases so does their anatomical dead space that should make sense right okay so here we go so we have let's just use the same one okay we have this six foot four mill we just say that his identify link is ninety one point eight kilos right okay now some of your school beans may allow you to round that up to 92 some say keep it at ninety one point eight okay so for simplistic sakes I'm just gonna round this up to ninety two kilograms okay approximately ninety two kilograms now what I do is the first thing I do when I'm calculating the initial vent settings is the first thing I want to know is what is my title volume range need to be so I'm going to take my ideal body weight and then I know the initial bit setting title volume range on from mechanical ventilation not normal title volume for healthy normal breathing people that's five to eight MLS per kilo that's not what we're Catherine we're calculating an initial vent setting title volume range which is six to eight kilos six to eight MLS per kilo okay so what we need to do is we need to calculate 92 times six and 92 times eight so we do 92 times six equals 552 and we do 92 times eight and we get 736 MLS this is your initial title volume range okay which means when you're choosing a volume mode of ventilation that you're initially going to put your patient in your title volume should fall in this range for a six foot four mil 567 ten six-fifty all of those okay or within the initial range for mechanical ventilation when you're talking initial settings okay this is for type of lighting we're gonna do one more for a female okay from the very very beginning so five foot six female 105 plus five times six this is the five so we're just gonna plug this in right here okay so six is 105 plus 30 equals 135 135 is pounds 135 pounds divided by two point two equals you got the sniffles this morning sixty one point three kilograms okay now we're gonna take this x six and eight because that's our range so 61 point three times six is three sixty seven and sixty one point three times eight equals four ninety we're gonna choose for this young lady here a title volume in this range so let's say we're gonna put them in DC AC okay then our first of all our first stepping is going to be a title volume in this range okay so let's just go with 400 this is MLS so 400 falls in this range okay so we can use 400 that's gonna be our initial title bottom now we gotta set a respiratory rate respiratory rate initial range is 10 to 16 now let's think about this if we set this patient and we choose 10 then 10 times 400 respiratory rate of 10 times tidal volume of 400 is going to give us a minute ventilation of 4 liters that's below a normal minute ventilate right so we probably want to choose a rate that's going to provide this person with a minute ventilation that's going to effectively okay remove co2 all right we don't want to put them on a vent and hype open later so if normal minute ventilation is five to six five to seven the pivotal image text you're learning out of okay then if you put them on ten your minute ventilation is gonna be four that's not going to be enough so let's choose a higher rate if we choose 14 then I manipulation will be five point six let's go with that so we're gonna choose 14 here okay inside of this range and we choose 14 okay now you gotta choose the flow flow setting for an initial setting is 40 to 60 liters per minute okay if this patient has COPD or some obstructive lung disease then you possibly may want to go higher upward of 70 okay now I'll shorten high time and give you a longer time which will give them more time to exhale reduce the chance for air trapping because they're by nature of the obstructive lung disease likely to do so okay before no obstructive lung disease you can pick up flow here between 40 and 60 so let's just go 50 okay these are normal ranges we need to set a trigger so the patient can initiate the vent okay this is a flow setting you can start flow with two liters per minute or if you're going pressure you can do negative two centimeters of water pressure those are typically good starting spots when you're talking about flow and then of course you assess if it's too sensitive you make it you increase it you make it harder to trigger if it's not sensitive enough then you decrease it make it easier for them to to to trigger the man okay we need to set an fio2 always got to have an fio2 every bit mode has an fio2 why because we control the amount of oxygen this person is breathing okay now oxygen fio2 initial setting varies based off scenarios okay so the if you read out of Egan's Egon says choose an fio2 that meets their action needs and then wind out appropriately okay some mechanical ventilation the world of teaching towards mvrc say you start 40 to 60% unless it's an emergency situation where you would start at a hundred percent so if somebody comes in with a qmi and they're set up event you're gonna start at a hundred percent and then weaned on from there as tolerated somebody comes in like a near drowning or a CPR you know a code in progress or something like that you're not gonna start them at forty percent you're gonna go a hundred percent and when you have data that says you can cut back and you cut back you know appropriately yeah it's a COPD or that you're been waiting for acute military failure superimposed on product if failure and they live at a PA o tubes let's say 60 millimeters of mercury and before you intubated their satting 92% on a 30% or 35% mini mast then you can just go to that value because the 35% of any mask was meeting their oxygen they oxygenation needs so you can start them at 35% that's why fio2 is very specific to the scenario or to the patient okay but safe starting range you can typically shoot ballpark forty to sixty percent but they'll always adjust and make these these these either increase or decrease based off of your your pulse oximetry reading okay and then when we talk finally we talked about peep typically five centimeters of water pressure is a good starting point unless you know more about your patient if you're coming from a bypass and they were requiring ten of a path to effectively oxygenate then obviously you're gonna start higher than that okay but traditionally starting at at people five and in making adjustments after that is what we see and some people don't even include peep in initial hip settings because once upon a time we didn't put everybody on people now everybody goes on people initially and so it kind of comes into the discussion where do we start our peope okay and five no other reason other than that's just typically what we do which is why I say start there unless you have reasons to start higher and then make an adjustment based off of your patients chest film based off your oxygenation status oh you know those things the things that say hey this person needs more peep okay so so good starting point here these are good this is your initial vent settings now initial is the key word because after you get a blood gas after you after you've initiated these initial vent settings then you change what you need to if you're if your your your your volume loops your your pressure volume loop is showing that 400 is too much for this particular patient because you have a bird beat then you turn it down okay and you wean the tidal volume down to meet the needs of that specific patient if your rate needs to go up you can increase your rate this is not saying this is how we mechanically ventilate everybody this is a starting platform when setting up a vent initially for patients who need mechanical ventilation okay hey from now ideal body weight to the initial tidal volume to the initial vent settings all together I hope this makes sense please leave a comment please ask a question if you have to subscribe please do so right now hit that button right there no reason not to okay are you gonna do is get free videos almost daily that is hopefully gonna help you learn and become a better respiratory therapist love to hear your feedback have a great day