シャドーイング練習: FAST Exam: Focused Assessment with Sonography in Trauma - 動画で英語スピーキングを学ぶ

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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このレッスンの語彙とスピーキングのポイント

このスピーキングレッスンは、動画「FAST Exam: Focused Assessment with Sonography in Trauma」を教材にしています。繰り返し出てくる語は次のとおりです：fluid, view, probe, exam, Fast。この動画には、シャドーイング用の文が61文、単語が1167語あります。音声の長さは7:28です。話す速さは1分あたり約156語で、日常会話に近い自然なペースです。英語の頻出3,000語に含まれる単語は72%だけなので、語彙は難しめです。

この動画の重要語彙

動画に出てくる覚えておきたい単語15語を、発音と意味つきで紹介します。

単語	発音	意味
fluid 名詞	/ˈflu.ɪd/	流体, 液体
examination 名詞	/ɪɡˌzæm.ɪˈneɪ.ʃən/	診察, 検査
indicate 動詞	/ˈɪndɪˌkeɪt/	示す, 指す
obtain 動詞	/əbˈteɪn/	手に入れる, 取得する
indicator 名詞	/ˈɪn.dɪˌkeɪ.tə(ɹ)/	インジケータ, インジケーター
kidney 名詞	/ˈkɪdni/	腎臓
assessment 名詞	/əˈsɛsmənt/	評価
arrow 名詞	/ˈæɹəʊ/	矢
trauma 名詞	/ˈtɹɔm.ə/	外傷, 損傷
bladder 名詞	/ˈblædɚ/	嚢状組織, 嚢
ultrasound 名詞	/ʌl.tɹə.saʊnd/	超音波
helpful 形容詞	/ˈhɛlp.fl̩/	役に立つ, 有用
frequency 名詞	/ˈfɹiːkwənsi/	頻度
lecture 名詞	/ˈlɛk.t͡ʃə/	講義
indication 名詞	/ɪndɪˈkeɪʃən/	記号, 符号

この動画の文法

話し手がよく使っている文型を、動画の実際の表現とともに紹介します。

文型	動画での表現
受動態 be + 過去分詞 — 誰がするかより、何が起きるかに焦点を当てる	should be considered · be utilized · is performed
関係詞節 who / which + 節 — 人や物について情報を加える	probe, which is

注意したい発音

話し手はI'm, we'll, we'reなど、短縮形や弱形を3回使っています。聞こえたとおりの短い形で発音しましょう。

「th」の音: breathe /bɹiːð/, thoracic /θəˈɹæsɪk/
「sh」と「zh」の音: examination /ɪɡˌzæm.ɪˈneɪ.ʃən/, indication /ɪndɪˈkeɪʃən/, limitation /lɪmɪˈteɪʃən/, shock /ʃɔk/, associate /əˈsoʊʃi.ət/
長い単語（アクセントの位置に注意）: examination /ɪɡˌzæm.ɪˈneɪ.ʃən/, indicator /ˈɪn.dɪˌkeɪ.tə(ɹ)/, indication /ɪndɪˈkeɪʃən/, anatomy /əˈnætəmi/, auxiliary /ɔɡˈzɪl.(jə).ɹi/

日本語話者が苦手な音：

/r/ と /l/ の区別 — /l/ は舌先を歯茎につけ、/r/ はどこにもつけない: ultrasound /ʌl.tɹə.saʊnd/, auxiliary /ɔɡˈzɪl.(jə).ɹi/, firstly /ˈfɜɹstli/, abnormal /ˌæbˈnɔɹ.ml̩/, visceral /ˈvɪsəɹəl/
/v/ — /b/ にならないように、上の歯を下唇に当てる: evaluate /ɪˈvaljʊeɪt/, sensitivity /ˌsɛn.səˈtɪv.ə.ti/, operative /ˈɑpəɹətɪv/, alternatively /ɔlˈtɝ.nə.tɪv.li/, cavity /ˈkæv.ɪt.i/
/f/ — 「フ」ではなく、上の歯と下唇で出す: fluid /ˈflu.ɪd/, helpful /ˈhɛlp.fl̩/, frequency /ˈfɹiːkwənsi/, define /dɪˈfaɪn/, inferior /ɪnˈfɪɹ.i.ɚ/

この動画での練習方法

まず声を出さずに動画を最後まで聞き、知らない単語をメモします。
まず0.75倍速で一文ずつシャドーイングし、慣れてきたら通常の速度に戻します。
自分の声を録音して元の音声と比べます。fluid, examination, indicateなどの単語に特に注意しましょう。

シャドーイングとは？英語上達に効果的な理由

シャドーイング（Shadowing）は、もともとプロの通訳者養成プログラムで開発された言語学習法で、多言語習得者として知られるDr. Alexander Arguelles によって広く普及されました。方法はシンプルですが非常に効果的：ネイティブスピーカーの英語を聞きながら、1〜2秒の遅延で声に出してすぐに繰り返す——まるで「影（shadow）」のように話者を追いかけます。文法ドリルや受動的なリスニングと異なり、シャドーイングは脳と口の筋肉が同時にリアルタイムで英語を処理・再現することを強制します。研究により、発音精度、抑揚、リズム、連音、リスニング力、そして会話の流暢さが大幅に向上することが確認されています。IELTSスピーキング対策や自然な英語コミュニケーションを目指す方に特におすすめです。

シャドーイングのやり方: ステップ別の完全ガイドを読む →

シャドーイング練習: FAST Exam: Focused Assessment with Sonography in Trauma - 動画で英語スピーキングを学ぶ

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