تدريب Shadowing: ST Elevation and Depression on an EKG Rhythm Strip - تعلم التحدث بالإنجليزية عبر الفيديو
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In this video, we'll take a look at ST segment changes.
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How do we identify and measure ST elevation and depression?
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And what does it mean for our patient?
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The ST segment is the space between the QRS and the T wave.
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It should be resting comfortably on the baseline, but in some strips you may see it above or below the baseline.
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When you're checking location of the ST segment, sometimes it seems a little variable.
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But what we're basing this measurement on is where the J -point is.
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That's the junction between the QRS and the ST segment.
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It's where we stopped measuring the QRS complex.
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So start by identifying where the baseline is.
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Where does your PR segment rest?
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And where does your diastolic phase between the T -wave and the P -wave come to rest?
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That's your baseline.
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Now, is the J -point on, below, or above the baseline.
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The threshold for this is one millimeter or more elevated or depressed,
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so one small box above or below the baseline is considered significant and warrants noting on the interpretation.
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Take your calipers.
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Place one point on the baseline and one point on the J -point.
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You're measuring vertically for this, so take that measurement to a nice clear area where you can count the small boxes.
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Vertically, each box represents one millimeter, so count the boxes and note ST elevation or depression
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if you have at least one full small box or one millimeter of change from the baseline.
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For this strip we have elevation.
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The J point is three small boxes above the baseline.
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So it's a three millimeter ST elevation.
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For this strip we have depression.
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The J point is two small boxes below the baseline.
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So it's a two millimeter ST depression.
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A lot of elevation and depression is chronic, and is indicative of some level of ischemic damage.
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You can get a lot more specific with that
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if you do a 12 -lead and look at how the ST changes appear on a number of different leads,
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but on a 3 and 5 -lead monitor, we'll just say they indicate ischemia.
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There are a couple of findings that are a bit more concerning, though.
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If you see acute elevation, meaning it wasn't there before, and after the J -point you see a convex curve,
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meaning after the j -point the tracing goes back up before returning to the baseline.
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It ends up taking on a shape known commonly as a tombstone.
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When you see tombstones, think heart attack.
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The tombstone shape won't always show in every lead.
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Depending on where the infarct is, the tombstone will show itself in the associated leads, and others may show nothing.
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Here's an example of a 12 -lead EKG.
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If we were looking at lead 2, we would have seen a tombstone shape appear for our patient.
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But if we were looking at lead 1, it's only showing a minor depression.
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Some other leads, like 3 or AVF, are showing the tombstone, but the rest are showing depression or sometimes no change at all.
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This EKG may be indicative of an inferior wall MI,
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which can be figured out based on which leads are showing the elevation changes and which are not.
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That being Having said, we'll only be viewing leads 1, 2, 3, AVR, AVL, AVF and V1 on our 5 -lead setup.
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And primarily, we'll be looking at lead 2.
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So we can't see every infarct with a 5 -lead setup.
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But when you do see it, check your patient for symptoms and activate the emergency response.
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If the patient is showing symptoms, even if the 5 -lead isn't showing any elevation, activate the emergency response.
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The 12 -lead may reveal what we couldn't see with the 5.
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Another acute change you may see is when after the J -point, the ST segment curves down into a concave curve.
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It can be indicative of pericarditis.
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This ST change is usually widespread across many leads.
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Pericarditis is inflammation of the pericardial sac surrounding the heart.
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Symptoms include sharp chest pains, much like infarction.
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So again, if you see this ST change on your strip, check your patient for symptoms and activate the emergency response.
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المفردات وملاحظات التحدث لهذا الدرس
هذا الدرس في المحادثة مبني على الفيديو “ST Elevation and Depression on an EKG Rhythm Strip”. أكثر الكلمات تكرارًا في الفيديو: lead, baseline, elevation, depression, tombstone. يحتوي هذا الفيديو على 56 جملة و693 كلمة للتدرب على الترديد. مدة الكلام 4:15. يتكلم المتحدث بسرعة طبيعية، نحو 163 كلمة في الدقيقة، قريبة من المحادثة اليومية. 77% فقط من الكلمات ضمن أكثر 3,000 كلمة شيوعًا في الإنجليزية، فالمفردات صعبة نسبيًا.
أهم المفردات في هذا الفيديو
15 كلمة من الفيديو تستحق التعلّم، مع النطق والمعنى:
| الكلمة | النطق | المعنى |
|---|---|---|
| symptom اسم | /ˈsɪm(p)təm/ | عَرَض, عَلَامَة |
| curve اسم | /kɚv/ | منحنى |
| activate فعل | /ˈæktɪˌveɪt/ | فَعَّلَ |
| sharp صفة | /ʃɑɹp/ | حَادّ |
| reveal فعل | /ɹɪˈviːl/ | كَشَفَ |
| commonly ظرف | /ˈkɑmənli/ | غالبا, عَادَةً |
| monitor اسم | /ˈmɑ.nɪ.tɚ/ | مُرَاقِب, مُرَاقِبَة |
| indicate فعل | /ˈɪndɪˌkeɪt/ | دَلَّ عَلَى, رَمَزَ إِلَى |
| interpretation اسم | /ɪnˌtɜːpɹəˈteɪʃən/ | تَفْسِير, تأويل |
| chronic صفة | /ˈkɹɑ.nɪk/ | عَوِيص |
| trace اسم | /tɹeɪs/ | أَثَر |
| depressed صفة | /dɪˈpɹɛst/ | مُحْبَط, مُكْتَئِب |
| threshold اسم | /ˈθɹɛʃ(h)oʊld/ | عَتَبَة |
| surround فعل | /səˈɹaʊnd/ | أَحَاطَ, حَفَّ |
| inflammation اسم | /ɪnfləˈmeɪ̯ʃən/ | اِلْتِهَاب |
نطق يحتاج إلى انتباه
يستخدم المتحدث 12 من الصيغ المختصرة، مثل we'll, you're, can't. انطقها بصيغتها القصيرة كما تسمعها.
- أصوات “sh” و“zh”: elevation /ˌɛlɪˈveɪʃn̩/, measurement /ˈmɛʒ.ə.mənt/, sharp /ʃɑɹp/, associate /əˈsoʊʃi.ət/, interpretation /ɪnˌtɜːpɹəˈteɪʃən/
- الكلمات الطويلة — انتبه لموضع النبر: indicative /ɪnˈdɪk.ə.tɪv/, primarily /ˈpɹaɪ.mə.ɹə.li/, associate /əˈsoʊʃi.ət/, interpretation /ɪnˌtɜːpɹəˈteɪʃən/, inferior /ɪnˈfɪɹ.i.ɚ/
أصوات يجدها متحدثو العربية صعبة:
- /p/ — ليس /b/: انطقه مع نفخة هواء: strip /ˈstɹɪp/, symptom /ˈsɪm(p)təm/, primarily /ˈpɹaɪ.mə.ɹə.li/, sharp /ʃɑɹp/, interpretation /ɪnˌtɜːpɹəˈteɪʃən/
- /v/ — ليس /f/: مع اهتزاز الأوتار الصوتية: elevation /ˌɛlɪˈveɪʃn̩/, curve /kɚv/, activate /ˈæktɪˌveɪt/, indicative /ɪnˈdɪk.ə.tɪv/, reveal /ɹɪˈviːl/
- تتابع الصوامت — لا تضف حركة بينها: segment /ˈsɛɡmɛnt/, strip /ˈstɹɪp/, symptom /ˈsɪm(p)təm/, measurement /ˈmɛʒ.ə.mənt/, primarily /ˈpɹaɪ.mə.ɹə.li/
كيف تتدرب بهذا الفيديو
- استمع إلى الفيديو كاملًا مرة واحدة دون أن تتكلم، ودوّن الكلمات التي لا تعرفها.
- ابدأ بسرعة 0.75×، وردّد جملة جملة، ثم عُد إلى السرعة العادية عندما يصبح الأمر سهلًا.
- سجّل صوتك وقارنه بالأصل، مع الانتباه إلى كلمات مثل symptom, curve, activate.
ما هي تقنية التظليل الصوتي؟
التظليل الصوتي (Shadowing) تقنية تعلم لغة مدعومة علمياً، طُورت أصلاً لتدريب المترجمين الفوريين المحترفين. الطريقة بسيطة لكنها قوية: تستمع لصوت إنجليزي أصلي وتكرره فوراً بصوت عالٍ — كظل يتبع المتحدث بتأخير 1-2 ثانية. تُظهر الأبحاث تحسناً كبيراً في دقة النطق والتنغيم والإيقاع وربط الأصوات والاستماع والطلاقة.