Shadowing-Übung: FAST Exam: Focused Assessment with Sonography in Trauma - Englisch Sprechen Lernen mit Video

Hello, everyone.

My name is Dr. Aidan Sharkey.

I'm an attending anesthesiologist at the Beth Israel Deaconess Medical Center in Boston, Massachusetts, and today we're going to be discussing the FAST exam.

The key takeaways of today's lecture are to firstly discuss the indications and limitations of performing the FAST exam, secondly to discuss the equipment required,

and finally we'll go through some basic views involved in performing the FAST exam.

To begin let us first define what exactly a FAST exam is.

FAST stands for Focus Assessment with Sonography and Trauma

and this is a rapid assessment done at the bedside for trauma patients in order to diagnose and guide therapy.

With the FAST exam we are assessing for free fluid which would indicate visceral injury in four key regions,

peri -hepatic, perisplenic, pericardium, and suprapubic areas.

The indications for performing a FAST exam are very broad, and its use should be considered in all abdominal and or thoracic trauma situations,

where the mechanism of injury is blunt or penetrating in nature.

Patients presenting with undifferentiated hypotension or shock should also undergo a FAST exam as part of their workup.

With respect to the limitations of performing a FAST exam, there are no absolute contraindications.

However, the exam should not delay treatment of unstable patients, and the operator should be aware of the limited sensitivity of a negative exam.

Therefore, an unstable patient with a negative FAST exam or a patient in

which there is a high index of suspicion for visceral injury

should undergo further testing in the form of a CT scan or operative assessment.

In terms of equipment required for performing a FAST exam, you will need access to an ultrasound machine and the correct ultrasound probe.

For abdominal scans, we generally choose the curvilinear probe, which is a probe with a low frequency resulting in increased depth of penetration.

Alternatively, the phased array probe, which is also a low frequency probe, can also be utilized as part of the FAST exam.

It is important to note the location of the indicator marker on the probe

and which side of the image this corresponds to when looking at the screen.

For the curvilinear probe, this is generally on the left of the screen.

And for the phased array probe, this is on the right of the screen.

Moving on to performing the FAST exam, and this is performed by examining four areas for the presence of free fluid.

that is the right upper quadrant for fluid in the peri

-hepatic space left upper quadrant for fluid in the perisplenic space subcostal area for pericardial fluid

and finally the pelvic area for suprapubic fluid we will now go through each of these views

and discuss how each view is obtained

and look at some sonoanatomy the right upper quadrant

or peri -hepatic view is used to assess for free fluid in the space between the liver and the right kidney.

To obtain this view, we place the probe in the mid -axillary line on the right side between the 8th

and 11th intercostal space.

The indicator should be facing towards the 12 o 'clock position or the patient's head.

This view is most useful for the assessment of free fluid in the peri -epatic space, also known as Morrison's pouch, as depicted in this image.

This example depicts fluid in the peri -hepatic space as indicated by the yellow arrows.

An image such as this is very concerning for a visceral injury.

Moving on to the left upper quadrant or perisplenic view.

This view is used to assess for free fluid around the left kidney and spleen.

To obtain this view we place the probe in the mid

-auxiliary line on the left side between the 8th to 11th

intercostal space with the indicator again facing towards the 12 o 'clock position or patient's head.

As anatomically the spleen is a very posterior structure, the probe will also need to be in a very posterior position in order to obtain this view.

In this view, the structures identified include the spleen to the left of the screen, the left kidney to the right of the screen, and the diaphragm to the bottom of the screen.

Sliding between intercostal spaces may again be required to optimize this view.

In this view, we are looking for free fluid accumulation in two spaces the perisplenic space between the spleen

and the diaphragm as indicated by the green line

and the splenorenal space between the spleen and the left kidney as indicated by the yellow line

free fluid will preferentially be located in the perisplenic space

or into the presence of the splenorenal ligament

which limits the ability of fluid to track in between the spleen

and the left kidney in this image we see free fluid as indicated by the yellow arrows surrounding the space.

To obtain the subcostal view, we place the probe just inferior to the xiphoid process.

If we are using the curvilinear probe, we have the indicator facing to the patient's right.

However, if we are using the phased array probe, we have the indicator facing to the patient's left.

It is often helpful to have the patient bend their knees and take a breath in to optimize this view.

And also the ultrasound probe should be aligned slightly anteriorly.

In this view, we should be able to identify the liver, pericardium, and the two atria and two ventricles of the heart as depicted in this video loop.

This view is particularly useful for evaluating for free fluid in the pericardial space, as seen in these videos depicted by the yellow arrows.

Both video clips demonstrate circumferential fluid collection.

The video to the right of the screen additionally depicts one of the distinguishing features suggesting possible tamponade physiology,

that is right ventricular diastolic collapse.

Finally, the pelvic scan will assess for fluid in the suprapubic region.

To obtain this view, we place the probe right above the pubic symphysis with the indicator probe facing to the patient's right.

Ideally, the patient would have a full bladder

so as to act as an acoustic window

and then the probe should be tilted caudally so as to scan deep into the pelvic cavity.

In this view, we should be able to identify the bladder, prostate and rectum in males and in females the bladder,

uterus and rectum should be seen. In males,

fluid tends to accumulate in the recto for cycle pouch whereas in females fluid collects in the recto uterine pouch

which is also known as the pouch of Douglas.

In this example, we can see free fluid accumulating in the recto uterine pouch, as indicated by the yellow arrows,

possibly indicating a ruptured ectopic pregnancy in this patient.

That concludes our lecture on the FAST exam today.

In summary, we went through the four basic U's to perform a FAST exam, along with highlighting both normal and abnormal anatomy associated with these views.

Thank you for watching, and I hope you found this topic helpful.

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Wortschatz und Sprechhinweise zu dieser Lektion

Diese Sprechübung basiert auf dem Video „FAST Exam: Focused Assessment with Sonography in Trauma“. Diese Wörter kommen am häufigsten vor: fluid, view, probe, exam, Fast. Dieses Video enthält 61 Sätze und 1167 Wörter zum Nachsprechen. Der gesprochene Teil dauert 7:28. Der Sprecher spricht in natürlichem Tempo, etwa 156 Wörter pro Minute, ähnlich wie im Alltagsgespräch. Nur 72 % der Wörter gehören zu den 3.000 häufigsten im Englischen, der Wortschatz ist also anspruchsvoll.

Wichtiger Wortschatz in diesem Video

15 lernenswerte Wörter aus dem Video, mit Aussprache und Bedeutung:

Wort	Aussprache	Bedeutung
fluid Substantiv	/ˈflu.ɪd/	Fluid, Flüssigkeit
examination Substantiv	/ɪɡˌzæm.ɪˈneɪ.ʃən/	Prüfung, Untersuchung
indicate Verb	/ˈɪndɪˌkeɪt/	anzeigen, anweisen
obtain Verb	/əbˈteɪn/	erlangen, erhalten
indicator Substantiv	/ˈɪn.dɪˌkeɪ.tə(ɹ)/	Indikator, Anzeige
kidney Substantiv	/ˈkɪdni/	Niere
assessment Substantiv	/əˈsɛsmənt/	Bewertung, Schätzung
arrow Substantiv	/ˈæɹəʊ/	Pfeil
assess Verb	/əˈsɛs/	schätzen, bewerten
trauma Substantiv	/ˈtɹɔm.ə/	Trauma
array Substantiv	/əˈɹeɪ/	Bekleidung, Tracht
bladder Substantiv	/ˈblædɚ/	Blase
ultrasound Substantiv	/ʌl.tɹə.saʊnd/	Ultraschall
helpful Adjektiv	/ˈhɛlp.fl̩/	hilfreich, hilfsbereit
frequency Substantiv	/ˈfɹiːkwənsi/	Häufigkeit, Frequenz

Grammatik in diesem Video

Die Strukturen, die der Sprecher am häufigsten verwendet, mit den genauen Worten aus dem Video:

Struktur	Im Video
Passiv be + Partizip Perfekt – wichtig ist, was geschieht, nicht wer es tut	should be considered · be utilized · is performed
Relativsätze who / which + Satz – eine Zusatzinformation über eine Person oder Sache	probe, which is

Aussprache, auf die du achten solltest

Der Sprecher verwendet 3 Kurzformen und abgeschwächte Formen, zum Beispiel I'm, we'll, we're. Sprich sie in der kurzen Form, so wie du sie hörst.

Die „th“-Laute: breathe /bɹiːð/, thoracic /θəˈɹæsɪk/
Die Laute „sh“ und „zh“: examination /ɪɡˌzæm.ɪˈneɪ.ʃən/, indication /ɪndɪˈkeɪʃən/, limitation /lɪmɪˈteɪʃən/, shock /ʃɔk/, associate /əˈsoʊʃi.ət/
Lange Wörter – auf die Betonung achten: examination /ɪɡˌzæm.ɪˈneɪ.ʃən/, indicator /ˈɪn.dɪˌkeɪ.tə(ɹ)/, indication /ɪndɪˈkeɪʃən/, anatomy /əˈnætəmi/, auxiliary /ɔɡˈzɪl.(jə).ɹi/

Laute, die Deutschsprachigen schwerfallen:

/w/ — mit runden Lippen, nicht wie das deutsche „w“ (/v/): frequency /ˈfɹiːkwənsi/, whereas /(h)wɛɹˈæz/, distinguish /dɪˈstɪŋ.ɡwɪʃ/, quadrant /ˈkwɑ.dɹənt/, takeaway /ˈteɪkəweɪ/
Stimmhafter Auslaut — /b/, /d/, /g/, /z/, /v/ am Wortende nicht verhärten: fluid /ˈflu.ɪd/, probe /pɹoʊb/, ultrasound /ʌl.tɹə.saʊnd/, whereas /(h)wɛɹˈæz/, rapid /ˈɹæp.ɪd/
/æ/ — offener als „ä“: examination /ɪɡˌzæm.ɪˈneɪ.ʃən/, arrow /ˈæɹəʊ/, scan /skæn/, bladder /ˈblædɚ/, anatomy /əˈnætəmi/

So übst du mit diesem Video

Höre dir das ganze Video einmal an, ohne zu sprechen, und notiere die Wörter, die du nicht kennst.
Beginne mit 0,75-facher Geschwindigkeit, sprich Satz für Satz nach und wechsle zur normalen Geschwindigkeit, sobald es leichtfällt.
Nimm dich auf und vergleiche mit dem Original; achte dabei auf Wörter wie fluid, examination, indicate.

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