Практика Shadowing: FAST Exam: Focused Assessment with Sonography in Trauma - Изучайте разговорный английский по видео
Создание урока...
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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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Лексика и советы по произношению к этому уроку
Этот урок разговорной практики построен на видео «FAST Exam: Focused Assessment with Sonography in Trauma». Чаще всего повторяются слова: fluid, view, probe, exam, Fast. В этом видео 61 предложений и 1167 слов для шедоуинга. Речь длится 7:28. Говорящий говорит в естественном темпе, около 156 слов в минуту, близком к повседневной речи. Только 72% слов входят в 3000 самых частых слов английского языка, поэтому лексика сложная.
Ключевая лексика этого видео
15 слов из видео, которые стоит выучить, с произношением и значением:
| Слово | Произношение | Значение |
|---|---|---|
| fluid существительное | /ˈflu.ɪd/ | жи́дкость, флюи́д |
| probe существительное | /pɹoʊb/ | зонд, щуп |
| examination существительное | /ɪɡˌzæm.ɪˈneɪ.ʃən/ | прове́рка, иссле́дование |
| indicate глагол | /ˈɪndɪˌkeɪt/ | ука́зывать, указа́ть |
| obtain глагол | /əbˈteɪn/ | добыва́ть, добы́ть |
| indicator существительное | /ˈɪn.dɪˌkeɪ.tə(ɹ)/ | индика́тор, указа́тель |
| kidney существительное | /ˈkɪdni/ | по́чка |
| assessment существительное | /əˈsɛsmənt/ | оце́нка налогообложе́ния |
| arrow существительное | /ˈæɹəʊ/ | стрела́ |
| assess глагол | /əˈsɛs/ | определя́ть, определи́ть |
| scan глагол | /skæn/ | разгля́дывать |
| trauma существительное | /ˈtɹɔm.ə/ | тра́вма, ра́на |
| array существительное | /əˈɹeɪ/ | убо́р, наря́д |
| bladder существительное | /ˈblædɚ/ | пузы́рь |
| ultrasound существительное | /ʌl.tɹə.saʊnd/ | ультразву́к |
Грамматика в этом видео
Конструкции, которые говорящий использует чаще всего, с точными словами из видео:
| Конструкция | В видео |
|---|---|
| Пассивный залог be + причастие прошедшего времени — важно, что происходит, а не кто это делает | should be considered · be utilized · is performed |
| Придаточные определительные who / which + предложение — уточнение о человеке или предмете | probe, which is |
Произношение, на которое стоит обратить внимание
Говорящий использует 3 сокращённых и редуцированных форм, например I'm, we'll, we're. Произносите их коротко, так, как слышите.
- Звуки «th»: breathe /bɹiːð/, thoracic /θəˈɹæsɪk/
- Звуки «sh» и «zh»: examination /ɪɡˌzæm.ɪˈneɪ.ʃən/, indication /ɪndɪˈkeɪʃən/, limitation /lɪmɪˈteɪʃən/, shock /ʃɔk/, associate /əˈsoʊʃi.ət/
- Длинные слова — следите за ударением: examination /ɪɡˌzæm.ɪˈneɪ.ʃən/, indicator /ˈɪn.dɪˌkeɪ.tə(ɹ)/, indication /ɪndɪˈkeɪʃən/, anatomy /əˈnætəmi/, auxiliary /ɔɡˈzɪl.(jə).ɹi/
Звуки, трудные для русскоязычных:
- /w/ — губы округлены, это не /v/: frequency /ˈfɹiːkwənsi/, whereas /(h)wɛɹˈæz/, distinguish /dɪˈstɪŋ.ɡwɪʃ/, quadrant /ˈkwɑ.dɹənt/, takeaway /ˈteɪkəweɪ/
- /h/ — лёгкий выдох, а не русское «х»: helpful /ˈhɛlp.fl̩/, whereas /(h)wɛɹˈæz/, highlight /ˈhaɪˌlaɪt/
- Звонкие согласные в конце слова — не оглушайте их: fluid /ˈflu.ɪd/, probe /pɹoʊb/, ultrasound /ʌl.tɹə.saʊnd/, whereas /(h)wɛɹˈæz/, rapid /ˈɹæp.ɪd/
Как заниматься с этим видео
- Прослушайте всё видео один раз молча и выпишите незнакомые слова.
- Начните со скорости 0,75×, повторяйте предложение за предложением и вернитесь к обычной скорости, когда станет легко.
- Запишите себя и сравните с оригиналом, обращая внимание на такие слова, как fluid, probe, examination.
Что такое техника Shadowing?
Shadowing — это научно обоснованная техника изучения языка, изначально разработанная для подготовки профессиональных переводчиков и популяризированная полиглотом доктором Александром Аргуэльесом. Метод прост, но эффективен: вы слушаете аудио на английском от носителей языка и немедленно повторяете вслух — как тень, следующая за говорящим с задержкой в 1–2 секунды. В отличие от пассивного прослушивания или грамматических упражнений, Shadowing заставляет мозг и мышцы рта одновременно обрабатывать и воспроизводить реальные речевые паттерны. Исследования показывают, что это значительно улучшает точность произношения, интонацию, ритм, связную речь, понимание на слух и беглость речи — что делает его одним из самых эффективных методов для подготовки к IELTS Speaking и реального общения на английском.