์‰๋„์ž‰ ์—ฐ์Šต: Can You Guess the Diagnosis Before I Do? ๐Ÿ‘€ - ์˜์ƒ์œผ๋กœ ์˜์–ด ๋งํ•˜๊ธฐ ๋ฐฐ์šฐ๊ธฐ

์—ฐ์Šต ๋ชจ๋“œ ์„ ํƒ

๊ฐ ๋ชจ๋“œ๋Š” ์ „์ฒด ํ™”๋ฉด ์—ฐ์Šต์‹ค๋กœ ์—ด๋ฆฝ๋‹ˆ๋‹ค.

21 ๋ฌธ์žฅ
๋ฌธ์žฅ์ด ๋„ˆ๋ฌด ์งง๊ฑฐ๋‚˜ ๊ธธ๋ฉด Edit๋ฅผ ๋ˆŒ๋Ÿฌ ์กฐ์ •ํ•˜์„ธ์š”.
1
All right, nursing students, let's see if you can figure this one out before I give you the answer.
2
Okay, I've got a patient for you.
3
She's a 72 -year -old woman who came into the emergency department saying she just doesn't feel right.
4
Here are her vital signs.
5
I'll give you a second to look those over.
6
She's also confused, much sleepier than usual, and her family says that she was completely fine yesterday.
7
Now, her labs come back and they show a lactate of 5 .1, A white count of 18 ,000.
8
Creatinine is elevated compared to her baseline.
9
So what is our top concern over here?
10
I'll give you a second again to think about it.
11
Comment it down below if you got it.
12
The answer I'm thinking of is potentially sepsis, likely progressing towards septic shock.
13
Now here's why.
14
She has signs of infection with a high fever and elevated white count.
15
Her blood pressure's low, heart rate and respiratory rate are elevated.
16
She's becoming confused and her kidneys are starting to show signs of dysfunction
17
and that lactate it tells us that her tissues aren't getting enough oxygen
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because of poor perfusion
19
now this is exactly the kind of patient where early recognition
20
can save a life the sooner sepsis is identified the sooner
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we can start fluids obtain blood cultures administer broad spectrum antibiotics and closely monitor for signs of worsening shock

์•ฑ ๋‹ค์šด๋กœ๋“œ

์œ ์ฐฝํ•˜๊ฒŒ ๋งํ•˜๋Š” ๋ฐ ํ•„์š”ํ•œ ๋ชจ๋“  ๊ฒƒ

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์ด ๋ ˆ์Šจ์˜ ์–ดํœ˜์™€ ๋งํ•˜๊ธฐ ํฌ์ธํŠธ

์ด ๋งํ•˜๊ธฐ ๋ ˆ์Šจ์€ ์˜์ƒ โ€œCan You Guess the Diagnosis Before I Do? ๐Ÿ‘€โ€์„(๋ฅผ) ๋ฐ”ํƒ•์œผ๋กœ ํ•ฉ๋‹ˆ๋‹ค. ์ด ์˜์ƒ์—๋Š” ์„€๋„์ž‰ํ•  ๋ฌธ์žฅ 21๊ฐœ์™€ ๋‹จ์–ด 233๊ฐœ๊ฐ€ ์žˆ์Šต๋‹ˆ๋‹ค. ๋งํ•˜๋Š” ๊ตฌ๊ฐ„์˜ ๊ธธ์ด๋Š” 1:14์ž…๋‹ˆ๋‹ค. ํ™”์ž๋Š” ๋ถ„๋‹น ์•ฝ 189๋‹จ์–ด๋กœ ๋น ๋ฅด๊ฒŒ ๋งํ•˜๋ฏ€๋กœ ์—ฐ์Œ๊ณผ ์•ฝํ•˜๊ฒŒ ๋ฐœ์Œ๋˜๋Š” ์†Œ๋ฆฌ๊ฐ€ ๋งŽ์Šต๋‹ˆ๋‹ค. ์˜์–ด์—์„œ ๊ฐ€์žฅ ๋งŽ์ด ์“ฐ์ด๋Š” 3,000๋‹จ์–ด์— ์†ํ•˜๋Š” ๋‹จ์–ด๊ฐ€ 77%๋ฟ์ด๋ผ ์–ดํœ˜๊ฐ€ ์–ด๋ ค์šด ํŽธ์ž…๋‹ˆ๋‹ค.

์ด ์˜์ƒ์˜ ํ•ต์‹ฌ ์–ดํœ˜

์˜์ƒ์— ๋‚˜์˜ค๋Š” ์ตํ˜€ ๋‘˜ ๋งŒํ•œ ๋‹จ์–ด 15๊ฐœ๋ฅผ ๋ฐœ์Œ, ๋œป๊ณผ ํ•จ๊ป˜ ์ •๋ฆฌํ–ˆ์Šต๋‹ˆ๋‹ค.

๋‹จ์–ด๋ฐœ์Œ๋œป
shock ๋ช…์‚ฌ/สƒษ”k/์ถฉ๊ฒฉ, ์‡ผํฌ
recognition ๋ช…์‚ฌ/หŒษนษ›kษ™ษกหˆnษชสƒ(ษ™)n/์ธ์‹
compare ๋™์‚ฌ/kษ™mหˆpษ›ษš/๋น„๊ตํ•˜๋‹ค, ๋น„์œ ํ•˜๋‹ค
nurse ๋ช…์‚ฌ/nษs/๊ฐ„ํ˜ธ์›, ๊ฐ„ํ˜ธ์‚ฌ
obtain ๋™์‚ฌ/ษ™bหˆteษชn/์–ป๋‹ค, ํš๋“ํ•˜๋‹ค
vital ํ˜•์šฉ์‚ฌ/หˆvaษชtษ™l/์ƒ๋ช…์˜
monitor ๋ช…์‚ฌ/หˆmษ‘.nษช.tษš/๋ชจ๋‹ˆํ„ฐ
infection ๋ช…์‚ฌ/ษชnหˆfษ›kสƒษ™n/๊ฐ์—ผ, ์ „์—ผ
tissue ๋ช…์‚ฌ/หˆtษชสƒ.(j)u/์กฐ์ง
spectrum ๋ช…์‚ฌ/หˆspษ›ktษนษ™m/์ŠคํŽ™ํŠธ๋Ÿผ, ๋ถ„๊ด‘
oxygen ๋ช…์‚ฌ/หˆษ‘ksษชdอกส’ษ™n/์‚ฐ์†Œ
fever ๋ช…์‚ฌ/หˆfivษš/์—ด, ์—ด๋ณ‘
fluid ๋ช…์‚ฌ/หˆflu.ษชd/์œ ์ฒด, ์œ ๋™์ฒด
kidney ๋ช…์‚ฌ/หˆkษชdni/์ฝฉํŒฅ, ์‹ ์žฅ
sleepy ํ˜•์šฉ์‚ฌ/หˆsliหpi/์กธ๋ฆฌ๋‹ค

์˜์ƒ์— ๋‚˜์˜ค๋Š” ๊ตฌ๋™์‚ฌ

๋‹จ์–ด๋œป
come back ๋™์‚ฌ๋Œ์•„์˜ค๋‹ค

์ฃผ์˜ํ•  ๋ฐœ์Œ

ํ™”์ž๋Š” I'll, aren't, doesn't ๊ฐ™์€ ์ถ•์•ฝํ˜•๊ณผ ์•ฝํ™”๋œ ํ˜•ํƒœ๋ฅผ 6๋ฒˆ ์‚ฌ์šฉํ•ฉ๋‹ˆ๋‹ค. ๋“ค๋ฆฌ๋Š” ๋Œ€๋กœ ์งง๊ฒŒ ๋ฐœ์Œํ•˜์„ธ์š”.

  • โ€œshโ€์™€ โ€œzhโ€ ์†Œ๋ฆฌ: shock /สƒษ”k/, recognition /หŒษนษ›kษ™ษกหˆnษชสƒ(ษ™)n/, potentially /pษ™หˆtษ›nสƒ(ษ™)li/, infection /ษชnหˆfษ›kสƒษ™n/, tissue /หˆtษชสƒ.(j)u/
  • ๊ธด ๋‹จ์–ด โ€” ๊ฐ•์„ธ ์œ„์น˜์— ์ฃผ์˜: recognition /หŒษนษ›kษ™ษกหˆnษชสƒ(ษ™)n/, potentially /pษ™หˆtษ›nสƒ(ษ™)li/, respiratory /ษนษชหˆspษช.ษนษ™t.ษ™.ษนi/, administer /ษ™dหˆmษชn.ษช.stษ™/, antibiotic /หŒรฆn.taษช.baษชหˆษ‘.tษชk/

ํ•œ๊ตญ์–ด ํ™”์ž๊ฐ€ ์–ด๋ ค์›Œํ•˜๋Š” ์†Œ๋ฆฌ:

  • /f/ โ€” ใ…(/p/)์œผ๋กœ ๋ฐ”๊พธ์ง€ ๋ง๊ณ  ์œ—๋‹ˆ๋ฅผ ์•„๋žซ์ž…์ˆ ์— ๋Œ€๊ธฐ: confused /kษ™nหˆfjuหzd/, infection /ษชnหˆfษ›kสƒษ™n/, fever /หˆfivษš/, fluid /หˆflu.ษชd/, dysfunction /dษชsหˆfสŒล‹k.สƒษ™n/
  • /v/ โ€” ใ…‚(/b/)๊ณผ ๊ตฌ๋ณ„ํ•˜๊ธฐ: vital /หˆvaษชtษ™l/, fever /หˆfivษš/, elevate /หˆษ›lษ™veษชt/

์ด ์˜์ƒ์œผ๋กœ ์—ฐ์Šตํ•˜๋Š” ๋ฐฉ๋ฒ•

  1. ๋จผ์ € ๋งํ•˜์ง€ ์•Š๊ณ  ์˜์ƒ์„ ๋๊นŒ์ง€ ๋“ฃ๊ณ  ๋ชจ๋ฅด๋Š” ๋‹จ์–ด๋ฅผ ์ ์–ด ๋‘ก๋‹ˆ๋‹ค.
  2. 0.75๋ฐฐ์†์œผ๋กœ ํ•œ ๋ฌธ์žฅ์”ฉ ์„€๋„์ž‰์„ ์‹œ์ž‘ํ•˜๊ณ , ์ต์ˆ™ํ•ด์ง€๋ฉด ๋ณดํ†ต ์†๋„๋กœ ๋Œ์•„๊ฐ‘๋‹ˆ๋‹ค.
  3. ์ž์‹ ์˜ ๋ชฉ์†Œ๋ฆฌ๋ฅผ ๋…น์Œํ•ด ์›๋ณธ๊ณผ ๋น„๊ตํ•˜๊ณ , shock, recognition, compare ๊ฐ™์€ ๋‹จ์–ด์— ํŠนํžˆ ์ฃผ์˜ํ•ฉ๋‹ˆ๋‹ค.

์‰๋„์ž‰์ด๋ž€? ์˜์–ด ์‹ค๋ ฅ์„ ๋น ๋ฅด๊ฒŒ ํ‚ค์šฐ๋Š” ๊ณผํ•™์  ๋ฐฉ๋ฒ•

์‰๋„์ž‰(Shadowing)์€ ์›๋ž˜ ์ „๋ฌธ ํ†ต์—ญ์‚ฌ ํ›ˆ๋ จ์„ ์œ„ํ•ด ๊ฐœ๋ฐœ๋œ ์–ธ์–ด ํ•™์Šต ๊ธฐ๋ฒ•์œผ๋กœ, ๋‹ค์–ธ์–ด ํ•™์ž์ธ Dr. Alexander Arguelles์— ์˜ํ•ด ๋Œ€์ค‘ํ™”๋œ ๋ฐฉ๋ฒ•์ž…๋‹ˆ๋‹ค. ํ•ต์‹ฌ ์›๋ฆฌ๋Š” ๊ฐ„๋‹จํ•˜์ง€๋งŒ ๋งค์šฐ ๊ฐ•๋ ฅํ•ฉ๋‹ˆ๋‹ค: ์›์–ด๋ฏผ์˜ ์˜์–ด๋ฅผ ๋“ค์œผ๋ฉด์„œ 1~2์ดˆ์˜ ์งง์€ ์ง€์—ฐ์œผ๋กœ ์ฆ‰์‹œ ์†Œ๋ฆฌ ๋‚ด์–ด ๋”ฐ๋ผ ๋งํ•˜๋Š” ๊ฒƒโ€”โ€”๋งˆ์น˜ '๊ทธ๋ฆผ์ž(shadow)'์ฒ˜๋Ÿผ ํ™”์ž๋ฅผ ๋”ฐ๋ผ๊ฐ€๋Š” ๊ฒƒ์ž…๋‹ˆ๋‹ค. ๋ฌธ๋ฒ• ๊ณต๋ถ€๋‚˜ ์ˆ˜๋™์ ์ธ ์ฒญ์ทจ์™€ ๋‹ฌ๋ฆฌ, ์‰๋„์ž‰์€ ๋‡Œ์™€ ์ž… ๊ทผ์œก์ด ๋™์‹œ์— ์‹ค์‹œ๊ฐ„์œผ๋กœ ์˜์–ด๋ฅผ ์ฒ˜๋ฆฌํ•˜๊ณ  ์žฌํ˜„ํ•˜๋„๋ก ํ›ˆ๋ จํ•ฉ๋‹ˆ๋‹ค. ์—ฐ๊ตฌ์— ๋”ฐ๋ฅด๋ฉด ์ด ๋ฐฉ๋ฒ•์€ ๋ฐœ์Œ ์ •ํ™•๋„, ์–ต์–‘, ๋ฆฌ๋“ฌ, ์—ฐ์Œ, ์ฒญ์ทจ๋ ฅ, ๋งํ•˜๊ธฐ ์œ ์ฐฝ์„ฑ์„ ํฌ๊ฒŒ ํ–ฅ์ƒ์‹œํ‚ต๋‹ˆ๋‹ค. IELTS ์Šคํ”ผํ‚น ์ค€๋น„์™€ ์ž์—ฐ์Šค๋Ÿฌ์šด ์˜์–ด ์†Œํ†ต์„ ์›ํ•˜๋Š” ๋ถ„๋“ค์—๊ฒŒ ํŠนํžˆ ํšจ๊ณผ์ ์ž…๋‹ˆ๋‹ค.

์„€๋„์ž‰ ๋ฐฉ๋ฒ•: ๋‹จ๊ณ„๋ณ„ ์ „์ฒด ๊ฐ€์ด๋“œ ์ฝ๊ธฐ โ†’