쉐도잉 연습: FAST Exam: Focused Assessment with Sonography in Trauma - 영상으로 영어 말하기 배우기
레슨 만드는 중...
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Hello, everyone.
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My name is Dr. Aidan Sharkey.
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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.
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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,
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and finally we'll go through some basic views involved in performing the FAST exam.
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To begin let us first define what exactly a FAST exam is.
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FAST stands for Focus Assessment with Sonography and Trauma
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and this is a rapid assessment done at the bedside for trauma patients in order to diagnose and guide therapy.
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With the FAST exam we are assessing for free fluid which would indicate visceral injury in four key regions,
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peri -hepatic, perisplenic, pericardium, and suprapubic areas.
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The indications for performing a FAST exam are very broad, and its use should be considered in all abdominal and or thoracic trauma situations,
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where the mechanism of injury is blunt or penetrating in nature.
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Patients presenting with undifferentiated hypotension or shock should also undergo a FAST exam as part of their workup.
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With respect to the limitations of performing a FAST exam, there are no absolute contraindications.
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However, the exam should not delay treatment of unstable patients, and the operator should be aware of the limited sensitivity of a negative exam.
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Therefore, an unstable patient with a negative FAST exam or a patient in
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which there is a high index of suspicion for visceral injury
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should undergo further testing in the form of a CT scan or operative assessment.
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In terms of equipment required for performing a FAST exam, you will need access to an ultrasound machine and the correct ultrasound probe.
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For abdominal scans, we generally choose the curvilinear probe, which is a probe with a low frequency resulting in increased depth of penetration.
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Alternatively, the phased array probe, which is also a low frequency probe, can also be utilized as part of the FAST exam.
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It is important to note the location of the indicator marker on the probe
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and which side of the image this corresponds to when looking at the screen.
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For the curvilinear probe, this is generally on the left of the screen.
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And for the phased array probe, this is on the right of the screen.
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Moving on to performing the FAST exam, and this is performed by examining four areas for the presence of free fluid.
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that is the right upper quadrant for fluid in the peri
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-hepatic space left upper quadrant for fluid in the perisplenic space subcostal area for pericardial fluid
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and finally the pelvic area for suprapubic fluid we will now go through each of these views
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and discuss how each view is obtained
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and look at some sonoanatomy the right upper quadrant
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or peri -hepatic view is used to assess for free fluid in the space between the liver and the right kidney.
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To obtain this view, we place the probe in the mid -axillary line on the right side between the 8th
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and 11th intercostal space.
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The indicator should be facing towards the 12 o 'clock position or the patient's head.
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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.
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This example depicts fluid in the peri -hepatic space as indicated by the yellow arrows.
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An image such as this is very concerning for a visceral injury.
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Moving on to the left upper quadrant or perisplenic view.
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This view is used to assess for free fluid around the left kidney and spleen.
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To obtain this view we place the probe in the mid
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-auxiliary line on the left side between the 8th to 11th
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intercostal space with the indicator again facing towards the 12 o 'clock position or patient's head.
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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.
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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.
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Sliding between intercostal spaces may again be required to optimize this view.
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In this view, we are looking for free fluid accumulation in two spaces the perisplenic space between the spleen
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and the diaphragm as indicated by the green line
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and the splenorenal space between the spleen and the left kidney as indicated by the yellow line
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free fluid will preferentially be located in the perisplenic space
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or into the presence of the splenorenal ligament
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which limits the ability of fluid to track in between the spleen
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and the left kidney in this image we see free fluid as indicated by the yellow arrows surrounding the space.
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To obtain the subcostal view, we place the probe just inferior to the xiphoid process.
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If we are using the curvilinear probe, we have the indicator facing to the patient's right.
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However, if we are using the phased array probe, we have the indicator facing to the patient's left.
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It is often helpful to have the patient bend their knees and take a breath in to optimize this view.
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And also the ultrasound probe should be aligned slightly anteriorly.
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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.
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This view is particularly useful for evaluating for free fluid in the pericardial space, as seen in these videos depicted by the yellow arrows.
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Both video clips demonstrate circumferential fluid collection.
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The video to the right of the screen additionally depicts one of the distinguishing features suggesting possible tamponade physiology,
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that is right ventricular diastolic collapse.
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Finally, the pelvic scan will assess for fluid in the suprapubic region.
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To obtain this view, we place the probe right above the pubic symphysis with the indicator probe facing to the patient's right.
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Ideally, the patient would have a full bladder
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so as to act as an acoustic window
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and then the probe should be tilted caudally so as to scan deep into the pelvic cavity.
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In this view, we should be able to identify the bladder, prostate and rectum in males and in females the bladder,
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uterus and rectum should be seen. In males,
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fluid tends to accumulate in the recto for cycle pouch whereas in females fluid collects in the recto uterine pouch
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which is also known as the pouch of Douglas.
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In this example, we can see free fluid accumulating in the recto uterine pouch, as indicated by the yellow arrows,
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possibly indicating a ruptured ectopic pregnancy in this patient.
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That concludes our lecture on the FAST exam today.
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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.
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Thank you for watching, and I hope you found this topic helpful.
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이 레슨의 어휘와 말하기 포인트
이 말하기 레슨은 영상 “FAST Exam: Focused Assessment with Sonography in Trauma”을(를) 바탕으로 합니다. 가장 자주 반복되는 단어는 다음과 같습니다: fluid, view, probe, exam, Fast. 이 영상에는 섀도잉할 문장 61개와 단어 1167개가 있습니다. 말하는 구간의 길이는 7:28입니다. 화자는 분당 약 156단어로, 일상 대화에 가까운 자연스러운 속도로 말합니다. 영어에서 가장 많이 쓰이는 3,000단어에 속하는 단어가 72%뿐이라 어휘가 어려운 편입니다.
이 영상의 핵심 어휘
영상에 나오는 익혀 둘 만한 단어 15개를 발음, 뜻과 함께 정리했습니다.
| 단어 | 발음 | 뜻 |
|---|---|---|
| fluid 명사 | /ˈflu.ɪd/ | 유체, 유동체 |
| examination 명사 | /ɪɡˌzæm.ɪˈneɪ.ʃən/ | 진찰, 검사 |
| indicate 동사 | /ˈɪndɪˌkeɪt/ | 가리키다 |
| obtain 동사 | /əbˈteɪn/ | 얻다, 획득하다 |
| indicator 명사 | /ˈɪn.dɪˌkeɪ.tə(ɹ)/ | 인디케이터, 지시약 |
| kidney 명사 | /ˈkɪdni/ | 콩팥, 신장 |
| assessment 명사 | /əˈsɛsmənt/ | 평가 |
| arrow 명사 | /ˈæɹəʊ/ | 화살 |
| trauma 명사 | /ˈtɹɔm.ə/ | 외상, 손상 |
| bladder 명사 | /ˈblædɚ/ | 부레 |
| ultrasound 명사 | /ʌl.tɹə.saʊnd/ | 초음파 |
| frequency 명사 | /ˈfɹiːkwənsi/ | 빈도 |
| lecture 명사 | /ˈlɛk.t͡ʃə/ | 강의 |
| indication 명사 | /ɪndɪˈkeɪʃən/ | 부호 |
| anatomy 명사 | /əˈnætəmi/ | 해부학, 해부 |
이 영상의 문법
화자가 가장 많이 쓰는 문형을 영상 속 실제 표현과 함께 정리했습니다.
| 문형 | 영상 속 표현 |
|---|---|
| 수동태 be + 과거분사 — 누가 하는지보다 무슨 일이 일어나는지에 초점 | should be considered · be utilized · is performed |
| 관계절 who / which + 절 — 사람이나 사물에 대한 추가 정보 | probe, which is |
주의할 발음
화자는 I'm, we'll, we're 같은 축약형과 약화된 형태를 3번 사용합니다. 들리는 대로 짧게 발음하세요.
- “th” 소리: breathe /bɹiːð/, thoracic /θəˈɹæsɪk/
- “sh”와 “zh” 소리: examination /ɪɡˌzæm.ɪˈneɪ.ʃən/, indication /ɪndɪˈkeɪʃən/, limitation /lɪmɪˈteɪʃən/, shock /ʃɔk/, associate /əˈsoʊʃi.ət/
- 긴 단어 — 강세 위치에 주의: examination /ɪɡˌzæm.ɪˈneɪ.ʃən/, indicator /ˈɪn.dɪˌkeɪ.tə(ɹ)/, indication /ɪndɪˈkeɪʃən/, anatomy /əˈnætəmi/, auxiliary /ɔɡˈzɪl.(jə).ɹi/
한국어 화자가 어려워하는 소리:
- /f/ — ㅍ(/p/)으로 바꾸지 말고 윗니를 아랫입술에 대기: fluid /ˈflu.ɪd/, helpful /ˈhɛlp.fl̩/, frequency /ˈfɹiːkwənsi/, define /dɪˈfaɪn/, inferior /ɪnˈfɪɹ.i.ɚ/
- /v/ — ㅂ(/b/)과 구별하기: evaluate /ɪˈvaljʊeɪt/, sensitivity /ˌsɛn.səˈtɪv.ə.ti/, operative /ˈɑpəɹətɪv/, alternatively /ɔlˈtɝ.nə.tɪv.li/, cavity /ˈkæv.ɪt.i/
- /z/ — ㅈ이 아니라 성대를 울리는 /s/: examination /ɪɡˌzæm.ɪˈneɪ.ʃən/, auxiliary /ɔɡˈzɪl.(jə).ɹi/, whereas /(h)wɛɹˈæz/, mechanism /ˈmɛk.ə.nɪ.zəm/, examine /ɪɡˈzæmɪn/
이 영상으로 연습하는 방법
- 먼저 말하지 않고 영상을 끝까지 듣고 모르는 단어를 적어 둡니다.
- 0.75배속으로 한 문장씩 섀도잉을 시작하고, 익숙해지면 보통 속도로 돌아갑니다.
- 자신의 목소리를 녹음해 원본과 비교하고, fluid, examination, indicate 같은 단어에 특히 주의합니다.
쉐도잉이란? 영어 실력을 빠르게 키우는 과학적 방법
쉐도잉(Shadowing)은 원래 전문 통역사 훈련을 위해 개발된 언어 학습 기법으로, 다언어 학자인 Dr. Alexander Arguelles에 의해 대중화된 방법입니다. 핵심 원리는 간단하지만 매우 강력합니다: 원어민의 영어를 들으면서 1~2초의 짧은 지연으로 즉시 소리 내어 따라 말하는 것——마치 '그림자(shadow)'처럼 화자를 따라가는 것입니다. 문법 공부나 수동적인 청취와 달리, 쉐도잉은 뇌와 입 근육이 동시에 실시간으로 영어를 처리하고 재현하도록 훈련합니다. 연구에 따르면 이 방법은 발음 정확도, 억양, 리듬, 연음, 청취력, 말하기 유창성을 크게 향상시킵니다. IELTS 스피킹 준비와 자연스러운 영어 소통을 원하는 분들에게 특히 효과적입니다.