Shadowing Practice: Inside a Tox Resuscitation - Hyperthermia & Seizures [Medical Simulation] - Learn English Speaking with Video
Bir pratik modu seçin
Her mod tam ekran bir pratik odası açar.
653 cümleler
Cümleler çok kısa veya çok uzun ise, ayarlamak için Düzenle'ye tıklayın.
1
Jeff, we got a rectal temperature of 41 degrees Celsius.
Jeff, rektal ölçümde 41 derece Celsius ateş tespit edildi.
2
Okay, so the patient's hot.
Tamam, hastanın ateşi var.
3
I think that this is most likely due to a toxicologic cause, so we should start cooling the patient as soon as possible.
Bunun büyük olasılıkla toksikolojik bir nedenden kaynaklandığını düşünüyorum, bu nedenle hastayı mümkün olan en kısa sürede soğutmaya başlamalıyız.
4
So why don't we just start missing the patient and turning on the fans?
O halde neden hastayı özlemeye başlayıp vantilatörleri çalıştırmayalım?
5
You want pads on?
Ped takmak ister misiniz?
6
I notice they're quite tachycardic.
Kalp atış hızlarının oldukça yüksek olduğunu fark ettim.
7
Yes, we should.
Evet, yapmalıyız.
8
So let's just quickly review the vital signs.
O halde, hayati belirtileri hızlıca gözden geçirelim.
9
The patient is now having a seizure.
Hasta şu anda nöbet geçiriyor.
10
Seizing.
Tutukluk.
11
Okay, patient's seizing.
Tamam, hasta nöbet geçiriyor.
12
I have Ativan here.
Elimde Ativan var.
13
Yeah, so let's give Ativan 2 milligrams IV.
Evet, o zaman Ativan'dan 2 miligramı damardan verelim.
14
Hi, I'm Dr. Jeff Yu, a board -certified emergency physician in both the USA and Canada,
Merhaba, ben Dr. Jeff Yu, hem ABD hem de Kanada'da acil tıp alanında uzmanlık belgesine sahip bir hekimim.
15
and this video demonstrates a simulated resuscitation of a young patient presenting with status epilepticus and severe hypothermia.
Bu video ise status epileptikus ve şiddetli hipotermi geçiren genç bir hastaya uygulanan simüle edilmiş bir canlandırma işlemini göstermektedir.
16
This scenario was inspired by a series of real patients treated at our hospital over the past couple of years, many of whom had tragic outcomes.
Bu senaryo, son birkaç yıldır hastanemizde tedavi gören ve birçoğunun trajik sonuçlarla karşılaştığı bir dizi gerçek hastadan esinlenilmiştir.
17
And this simulation is performed by me and my real emergency department colleagues,
Bu simülasyonu ben ve acil servisteki gerçek meslektaşlarım gerçekleştiriyoruz.
18
including nurses, respiratory therapists, and emergency physicians that I work with in real life.
Bunlara gerçek hayatta birlikte çalıştığım hemşireler, solunum terapistleri ve acil tıp doktorları da dahil.
19
The case is run in real time, in a single take, and it's completely unscripted.
Olay gerçek zamanlı olarak, tek çekimde ve tamamen doğaçlama olarak gerçekleşiyor.
20
Nothing has been removed for the sake of brevity, and because of that, mistakes are expected, and they're valuable learning opportunities.
Kısaltma amacıyla hiçbir şey çıkarılmamıştır ve bu nedenle hataların olması beklenir; bunlar değerli öğrenme fırsatlarıdır.
21
The purpose of simulation is to improve together as a team
Simülasyonun amacı, takım olarak birlikte gelişmektir.
22
so that when we encounter a critically ill patient in real life,
böylece gerçek hayatta kritik durumda olan bir hastayla karşılaştığımızda,
23
we're prepared to perform at our very best and give that patient the greatest possible chance of survival.
Elimizden gelenin en iyisini yapmaya ve hastaya mümkün olan en büyük hayatta kalma şansını vermeye hazırız.
24
Simulation is designed to replicate the real -world stress of managing critically ill and dying patients,
Simülasyon, ağır hasta ve ölmekte olan hastaların yönetimiyle ilgili gerçek dünyadaki stresi taklit etmek üzere tasarlanmıştır.
25
which can be really intense and triggering for both participants and viewers.
Bu durum hem katılımcılar hem de izleyiciler için gerçekten yoğun ve tetikleyici olabilir.
26
So after the simulation, stay around for the debriefing session, which is often the most important part of the learning process.
Simülasyonun ardından, öğrenme sürecinin genellikle en önemli kısmı olan değerlendirme oturumuna katılın.
27
Let's begin.
Başlayalım.
28
So your team is in an emergency department in an urban center,
Ekibiniz bir şehir merkezindeki acil serviste bulunuyor.
29
and you've been notified about a female patient in her 20s who's going to arrive in about five minutes.
Ve size yaklaşık beş dakika içinde gelecek olan 20'li yaşlarında bir kadın hasta hakkında bilgi verildi.
30
Paramedics called for a pre -arrival.
Paramedikler önceden olay yerine gelmeleri için çağrıda bulundu.
31
She was found confused outside of a rave tonight and reportedly used some substances.
Bu gece bir rave partisinin dışında kafası karışık halde bulunan kadının, bazı maddeler kullandığı bildirildi.
32
She was complaining of being hot when the paramedics arrived and shortly afterwards she had a generalized seizure.
Sağlık ekipleri olay yerine vardığında kadın aşırı sıcaktan şikayet ediyordu ve kısa süre sonra genel bir nöbet geçirdi.
33
The paramedics gave her five milligrams of IM midazolam.
Sağlık görevlileri ona kas içine beş miligram midazolam enjekte etti.
34
Post seizure she was postictal.
Nöbet geçirdikten sonra postiktal durumdaydı.
35
Her GSCS is eight.
Onun GSCS puanı sekizdir.
36
She's not intubated.
Entübe edilmedi.
37
She's got IV access and her ETA is about five minutes.
Serum bağlantısı yapıldı ve tahmini varış süresi yaklaşık beş dakika.
38
Okay, great.
Tamam, harika.
39
So since we have a couple minutes before the patient arrives, let's just quickly do a round of introductions with roles.
Hastanın gelmesine birkaç dakika kaldığı için, hızlıca rollerimizi belirterek kendimizi tanıtalım.
40
So I'm Jeff Yu.
Ben Jeff Yu.
41
I'm going to be the team leader for this case.
Bu davada takım lideri ben olacağım.
42
I'm Scott, one of the residents here at St. Paul's.
Ben Scott, St. Paul's'ta yaşayan sakinlerden biriyim.
43
I'll be the second physician on.
İkinci doktor ben olacağım.
44
I'm Reed.
Ben Reed.
45
I'm a respiratory therapist.
Ben bir solunum terapistiyim.
46
Moses, I'll be the monitor nurse.
Musa, ben nöbetçi hemşire olacağım.
47
Dave, I'll be the bedside owner.
Dave, başucundaki sorumlu kişi ben olacağım.
48
I'm Anna.
Ben Anna.
49
I'll be the nurse lead.
Hemşire sorumlusu ben olacağım.
50
Okay, great.
Tamam, harika.
51
So I think we have everything here.
Sanırım burada her şeye sahibiz.
52
So it sounds like the patient might have seized.
Anlaşılan hasta nöbet geçirmiş olabilir.
53
It sounds like she's hot, a little bit confused.
Anlattıklarınızdan anladığım kadarıyla kız çekici ama biraz da kafası karışık.
54
So I'm really concerned that the patient might be coming in with a toxicologic seizure hot and bothered.
Bu yüzden hastanın toksikolojik bir nöbet geçirerek, ateş ve huzursuzluk içinde gelmesinden gerçekten endişeliyim.
55
So the priorities when she arrives is to get her hooked up to the monitors, get two large bore IVs as soon as possible.
Dolayısıyla, hastaneye geldiğinde öncelikler onu monitörlere bağlamak ve mümkün olan en kısa sürede iki adet geniş çaplı serum takmak olacaktır.
56
We might need to give her some cooled IV fluids as well.
Ona ayrıca soğutulmuş serum da vermemiz gerekebilir.
57
We'll get her hooked up to, yeah, monitors get a full set of vital signs, including a core temperature and glucose
Onu monitörlere bağlayacağız, evet, vücut ısısı ve glikoz dahil olmak üzere hayati belirtilerinin tamamını ölçeceğiz.
58
and we'll send off a full tox panel as well so
Ayrıca kapsamlı bir toksikoloji testi de göndereceğiz.
59
if we could send off like acetaminophen levels salicylate levels ethanol levels along with rapid metabolic panels
Eğer asetaminofen düzeyleri, salisilat düzeyleri, etanol düzeyleri ve hızlı metabolik paneller gibi sonuçları gönderebilseydik.
60
so that we're getting that back as quickly as possible
Böylece bunu mümkün olan en kısa sürede geri alabiliyoruz.
61
and then scott when the patient arrives maybe you can just start with a primary survey
Ve sonra Scott, hasta geldiğinde belki de öncelikle bir ön değerlendirme ile başlayabilirsin.
62
while i get collateral history from the paramedics
Ben de paramediklerden ek tıbbi bilgi alırken
63
and we'll go from there is everyone clear does anyone have any questions
Oradan devam ederiz. Herkes anladı mı? Herhangi bir sorusu olan var mı?
64
or suggestions before the patient arrives do you want any medications prepped ahead of time?
Ya da hasta gelmeden önce önerileriniz neler? Önceden herhangi bir ilaç hazırlanmasını ister misiniz?
65
Yeah, that's a good point.
Evet, bu iyi bir nokta.
66
Why don't we get lorazepam prepped ahead of time in case we have to abort any seizures?
Olası nöbetleri önlemek için lorazepam ilacını önceden hazırlasak neden?
67
And in case the patient does need to be intubated,
Ve eğer hastanın entübe edilmesi gerekiyorsa,
68
we can get propofol and maybe get succinylcholine and rocuronium prepared just so that we can choose between the two,
Propofol temin edebiliriz ve belki de süksinilkolin ve rokuronyumu da hazırlatabiliriz, böylece ikisi arasında seçim yapabiliriz.
69
but we can discuss that when the patient arrives okay
Ama hasta geldiğinde bunu konuşabiliriz, tamam mı?
70
so we'll get ativan um
Yani Ativan alacağız, eee...
71
and the intubation medication is ready to go yeah exactly great any other questions
Entübasyon ilacı da hazır, evet, aynen öyle, harika. Başka sorunuz var mı?
72
or suggestions before the patient arrives no great okay
veya hasta gelmeden önce öneriler, çok iyi değil.
73
so we'll just glove up get ready and uh okay
O zaman eldivenlerimizi takıp hazırlanalım ve tamamdır.
74
so it looks like the patient's rolling in now
Görünüşe göre hastalar şimdi gelmeye başladı.
75
and they're coming in with a friend who can provide some collateral history great
Ve yanlarında, geçmişe dair bazı teminat sağlayabilecek bir arkadaşlarıyla geliyorlar, harika.
76
hello hi are you uh what's your relationship to the person um she's my friend okay yeah tell me What happened?
Merhaba, selam, sen nasılsın? Şey, o kişiyle ilişkiniz nedir? Şey, o benim arkadaşım. Tamam, evet, anlat bakalım. Ne oldu?
77
We were at a rave and we just took some MDMA and I think some cocaine.
Bir rave partisindeydik ve biraz MDMA, sanırım biraz da kokain aldık.
78
And she just left somewhere and she came back unconscious.
Kadın bir yere gitti ve geri döndüğünde bilinci kapalıydı.
79
Okay.
Tamam aşkım.
80
Does she have any past medical conditions that I should be aware of?
Bilmem gereken herhangi bir sağlık sorunu geçmişi var mı?
81
She has anxiety.
Kaygı bozukluğu var.
82
Ma 'am?
Hanımefendi?
83
Ma 'am, my name is Dr. Bell.
Hanımefendi, benim adım Doktor Bell.
84
Can you tell me your name?
Bana adınızı söyleyebilir misiniz?
85
There's no verbal response, just a bit of moaning.
Sözlü bir yanıt yok, sadece biraz homurdanma var.
86
There is some rigidity in the jaw a little bit.
Çenede hafif bir sertlik var.
87
I'm looking in the airway.
Solunum yoluna bakıyorum.
88
I'm listening to both lungs and the heart.
Hem akciğerleri hem de kalbi dinliyorum.
89
You're hearing breath sounds present on both sides and the heart sounds are normal, but she's very tachycardic.
Her iki tarafta da solunum sesleri duyuluyor ve kalp sesleri normal, ancak kalp atış hızı çok yüksek.
90
Okay.
Tamam aşkım.
91
I'm checking her cap refill.
Onun tüpünün dolumunu kontrol ediyorum.
92
A bit delayed.
Biraz gecikme oldu.
93
Okay.
Tamam aşkım.
94
I'm going to quickly check her eyes.
Hemen gözlerine bir bakacağım.
95
What are her pupils?
Öğrencileri kimlerdir?
96
Is there any movements? quite dilated and you notice
Hareketlenme var mı? Oldukça genişlemiş ve fark ediyorsunuz.
97
that there there's clonus as well okay heart rate is 160 is she moving all four limbs
Orada klonus da var, tamam, kalp atış hızı 160, dört uzvunu da hareket ettiriyor mu?
98
she is moving all of her extremities yeah you notice
Vücudunun tüm uzuvlarını hareket ettiriyor, evet fark ettiniz mi?
99
that she's hyper reflexic when you check her reflexes
Reflekslerini kontrol ettiğinizde aşırı refleksli olduğunu görürsünüz.
100
and you see some clonus there as well inducible
Ve orada da uyarılabilir bazı klonuslar görüyorsunuz.
101
and the feet blood pressure 168 it sounds like she's quite sick right now so we're gonna do some investigations and start
Ayaktan ölçülen tansiyonu 168, şu an oldukça hasta gibi görünüyor, bu yüzden bazı araştırmalar yapıp başlayacağız.
102
But you know, why don't you have a seat in the waiting room?
Ama biliyor musunuz, neden bekleme salonunda bir yere oturmuyorsunuz?
103
I'll get the social worker too.
Sosyal hizmet uzmanını da çağıracağım.
104
Can I walk you up there quickly?
Sizi oraya hızlıca götürebilir miyim?
105
You notice that her skin is quite hot.
Cildinin oldukça sıcak olduğunu fark ediyorsunuz.
106
And she's sweaty.
Ve ter içinde kalmış.
107
Okay.
Tamam aşkım.
108
So, can we just regroup as a team and we'll just,
O halde, takım olarak yeniden bir araya gelip,
109
I'll quickly summarize what I got from collateral and then you can summarize what you have from primary survey.
Teminatlardan elde ettiğim bilgileri kısaca özetleyeceğim, ardından siz de birincil araştırmanızdan elde ettiğiniz bilgileri özetleyebilirsiniz.
110
Okay.
Tamam aşkım.
111
So the patient's friend tells me that they were at the club, they used some MDMA and cocaine.
Hastanın arkadaşı bana kulüpte olduklarını, MDMA ve kokain kullandıklarını söyledi.
112
Sounds like she's been taking tramadol for a recent dental surgery and she's on,
Anlaşılan yakın zamanda geçirdiği diş ameliyatı nedeniyle tramadol kullanıyormuş ve şu anda...
113
I believe, citalopram or some kind of other antidepressant or anti -anxiety medication.
Sanırım sitalopram veya başka bir antidepresan ya da anksiyete giderici ilaç.
114
And it sounds like she went outside for a bit, possibly used some drugs and then had felt really hot and might have had a seizure.
Anlatılanlara göre, bir süre dışarı çıkmış, muhtemelen uyuşturucu kullanmış ve ardından çok sıcak basmış ve nöbet geçirmiş olabilir.
115
What did you find on primary?
İlk araştırmanızda ne buldunuz?
116
So she's hot, she's diaphoretic, she's got dilated pupils with ocular colonists.
Yani, ateşi var, terliyor, göz bebekleri genişlemiş ve gözlerinde koloniler oluşmuş.
117
She also has colonists bilaterally in her lower extremities.
Ayrıca alt ekstremitelerinde her iki tarafta da kolonistleri bulunmaktadır.
118
She's hyperreflexic.
O, aşırı refleksli.
119
Vitally, she's tachycardic and she's on a few liters of oxygen, maintaining her saturations at 94%.
En önemlisi, kalp atış hızı yüksek ve oksijen desteğiyle, oksijen doygunluğu %94 seviyesinde tutuluyor.
120
Okay.
Tamam aşkım.
121
Okay.
Tamam aşkım.
122
Okay, so guys, I'm really concerned that this patient might have toxicologic seizures.
Tamam arkadaşlar, bu hastanın toksikolojik nöbet geçirme ihtimalinden gerçekten endişeliyim.
123
You said that she felt hot to be, you said we got a temp on her?
Onun ateşinin yükseldiğini söyledin, ateşini ölçtüğümüzü söyledin, değil mi?
124
Yeah, oh yeah, we're going to get a temp for now.
Evet, evet, şimdilik geçici bir çözüm bulacağız.
125
Okay, let's get a temp and a glucose as well.
Tamam, bir de ateş ve kan şekeri ölçümü yapalım.
126
But the things that I'm concerned about are neuroleptic malignant syndrome,
Ancak beni endişelendiren şey nöroleptik malign sendromdur,
127
malignant hyperthermia, serotonin syndrome, meningitis and sepsis,
malign hipertermi, serotonin sendromu, menenjit ve sepsis,
128
anticholinergic syndrome, thyroid storm, sympathomimetics and salicylates.
Antikolinerjik sendrom, tiroid fırtınası, sempatomimetikler ve salisilatlar.
129
So these are all the things that we need to be considering right now.
Yani şu anda dikkate almamız gereken tüm hususlar bunlar.
130
I think we should send off a full tox panel.
Bence kapsamlı bir toksikoloji testi yaptırmalıyız.
131
Yeah, Jeff, we had a rectal temperature of 41 degrees Celsius.
Evet Jeff, rektal sıcaklığımız 41 dereceydi.
132
Okay, so the patient's hot.
Tamam, hastanın ateşi var.
133
I think that this is most likely due to a toxicologic cause, so we should start cooling the patient as soon as possible
Bunun büyük olasılıkla toksikolojik bir nedenden kaynaklandığını düşünüyorum, bu nedenle hastayı mümkün olan en kısa sürede soğutmaya başlamalıyız.
134
so why don't we just start missing the patient
O halde neden hastayı özlemeyi bırakmıyoruz?
135
and turning on fans you want pads on i know they're quite tachycardic yes we should
Ve fanları açarken, koruyucu pedleri takmak istiyorsunuz, biliyorum ki kalp atış hızınız çok yüksek, evet takmalıyız.
136
so let's just quickly review the vital science patient patient is now having a seizure okay okay she's seizing
O halde, hayati önem taşıyan bilimsel bilgileri hızlıca gözden geçirelim. Hasta şu anda nöbet geçiriyor, tamam mı? Nöbet geçiriyor.
137
i have ativan here yeah so let's give ativan two milligrams iv patient as tachycardic
Elimde Ativan var, evet, o zaman taşikardisi olan hastaya damardan iki miligram Ativan verelim.
138
and a bit hypoxic as well so yeah read you can just assist for ventilations and Anna
Ayrıca biraz hipoksik de, yani evet, havalandırma konusunda yardımcı olabilirsiniz ve Anna
139
if you could just let me know how long the patients been seizing for just keep track of
140
that okay and let me know when three minutes has elapsed
141
and we'll give another day at a van two milligrams given okay okay excellent so patients oxen saturations are
142
You do have air entry.
143
She's got good chest rise.
144
I've got good air entry bilaterally.
145
Does she sound clear to both lungs as well?
146
Yes, both lungs are clear.
147
Sorry, ma 'am.
148
We're gonna need to take your clothes off so we can cool you down, okay?
149
It's been one minute.
150
Is she still actively seizing?
151
She's still actively seizure.
152
Okay, let's just prep Adavan 4 milligrams IV so that we can give that to her if...
153
In two minutes.
154
Yeah, just get that prepped and ready.
155
That's rough for now.
156
You can let me know in two minutes.
157
We'll do.
158
So the patient hasn't returned to her mental baseline between her first seizure en route to hospital and this one.
159
So I'm concerned that she has status epilepticus.
160
So we're currently in the status algorithm as well.
161
So we'll give, if she's still seizing in a couple of minutes, we'll give another dose of Ativan.
162
We should also call pharmacy and ask them to send up a Keppra 2 grams IV.
163
Okay, we'll do that.
164
Excellent.
165
Excellent.
166
Can we also, Dave, do you mind just grabbing some medications for intubation as well?
167
Sure.
168
What medications do you want for the patient?
169
So given that the patient is in status epilepticus,
170
I think that we should probably give propofol as the induction medication because that will cause birth suppression of the seizures.
171
And I think for the paralytic medication, because we don't know if this patient's in ribbomyelitis we don't know
172
if she has neuroleptic malignant syndrome
173
or malignant hyperthermia we probably should not use succinylcholine even though I think
174
we should probably use rocuronium even though there is a risk of possible subclinical seizures with the rocuronium
175
but yeah why don't we drop propofol 150 milligrams
176
and rocuronium 150 milligrams as well okay so it's been three minutes we can give four milligrams of IV Ativan.
177
Okay let's do four milligrams IV Ativan.
178
Just let me know when that's done.
179
Dave or Moses?
180
Yeah.
181
Dave's gonna get that.
182
Can you remind me of the...
183
Now for prepping the intubase, do you mind taking the airway?
184
I can take the airway.
185
150 of all.
186
The patient's still seizing.
187
Four milligrams IV Ativan administer is still seizing so we should definitely prep for intubation.
188
Scott if you want to just work with Reed and just get all the equipment ready.
189
Yep.
190
I'll just quickly summarize the case while we're we're getting prepared.
191
Perfect.
192
So we both have status epilepticus and we're in kind of like the active cooling hyperthermia algorithm.
193
Is that a three?
194
We think
195
that this is most likely due to serotonin syndrome
196
she does meet a lot of hunter criteria for serotonin syndrome with the octaloclonus
197
with the agitation confusion and the inducible myoclonus as well
198
so can we also call the tox uh the poison control center
199
and just ask them for advice like particularly
200
if you could just call them to ask if we should be giving cypher heptidine that'd be great.
201
So the seizure has aborted, but she's still very uptended.
202
Okay.
203
Okay.
204
Well, we should definitely proceed with intubation as well.
205
Intubation meds are proof.
206
Okay.
207
Did we already give Keppra two grams IV as well?
208
We have not.
209
No. It's coming from the pharmacy.
210
It's coming from pharmacy.
211
Okay.
212
If you could just let me know when Keppra arrives, that'd be great.
213
Okay.
214
Okay.
215
So let me know when you guys are prepped
216
and ready to go we'll do a quick pre -intivation pause to discuss the plan.
217
Get your boozy and your LMA, or IGEL as backup.
218
Okay.
219
7 .5 tubes.
220
Fantastic.
221
Sats are still 90.
222
Let's see if I can bag her up just a little bit for those saturations.
223
Yeah, it's weird that her O2 sats haven't come up at all.
224
Mm -hmm.
225
Okay, so her sats are kind of you're you're begging her she's got good air
226
and she's got good air and she's got good air
227
and she's got good air and she's got good air
228
and she's got good air and she's got good air
229
and she's got good air and she's got good air
230
and she's got good air and she's got good air
231
and she's got good air and she's got good air
232
and she's got good air and she's got good air
233
and she's got good air and she's got good air
234
and she's got good air and she's got good air
235
and she's got good air and she's got good air
236
and she's got good air and she's got good air
237
and she's got good air and she's got good air
238
and she's got good air and she's got good air
239
and she's got good air and she's got good air
240
and she's got good air and she's got good air
241
and she's got good air and she's got good air
242
and she's got good air and she's got good her groin
243
and we've got iv fluids going i think
244
if the patient is still hyperthermic despite these measures after
245
we do the intubation we should consider escalating to ice water submersion
246
jeff uh we've bagged her up to 95 here whenever you're ready we're ready to proceed with intubation okay um
247
and how frequently are we repeating
248
that blood pressure we're repeating it every two minutes every two minutes uh
249
so the kepper is here from pharmacy here you go yeah and i just checked the blood sugar is 5 .5.
250
5 .5 oh perfect okay
251
so we'll hang Keppra as well what do we have for IV access is it just two 18s okay
252
so we'll hang Keppra on one and we'll use the other line for the rapid sequence intubation.
253
What's the caprodosis?
254
Two grams IV and you can just give that over 15 minutes.
255
Poison control has called back and said that we can go ahead with Ciprohepta, I believe when the patient is intubated and stable.
256
Okay, so I think that will be a lower priority item.
257
I think for now the - I will just continue to document what the recommendations.
258
That'd be great, thank you priority from poison control is actually once she's stabilized
259
with intubation is rapid cooling is what they suggest okay Kepra 2 grams IV Kepra 2 grams IV
260
so I I think the main priority after intubation is to
261
get her temperature below 38 degrees within like 10 20 minutes like I think
262
that's the we are at seven minutes at seven minutes yeah
263
Yeah, if you could get ready for submersion while we do this intubation, that'd be great.
264
Yeah, a little like that.
265
Fantastic.
266
Are you ready to go?
267
I'm ready to proceed.
268
We're just doing a quick timeout here, a sterile cockpit for the intubation.
269
So we have a young female here.
270
She's unable to protect her own airway.
271
She's had status.
272
We're going to be securing that with her.
273
My primary method of operation is going to be a video laryngoscope.
274
We have a bougie as a backup and then we have number four eye gel on the way back.
275
We have intubation meds drawn up.
276
We're going to be using propofol 100 as well as rocoronium 100 for our RSI dosage.
277
We have a patent IV currently flowing.
278
We've got monitors with a cycling BP cuff.
279
We have RT for support and I have a 7 .5 ET tube with a stylet in.
280
I'm happy with this bed height.
281
I'm going to just actually optimize the position just by dropping your head maybe about 10 degrees
282
or so we have a nurse at the bedside ready to push the meds okay
283
if we can start with 100 appropriate fall and you can just
284
so Scott I'll watch her vital signs while you do that but right now her vital signs are optimized.
285
Fantastic.
286
100 milligrams of IV propofol given.
287
We can follow that with 100 of rocuronium.
288
Great.
289
And if someone can just set the timer for 45 seconds.
290
100 milligrams of rocuronium given.
291
Okay.
292
While he does that, have any of the blood work come back from lab?
293
You are getting some initial labs back.
294
We should also call for STAT12 ADCG as well because I want to make sure that that curesse is not.
295
I'll call.
296
Can I please get ACG to trauma?
297
Okay, we're near 20 seconds now.
298
Okay.
299
The patient is slightly hyperclimated.
300
Go in.
301
I appreciate the cords.
302
I've got a grade one view.
303
I'm going to retreat to a grade two.
304
Okay.
305
Can I get this, can I get this started out at about two inches?
306
Thank you.
307
And all the way out.
308
One second.
309
Perfect.
310
You're happy with that too?
311
Give me one moment, it's just caught up on the towards. In the cords.
312
In the cords here.
313
If it's through the cords, just through the cords here.
314
Perfect.
315
If we can now, fantastic.
316
So 23 at the tooth.
317
So vital signs are still stable.
318
How much at the teeth?
319
23 at the teeth 23 at the teeth what size it's a seven
320
and a half seven
321
and a half print okay thanks she's got good orange by my lateral entry okay
322
and check the entire 32 okay good so got good
323
Intel co2 vital signs are still stabilized so David
324
if we could just get propofol going start let's start at 50 mics per kilogram per minute
325
and target a ras of minus four so that we're actually getting and breast suppression of those seizures.
326
What's her weight?
327
I'd say 60 kg.
328
60 kg, thank you.
329
So I'm just gonna summarize what we have on the blood work
330
and let's call for 12 -week ECG to be performed right now as well.
331
I just called, they're here.
332
So the patient has significant acidosis with a pH of 718.
333
Her lactate is 10, bicarb is 14, so she's got a really bad metabolic acidosis.
334
E2H is 20.
335
salicylates are negative, Tylenol is negative.
336
The rest of her blood work looks reassuring.
337
She has a little bit of hyperkalemia with potassium of 5 .2.
338
Her ECG shows just sinus tachycardia at a rate of 150,
339
narrow complex, there's no Y -complex uh cuirasses so i don't think
340
that she has any kind of sodium blockade or tca
341
or anything like that um so that's reassuring um great so can we just repeat a core temp as well
342
so yeah we just put in an esophageal temperature probe
343
and it is now reading uh 40 degrees celsius okay
344
so she's still hot we should uh progress to we should escalate to the cold water submersion
345
so yeah I got the bag ready for that so
346
Propofol infusing at 10 mgs per kg per minute can we increase the Propofol?
347
Let's bump out to 50.
348
50 okay thank you.
349
Propofol now is using at 15 mgs per kg per minute thank you Dave.
350
So I'll let you guys dump the patient in.
351
So, hey Reid, we're gonna need to roll.
352
Are you okay to keep up the airway?
353
Yeah.
354
Okay, so on your count.
355
Okay, rolling on three.
356
One, two, three.
357
Okay, you guys can come on back over.
358
Back down in one, two, three.
359
And I'll roll this way if you guys can get the bank underneath.
360
Okay.
361
Come back down.
362
Yeah.
363
Three, two, one.
364
All right.
365
We'll zip this up a little bit and then we'll, I got some ice just from our freezer outside so I'll...
366
Did you want a folion for a tox screen?
367
Yes.
368
Yeah, that's a great point.
369
Let's get a folion, send off for a urine drug tox screen.
370
and I think also just to cover all of our bases
371
we should also give the patient broad spectrum antibiotics okay
372
so let's give her a piptase of 3 .75
373
and banko 1 .5 grams as well IV the pipazo 3 .375
374
and banko 1 .5 yeah I don't think
375
that we actually drew blood cultures the first time
376
that we drew blood so we should call phlebotomy and ask them to draw blood cultures like any more blood work?
377
Did you get a CK?
378
Let's get a TSH and a TSH and we'll let's also repeat the rapid metabolic panel.
379
14 French Foley inserted.
380
Thank you Dave.
381
So while the patient's getting submerged, does anyone have any other questions or suggestions for what else that we should be doing?
382
Now that we have secured the airway, we can start putting an OG or an NG to give ciprohexidine a crush.
383
That's a great point.
384
So we put this esophageal and temprobe in.
385
Does the patient have an OG in as well?
386
Okay.
387
I think after we get the patient submerged in ice, we should uh sync an OG so that we can get all meds as well.
388
Um and if you want to call social worker just to see about family.
389
Oh social worker is just with a friend right now
390
but I will connect with them to catch to raise the family, okay?
391
Jana, OG2 isn't the two extra.
392
Um, did the other people what size?
393
16 friends?
394
I don't like to wash the lines and stuff.
395
How far up do we want to fill there, Jeff and Scott?
396
Just make sure that his chest is exposed.
397
We have different defibrillator pads on right now as well.
398
So if the patient does go into a life -threatening arrhythmia, we can still shock this patient while they're submerged.
399
Okay.
400
Just want to walk up her skin.
401
So we can zip it up and then we can start adding some water.
402
Just lift him a bit a little bit please.
403
Pull him over a bit.
404
One, two, three. And.
405
So PIPTASO 3 .375 and VANCO 1 .5 grams.
406
We're just waiting for labs to come by to draw blood culture before we start antibiotics.
407
If there's a delay for phlebotomy, let's just give
408
Rod's special antibiotics just to make sure that we're covering sepsis as a potential cause of her fermentation from here.
409
And Scott, when you examined her, you didn't notice any like meningismus or nuchal rigidity or anything like that?
410
No, no nuchal rigidity on her and no like her name or Brinsky sign.
411
The limits of her examination was quite altered when she came in, of course.
412
We should call ICU as well.
413
Just let them know that we have a critically ill patient
414
that came in with status epilepticus and hypothermia
415
and we're actively cooling I'll call the charge nurse that'd be great yeah doing what's the time for eating right now
416
40 .5 so 40 .5 okay so let's just continue filling
417
that body bag any issues right now from an airway standpoint
418
or a bilateral layer and create I'll throw a bite blocked on in case okay
419
so one of the things that we'll have to watch for is if the patient starts shivering through the, I guess the paralytic.
420
Are we expected to actively stir the ice and the water around?
421
Yeah, you can stir it around so that it becomes a slurry.
422
Can we also call neurology?
423
Because I think we should probably get active continuous EEG monitoring to make sure
424
that we're not missing subclinical seizures that are masked by the paralytics.
425
Okay, calling neurology?
426
Yeah, thank you.
427
ICU is aware, neurology and the intensivist will be coming down.
428
Okay, excellent.
429
One question drawn.
430
Can you remind me the dosage of the vancomycin?
431
Vancomycin, 1 .5 grams.
432
Lab needs to also draw a repeat RMP and also a CK and a TSH.
433
Yeah, maybe if you can just insert a third ID and
434
when you do that you can just draw off labs and send that off to the lab as well.
435
We'll throw around it in later.
436
Excellent.
437
Given that, do we have a Foley catheter in that's, Foley catheter's in?
438
Foley catheter's in.
439
So if the patient does not cool with this, we could consider cooled CBI as well for cavitary cooling.
440
So maybe we can just get the CBI equipment ready to go just in case the patient's temp doesn't come down.
441
And the other thing that we could consider is asking the ICU to consider possibly hemodialysis for more advanced cooling.
442
Are there any other suggestions that you guys can think about?
443
I think the metabolic profile looks pretty good in terms of electrolytes.
444
Can I please get a lab to the trauma room for a specimen collection?
445
So the temperature is now 39 .8 and ICU has arrived.
446
I think we can wrap up there.
447
Okay, excellent.
448
Now we're going to move into the debrief, which is one of the most important parts of simulation training.
449
During the debrief, the team takes time to process what happened.
450
We discuss our immediate reactions, what went well, what could have gone better,
451
and we also identify opportunities for improvement that we can apply for future resuscitations.
452
We also spend time reflecting on human factors and system -level issues that may influence how a resuscitation unfolds.
453
From my perspective as the team leader, one of the biggest challenges in this case was cognitive overload.
454
I had to process the patient's history, clinical findings, recognize the combination of seizures and hyperthermia,
455
and manage two time -critical problems simultaneously.
456
And at the same time, I was coordinating team dynamics, delegating tasks, and thinking several steps ahead.
457
So both in simulation and in real life, one of the best ways to manage that cognitive load is through deliberate delegation.
458
Offloading tasks to capable team members allows the leader to maintain situational awareness and focus on critical decisions.
459
Another key strategy is frequently summarizing the case out loud and actively inviting input from the team.
460
And this helps to maintain a shared mental model.
461
And as you might've noticed in this case, several important contributions came from team members speaking up.
462
And this is exactly why we train this way.
463
The goal of simulation is not perfection.
464
The goal is to learn together so that when a real patient arrives in critical condition,
465
the team can function as a cohesive unit and provide the best possible care.
466
So if you want to summarize a little bit before we start the debrief,
467
I think that'd be a good place to start and then go from there.
468
Yeah, so to summarize the case, we had a patient that had toxicologic exposure to street drugs,
469
MDMA, and cocaine, and she was already on serotonergic agents with tramadol,
470
PRN for a dental procedure and taking citalopram for an antidepressant
471
or anti -anxiety medication um you know she came in altered had ongoing seizures she was in the status epilepticus
472
so we were going down the status algorithm
473
but she was found to have hyperthermia and
474
so we started active cooling with the cooling algorithm as well um she was critically ill and she needed rapid sequence intubation.
475
I thought that, you know, that was quite fluid.
476
Yeah, what are your, what are your thoughts?
477
Did you want to take the lead or?
478
Okay, so I guess we'll start with the Moses special of just mentioning
479
that this is supposed to be a psychologically safe space, and it's just an opportunity for us to practice going through protocols of things
480
that we see very infrequently using equipment
481
and today was an added snag of like this body bag
482
and the ice and all the logistics of that so I think
483
that was awesome but in the beginning before we kind of go through the good things
484
that the team did together and some things
485
that you want to learn from it's just a chance for us to kind of talk about our emotions
486
and just how it felt going through the case so I'll let anyone start.
487
Hot, it felt hot.
488
There's a lot going on I think the patient was really really sick
489
and obviously a lot of things had to happen quickly so and they were hot.
490
It felt chaotic but good I would say you know we've had a number of fatal
491
toxic exposures that we've seen at this hospital that presented very similarly to this patient and that inspired this case.
492
And I can say that I think many people here were part of those initial resuscitations that they were very chaotic experiences.
493
And so to be moving forward in trying to put what we've seen into making the department a more efficient,
494
better place in the future is very rewarding and really goes to show
495
that just even running through in simulation can and really reduce the stress
496
because as much as this was a lot going on,
497
a lot of people, a lot of things need to happen at the same time with logistics,
498
it was so much smoother than what it was in real life.
499
And already you can see the protocols that we've tried to put into place,
500
how much those can go and help when we really need it in these critical moments of patient care.
501
I think we were quite organized with looping back into our algorithms,
502
so I really appreciated you just re -running from top to bottom with what has been done
503
and what we're doing and what we're anticipating.
504
It felt really fast, things were rapidly changing, so it was like super dynamic,
505
things were changing like minute to minute which is kind of reflective of real life, so it felt super fast to me.
506
Yeah, from a team leader perspective it felt a bit chaotic because there's like so many different moving pieces.
507
Like we're in like two separate, somewhat overlapping algorithms with the status algorithm and the hyperthermia algorithm.
508
And, uh, there were just so many things that needed to be so many bases that need to be covered.
509
Um, so I did appreciate like all of your thoughts chiming in.
510
Cause there were some points that I missed, like, you know, you mentioned some of the blood work that I missed on the initial lab draw,
511
like the CK, the TSH, those are obviously very, very important things, but it's just, you know, it's hard to capture all of those things.
512
And we're so focused in on what's going on at hand.
513
Yeah.
514
Yeah.
515
Cause you're trying to absorb so much information from all the different team members
516
while like thinking about these algorithms and kind of like directing the team and orchestrating this resuscitation.
517
So that can be quite challenging.
518
So I think that's a decent segue to go into some of the things that we think went well.
519
So I'm hearing that teamwork was great for you
520
and people bringing up other points that you might not have been thinking about
521
when you were prioritizing ABCs and all that other stuff so I would agree.
522
Anyone else want to talk about some positive things?
523
We try not to delay active cooling and intubation for other things like other minor procedures.
524
Like I liked how we were fluidly cooling the patient while getting all the other things prepared,
525
like while Scott was preparing for rapid sequence intubation, other team members were.. actively cooling the patient with the fans,
526
the ice packs, and also like getting the body bag ready,
527
getting all the other equipment ready so that we can actually escalate through that algorithm at the same time.
528
So I felt like there was a lot of like there
529
were people were kind of branching off doing different tasks
530
but everything seemed to be quite coordinated and I thought that we worked really well and fluidly as a team.
531
Yeah, that's dope.
532
And I'm glad you didn't just hone in on the drugs like you still were ruling out like encephalitis meningitis
533
and everything exactly that could have been going on with the patient
534
and I think the in the beginning you had a couple minutes to prep the team
535
so I think that roles being established was an awesome thing to do as well just
536
so the team was prepared
537
and you even had a chance to get some of the medications ready before the patient arrived
538
so I think that was also a nice thing from a team perspective.
539
So why don't we move on to things that were maybe challenging
540
or things that tripped us up or things that we think we can learn from this case.
541
I think one thing that we took away from this case
542
and from the case that inspired is just
543
that the management of ice is such a real challenge in the emergency
544
when you try to use like an active cooling method.
545
This is supposed to be deployed in the freezer
546
but I think even running through this case we realized
547
that just putting the ice in the freezer causes it to jam
548
and sometimes you can't easily deploy it
549
and you need to have some container to move it over
550
and I think that it just highlights
551
that having a system in place to try and transport the ice even
552
when you're storing it is super useful the department yeah yes I don't know
553
if you guys saw but we have
554
that big square freezer in our trauma bay now and
555
so even getting so the ice initially was in two big garbage bags and removing the ice from the
556
freezer was actually a challenge that we learned about today
557
so probably we need to package it and several smaller bags yeah
558
or like even the gas station bags I think would be sufficient
559
because I guess like
560
if you put it in smaller bags like this size
561
you could also use those as ice packs neck like that's probably one thing
562
that like I think you know you know those freezer bags for ziplock yeah I feel like
563
that would be a really good size yeah you can use them as ice packs
564
and then if you progress to using the body bag you dump yeah you open it up
565
and just dump it out yeah and wouldn't stick
566
because it already like kind of melt a bit right yeah
567
I think something just to be conscientious of in real time is
568
when you put the ice in the bag
569
and the active cooling has started just being conscious of like adhesive tapes
570
that are holding IVs and this and the other because if they're not reinforced if they're not protected
571
they're almost 100 % gonna
572
so that's a great point like putting as much on the patient as you can before
573
they go in the bag so pads on if you can even
574
so far as like ECG stickers and monitors because once they're wet
575
and they're in the bag
576
it's a lot harder to put those things after the fact you'd have to dry the patient
577
and then adhere the pads
578
so here you did put the pads on before they were in the the submersion
579
so it's another point it was really good
580
because people have said yeah we can can we hold off for 10 seconds
581
so we can get the foley in obviously before we get this done
582
and i think that was a good positive another good thing like moses said
583
when dumping the ice was we'll watch the skin because
584
if we're dumping icebergs onto the station we've got a ton of for sure sure
585
that you're true so if it's broken up into nice little thesis it's fine but
586
when do we give the um siptor i've never given
587
it yeah it's not a huge priority yeah um especially like for someone who's this critically ill
588
so yeah it would be something probably like once they have an og in
589
and this stuff is dealt with they're cool they have abcs all
590
that stuff um it can be done later
591
but it's not it's not going to save this person
592
this person's like too yeah yeah
593
i think the biggest priority is to rapidly cool them in less than 20 minutes
594
you want to get their core temp below you really ideally like under 38
595
but like you know for sure under 40 degrees celsius um
596
because i think if the longer they stay in hyperthermia the higher their mortality rate the higher chance
597
that they're going to go into rhabdomyolysis DIC, renal failure.
598
So the main priority is to get that temp down super, super quickly.
599
And for sure, the quickest way to do that is ice water submerging.
600
There's really no other comparison, right?
601
Can I ask you a question from our curiosity?
602
Is there a risk of overshooting in terms of keeping the patient hypothermic for too long,
603
just in terms of DIC or coagulopathies?
604
Yeah, I mean, for sure there is a risk of iatrogenic hypothermia, like overshooting the target and getting them down below that temperature.
605
But I think that's why it's important to have a core temp, like a continuous core temp in the esophagus, not in the rectum.
606
Because one of the biggest issues with keeping a rectal temp probe is it gets stuck in poo,
607
and the poo actually distorts what temperature the actual body is in.
608
So having an esophageal temp probe, which actually mirrors what the heart is feeling, because you're putting
609
that temp probe close to where the heart is um
610
that's like the best indicator of like what the temperature is
611
and you know when the patient gets down to the level of 36
612
definitely at 35 that's when you'd consider actually taking them out of the ice bath
613
and uh yeah logistically that would be hard yeah um
614
so one thing that one of the toxicologists told me is
615
that this is going to be so full of water
616
and ice and slush so you can cut the corner and then you can just dump it all out.
617
The slurry would be dumped into a big garbage bag or into the sink.
618
And then that's one way to easily empty the bag.
619
And then you would dry the patient.
620
And at that point, they're sedated, they're paralyzed, and you've sort of shut down that whole process of the hyperthermia. So, yeah.
621
Great.
622
Any other points for DeeperD?
623
No, I think it was intentionally a very difficult case because there's like 10 things going on at once.
624
And I think the, I mean, the priorities from the ED team were established, right?
625
Like ABCs and then getting,
626
so in real life, we had a similar case where the initial temperature was not hyperthermic and the hyperthermic range.
627
I think it was 37 .1 that it was reported as.
628
so getting a like once you've recognized that this is a potential
629
so your exam kind of pointed
630
you to this could be serotonin syndrome getting a core temperature
631
to kind of figure out what you're dealing with like how severe is this toxidrome
632
that we're dealing with so I think the early I was I thought it was great
633
that you guys got an early you recognize
634
that you got an early core temp
635
and then you're like okay now we know what our next steps might be so I think it was great.
636
I think you guys did a good job.
637
Awesome.
638
Yeah.
639
Good job, guys.
640
Yeah.
641
This simulation was designed to demonstrate structured team -based management of severe hypothermia
642
and status epilepticus and to help translate emerging practice guidelines into practical bedside care.
643
And while protocols and scopes of practice vary between institutions and regions,
644
the principles shown here reflect current evidence and evolving best practices in and hyperthermia management.
645
If you'd like to learn more about the background of this case, you can find a full written breakdown of the clinical context,
646
relevant guidelines, and supporting evidence on my website at drjeffu .com slash simulation.
647
This is the second simulated resuscitation video in a series
648
that we're developing to help medical teams train for the management of critically ill patients.
649
Everyone that you saw in this video volunteered their time and expertise, and we're making this educational content freely available.
650
If you found this video helpful, I'd really appreciate your support by liking this video,
651
leaving a comment about other cases that you'd like to see covered through simulation, and subscribing to the channel.
652
Thanks for watching and I'll see you the next one.
653
Thank you.
Uygulamayı İndir
Akıcı konuşmak için ihtiyacınız olan her şey
AI TelaffuzHer cümleyi puanla
IPA AlıştırmasıHer sesi ustalaştır
Kelime BilgisiKelime bankanızı oluşturun
Kelime OyunuOynarken öğrenin
Aynı Kanal
FOR YOU
Video Öner
C121 cümleler
Can You Guess the Diagnosis Before I Do? 👀
Daily ConversationUniversity Students
C11
91 cümleler
How To: Ultrasound for Pneumothorax Case Study Video
Daily ConversationUniversity StudentsWorking Adults
C172 cümleler
MRI-Negative Epilepsy
Daily ConversationUniversity Students
C13
133 cümleler
Taking Vicodin To Feel Like House | House M.D.
Daily ConversationUniversity StudentsWorking Adults
C11
380 cümleler
A man hiked in the woods. Every brain cell got cooked.
Daily ConversationUniversity StudentsWorking Adults
C156 cümleler
ST Elevation and Depression on an EKG Rhythm Strip
Daily ConversationUniversity Students
C11
188 cümleler
Obstetric History | Headache in Pregnancy | OSCE Guide | UKMLA | CPSA | PLAB 2
Daily ConversationUniversity Students
C1182 cümleler
Every Sleep Disorder & Their Effects Explained
Daily ConversationUniversity StudentsWorking Adults
B11
5 cümleler
Tips for Simulation Lab in Nursing School
Daily ConversationUniversity Students
C11
287 cümleler
Lecture 12: Retina, Part 2: Retinal vascular occlusions
Daily ConversationUniversity Students
C116
42 cümleler
6 Warning Signs of a Stroke
Daily ConversationUniversity StudentsWorking Adults
C16
108 cümleler
Homeostasis - How Your Body Keeps its Balance - Physiology Series
Daily ConversationUniversity Students
Bu dersin kelimeleri ve konuşma notları
Bu konuşma dersi “Inside a Tox Resuscitation - Hyperthermia & Seizures” videosuna dayanıyor. Bu videoda gölgeleme çalışması için 653 cümle ve 6823 kelime var. Konuşma bölümü 43:30 sürüyor. Konuşmacı dakikada yaklaşık 157 kelimeyle, günlük konuşmaya yakın doğal bir hızda konuşuyor. Kelimelerin yalnızca %81’i İngilizcede en sık kullanılan 3.000 kelime arasında, bu yüzden kelime dağarcığı zorlayıcı.
Bu videodaki önemli kelimeler
Videodan öğrenmeye değer 15 kelime, telaffuzu ve anlamıyla:
| Kelime | Telaffuz | Anlam |
|---|---|---|
| seizure isim | /ˈsi.ʒɚ/ | ele geçirme, gasp |
| simulation isim | /ˌsɪm.jəˈleɪ.ʃn̩/ | simülasyon |
| algorithm isim | /ˈælɡəɹɪðm̩/ | algoritma |
| arrive fiil | /əˈɹaɪv/ | varmak |
| priority isim | /pɹaɪˈɒɹɪti/ | öncelik |
| seize fiil | /ˈsiːz/ | kapmak |
| gram isim | /ˈɡɹæm/ | gram |
| vital sıfat | /ˈvaɪtəl/ | yaşamsal |
| syndrome isim | /ˈsɪndɹoʊm/ | sendrom |
| monitor isim | /ˈmɑ.nɪ.tɚ/ | ekran |
| freezer isim | /ˈfɹizɚ/ | buzluk, dondurucu |
| nurse isim | /nɝs/ | hemşire, tıp bacısı |
| suggestion isim | /səˈd͡ʒɛst.ʃən/ | öneri, teklif |
| probe isim | /pɹoʊb/ | sonda |
| pharmacy isim | /ˈfɑɹməsi/ | eczane |
Duyacağınız deyimsel fiiller
| Kelime | Anlam |
|---|---|
| come down fiil | düşmek |
| call back fiil | dönmek |
| draw up fiil | sıraya dizmek |
| figure out fiil | açığa çıkarmak |
| keep up fiil | ayak uydurmak, yetişmek |
Tekrar etmeye değer cümleler
Videodan, günlük konuşmada yeniden kullanabileceğiniz kısa ve tam cümleler:
- Can you tell me your name?
- Can I walk you up there quickly?
- What did you find on primary?
- What medications do you want for the patient?
- You're happy with that too?
Bu videodaki dil bilgisi
Konuşmacının en çok kullandığı yapılar, videodaki sözcüklerin aynısıyla:
| Yapı | Videoda |
|---|---|
| Koşul cümleleri if + cümle, will/would + fiil — bir koşul ve sonucu | If you found this video helpful, I'd really |
| Present perfect have/has + fiilin üçüncü hâli — geçmişte olan ama şimdi de önemli olan bir eylem | has been removed · you've been notified · has elapsed |
| Edilgen yapı be + fiilin üçüncü hâli — kimin yaptığı değil, ne olduğu önemli | was inspired · is performed · is run |
| İlgi cümlecikleri who / which + cümle — bir kişi ya da şey hakkında ek bilgi | session, which is · friend who can · debrief, which is |
Dikkat edilecek telaffuzlar
Konuşmacı we're, I'm, we'll gibi kısaltılmış biçimleri 169 kez kullanıyor. Bunları duyduğunuz gibi kısa söyleyin.
- “th” sesleri: algorithm /ˈælɡəɹɪðm̩/, bath /bɑːθ/, hyperthermia /ˌhaɪpə(ɹ)ˈθɜː(ɹ)miə/, hypothermia /ˌhaɪpəʊˈθɜː(ɹ)mi.ə/
- “sh” ve “zh” sesleri: seizure /ˈsi.ʒɚ/, simulation /ˌsɪm.jəˈleɪ.ʃn̩/, medication /mɛdɪˈkeɪʃən/, suggestion /səˈd͡ʒɛst.ʃən/, physician /fəˈzɪʃən/
- Uzun kelimeler — vurguyu doğru yere koyun: medication /mɛdɪˈkeɪʃən/, priority /pɹaɪˈɒɹɪti/, critically /ˈkɹɪt.ɪ.kə.li/, metabolic /mɛtəˈbɒlɪk/, anxiety /æŋˈzaɪ.əti/
Türkçe konuşanların zorlandığı sesler:
- /w/ — dudaklar yuvarlak, /v/ değil: worker /ˈwɝ.kɚ/, sequence /ˈsiː.kwəns/, awareness /əˈwɛɹ.nəs/, afterwards /ˈæf.tɚ.wɚdz/, airway /ˈɛɚ.weɪ/
- Kelime başındaki ünsüz kümesi — araya ünlü eklemeyin: priority /pɹaɪˈɒɹɪti/, gram /ˈɡɹæm/, critically /ˈkɹɪt.ɪ.kə.li/, freezer /ˈfɹizɚ/, probe /pɹoʊb/
- /æ/ — “e”den daha açık: algorithm /ˈælɡəɹɪðm̩/, gram /ˈɡɹæm/, rapid /ˈɹæp.ɪd/, actively /ˈæktɪvli/, pad /pæd/
Bu videoyla nasıl çalışılır
- Videonun tamamını konuşmadan bir kez dinleyin ve bilmediğiniz kelimeleri not edin.
- 0,75× hızla başlayın, cümle cümle tekrar edin ve kolaylaşınca normal hıza dönün.
- Kendinizi kaydedin ve orijinaliyle karşılaştırın; seizure, simulation, algorithm gibi kelimelere özellikle dikkat edin.
Gölgeleme Tekniği Nedir?
Gölgeleme, başlangıçta profesyonel tercüman eğitimi için geliştirilen ve çok dilli Dr. Alexander Arguelles tarafından popüler hale getirilen, bilim destekli bir dil öğrenme tekniğidir. Yöntem basit ama güçlüdür: ana dili İngilizce olan bir sesi dinler ve hemen yüksek sesle tekrar edersiniz — konuşmacıyı 1-2 saniye gecikmeyle takip eden bir gölge gibi. Pasif dinleme veya dilbilgisi alıştırmalarının aksine, gölgeleme beyninizi ve ağız kaslarınızı gerçek konuşma kalıplarını eşzamanlı olarak işlemeye ve yeniden üretmeye zorlar. Araştırmalar, telaffuz doğruluğu, tonlama, ritim, bağlı konuşma, dinleme anlama ve konuşma akıcılığını önemli ölçüde geliştirdiğini göstermektedir — bu da onu IELTS Konuşma hazırlığı ve gerçek dünya İngilizce iletişimi için en etkili yöntemlerden biri yapar.