Luyện nói tiếng Anh bằng Shadowing qua video: How To: Ultrasound for Pneumothorax Case Study Video

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Hello, my name is Phil Pereira, and I'm the Emergency Ultrasound Coordinator at the New York Presbyterian Hospital in New York City, and welcome to SoundBytes Cases.

In this module, we're going to look specifically at ultrasound of the lung to evaluate for pneumothorax.

Interestingly enough, a classical belief was that the lung was not optimal for ultrasound imaging.

However, newer findings have shown that actually ultrasound is an excellent modality for viewing the pleura and for detecting pneumothoraces.

There's been a lot of research looking at this, and what's interesting is

that ultrasound has been found now to be more sensitive than chest X -ray in the diagnosis of pneumothorax, especially in the supine trauma patient. And now,

we're going to add on views of the lungs looking for pneumothorax as part of our extended FAST exam

or the E -FAST exam that we'll be performing in trauma patients.

We can also detect pneumothoraces as well in our medical patients.

Now let's learn how to perform the ultrasound examination for the pneumothorax detection.

Here we have the high -frequency linear type array probe positioned

on the anterior chest wall at about the mid -clavicular line looking into about intercostal space three.

Now in most cases of pneumothorax with the patient's supine, the air would be predominantly seen in this area.

Note we're looking in a long axis configuration between the ribs with a marker dot oriented superiorly towards the patient's head.

Once we've identified both the ribs and the pleura, we can swivel the probe into the short axis configuration to further look at the pleura and to detect pneumothorax.

Here we have the probe oriented in a transverse or short axis orientation between the ribs, looking directly down at the pleura.

Notice in this case, the marker dot is located towards the lateral aspect of the patient.

Using both long and short axis configurations will allow you to detect a pneumothorax with a high degree of accuracy.

If no lung is seen on the anterior chest wall, one can size out a pneumothorax by looking in the lateral positions as shown here.

Notice the probe on the lateral chest wall in the short axis configuration between the ribs.

If lung is seen here laterally, but not anteriorly, this would tell you it was an incomplete pneumothorax.

We can complement the short axis view by locating the probe

into the long axis configuration with the marker dot towards the

patient's axilla to further examine into these lateral areas of the chest wall.

Here's a nice pictorial showing the normal findings of a lung in a long axis type configuration.

Superior rib to the left, inferior rib to the right.

Notice

that the ribs cast shadows posteriorly due to the inability of the sound waves to permeate the hard calcifications of the rib.

We see the chest wall anteriorly, and note here the two layers of the pleura.

And we see here the outer parietal pleura and the inner visceral pleura.

Now, while I've depicted these as two separate layers, in reality, on ultrasound examination,

they're seen as a single shimmering white line that moves back and forth as the patient breathes.

And as the patient breathes, we can see white comet tails or linear lines, vertical lines, coming off the pleura down deep into the lung.

So that will be the normal finding of a lung on long axis configuration.

Here's a nice ultrasound image showing a normal lung, and what we see here, we're in the long axis configuration, so the superior rib is to the left, inferior rib to the right,

chest wall anteriorly, and we see here the lung sliding, which is the opposition of the outer parietal and the inner visceral pleura,

and we see the vertical comet tails coming off the back of the pleura.

Thus, this is a completely normal exam, no pneumothorax.

But note the location of the pleura, deep to the ribs, and that classic shimmering line back and forth as the patient takes a breath.

Here we see more dramatic comet tails coming off the shimmering parietal and visceral pleura.

In this patient, we see the comet tail shooting off the back, telling us that this lung is up and there's no pneumothorax.

So vertical lines coming off the back of the pleura always mean

that the lung is up and are always a good sign on lung ultrasonography.

As we mentioned, we should also swivel the probe into the short axis configuration to further examine the lung, and what we see here is a normal lung in short axis configuration.

Note here we're looking in between the ribs, so all we see is the dome of the lung, and notice that it slides back and forth as the patient breathes, and we see the vertical comet tails coming off the back.

So a completely normal examination in the short axis plane.

Here's another ultrasound image taken from the short axis configuration.

Note here we see very prominent comet tails coming off the back of the lung as it slides back and forth.

Again, it's that opposition of the parietal and visceral layers of the pleura that allow the lungs shimmering, but notice here all the comet tails coming off the back.

In this case, this patient had some pulmonary edema associated with the lung, and these comet tails are more pronounced due to the presence of water within the pleura.

But notice all these vertical lines coming off the back telling us this lung is up.

A way to document that the lung is up to print out for the chart is to put M mode, and generally what we do is locate it so the M -mode cursor is down right at the pleura.

And what we see is the classic seashore sign or waves on the beach.

If we look anteriorly, we'll see the classic waves or no motion of the chest wall.

And below that, deep to the pleura, we'll see the positive motion of the lung making up the beach.

So waves on the beach or the seashore sign

and M -mode documentation that the lung is up and that there's no pneumothorax.

Now that we understand what a normal lung looks like on bedside examination, let's take a look at a pictorial showing a pneumothorax in a long axis view.

We see here that the parietal pleura is now split from the visceral pleura, which is attached to the lung, by a layer of air shown by the yellow color.

It's the splitting of the parietal and visceral pleura that now causes a lack of lung sliding,

and instead of the opposed visceral and parietal pleura sliding back and forth as the patient breathes, all we see is a single line,

the parietal pleura, with a lack of vertical comet tails coming off the back.

Here's an ultrasound image taken from a patient who was stabbed to the left chest and who had shortness of breath.

What we see here is a long axis view of a pneumothorax.

Let's take a look at the chest wall anteriorly, and right below that we see the parietal pleura, the single white line located directly inferior to the ribs,

but notice the classic lack of the lung sliding.

All we see here is a single white line that fails to slide back and forth as the patient breathes.

Notice also the absence of the vertical comet tails.

Here's another image of a pneumothorax in a long axis configuration, and we see here the chest wall anteriorly and the single white line which is the parietal pleura.

Now this patient was acutely dyspneic, so notice that there is some motion of the chest wall and that the parietal pleura moves up and down, but notice the failure of horizontal sliding.

Notice also the absence of any vertical comet tails coming off the back of the pleura.

Now let's inspect a pneumothorax from the short axis view.

We see the chest wall anteriorly, the parietal pleura as shown as a single non -mobile white line in the middle of the image.

Note the failure of movement back and forth, the lack of vertical comet tails, and what we see here is repeating horizontal air lines from the pneumothorax.

To document the absence of lung sliding and the presence of a pneumothorax, we'll again turn to M -mode.

If we put the M -mode cursor down on the pleura, what we'll see is a set of linear repeating lines.

This documents no motion of both the chest wall and of the lung, making up a finding known as the barcode sign.

Here's a pictorial showing an interesting finding, the signature of an incomplete pneumothorax known as lead point.

And what we see is an incomplete pneumothorax with error collecting to the superior aspect of the image to the left,

thus splitting the parietal from the visceral layers and causing an absence of lung sliding superiorly.

However, as the lung is coming up against the chest wall to the right or inferiorly,

that's where we'll see the presence of horizontal lung sliding and the presence of the vertical comet tails.

Here's an ultrasound image showing the lead point and what we see here is the lung sliding to the right, the area where the lung touches up against the chest wall and to the left,

the area of absence of lung sliding telling you there that air has collected between the visceral and parietal layers.

So the ultrasound equivalent of the image that we just looked at telling you that this is an incomplete pneumothorax.

But here we see that lead point or transition point very well on bedside sonography.

In conclusion, I'm glad I could share with you this ultrasound module going over ultrasound of the lung to evaluate for pneumothorax.

This is an excellent tool for viewing the pleura and making the diagnosis of pneumothorax.

And there's been some research showing that it may be more sensitive than chest X -ray in the diagnosis of pneumothorax, allowing rapid diagnosis of pneumo in both your trauma and medical patient,

thus facilitating more timely management of these most critical patients.

So I hope to see you back as SoundBytes continues.

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Từ vựng và ghi chú luyện nói cho bài học này

Bài luyện nói này dựa trên video “How To: Ultrasound for Pneumothorax Case Study Video”. Những từ được nhắc lại nhiều nhất trong bài: lung, pleura, pneumothorax, axis, chest. Video này có 91 câu và 1719 từ để luyện shadowing. Phần lời nói dài 9:11. Người nói nói nhanh, khoảng 187 từ mỗi phút, nên sẽ có nhiều chỗ nối âm và nuốt âm. Chỉ 73% số từ nằm trong 3.000 từ tiếng Anh thông dụng nhất, nên từ vựng khá khó.

Từ vựng quan trọng trong video

15 từ đáng học trong video, kèm phiên âm và nghĩa:

Từ	Phiên âm	Nghĩa
lung danh từ	/ˈlʌŋ/	phổi
axis danh từ	/ˈæksɪs/	trục
ultrasound danh từ	/ʌl.tɹə.saʊnd/	siêu âm
tail danh từ	/ˈteɪ̯l/	đuôi
slide danh từ	/ˈslaɪ̯d/	cầu trượt, cầu tuột
comet danh từ	/ˈkɒmɪt/	sao chổi
configuration danh từ	/kənˌfɪɡ.əˈɹeɪ̯.ʃən/	cấu hình
rib danh từ	/ɹɪb/	xương sườn, sườn
breathe động từ	/bɹiːð/	thở, hô hấp
examination danh từ	/ɪɡˌzæm.ɪˈneɪ.ʃən/	kiểm tra
layer danh từ	/ˈleɪ̯ɚ/	lớp
diagnosis danh từ	/daɪəɡˈnəʊsɪs/	chẩn đoán
detect động từ	/dɪˈtɛkt/	phát hiện, dò ra
trauma danh từ	/ˈtɹɔm.ə/	chấn thương
horizontal tính từ	/ˌhoɹəˈzɑn.təl/	ngang

Ngữ pháp trong video

Những cấu trúc người nói dùng nhiều nhất, kèm đúng cụm từ trong video:

Cấu trúc	Trong video
Thì hiện tại hoàn thành have/has + quá khứ phân từ — việc đã xảy ra nhưng còn liên quan đến hiện tại	have shown · There's been · has been found
Câu bị động be + quá khứ phân từ — nhấn vào việc xảy ra, không phải người làm	has been found · is located · is seen
Mệnh đề quan hệ who / which + mệnh đề — thêm thông tin về người hoặc vật	sliding, which is · pleura, which is · line which is

Phát âm cần chú ý

Người nói dùng 16 dạng rút gọn, ví dụ we'll, we're, I'm. Hãy nói theo dạng ngắn đúng như bạn nghe.

Âm “th”: breathe /bɹiːð/, pneumothorax /ˈnju.moʊˌθɔ.ɹæks/
Âm “sh” và “zh”: configuration /kənˌfɪɡ.əˈɹeɪ̯.ʃən/, examination /ɪɡˌzæm.ɪˈneɪ.ʃən/, transition /tɹænˈzɪʃ.ən/, shadow /ˈʃædəʊ̯/, conclusion /kənˈkluːʒən/
Từ dài — đặt trọng âm cho đúng: configuration /kənˌfɪɡ.əˈɹeɪ̯.ʃən/, examination /ɪɡˌzæm.ɪˈneɪ.ʃən/, superior /sʊˈpɪɹ.i.ɚ/, horizontal /ˌhoɹəˈzɑn.təl/, inferior /ɪnˈfɪɹ.i.ɚ/

Những âm người Việt thường gặp khó:

Cụm phụ âm cuối — đọc đủ từng âm, đừng nuốt âm cuối: ultrasound /ʌl.tɹə.saʊnd/, detect /dɪˈtɛkt/, aspect /ˈæspɛkt/, collect /ˈkɑlɪkt/, chart /t͡ʃɑɹt/
Âm /tʃ/, /dʒ/ và /ʒ/ — tiếng Việt không có, đừng đọc thành “ch” hay “gi”: module /ˈmɑd͡ʒul/, chart /t͡ʃɑɹt/, conclusion /kənˈkluːʒən/, signature /ˈsɪɡ.nə.t͡ʃə/, attach /əˈtæt͡ʃ/
Âm /æ/ — mở miệng rộng hơn âm “e”: axis /ˈæksɪs/, examination /ɪɡˌzæm.ɪˈneɪ.ʃən/, absence /ˈæb.s(ə)n̩s/, lateral /ˈlætəɹəl/, aspect /ˈæspɛkt/

Cách luyện với video này

Nghe hết video một lần, chưa cần nói, và ghi lại những từ bạn chưa biết.
Bắt đầu ở tốc độ 0,75×, nói đuổi từng câu, rồi quay lại tốc độ bình thường khi đã quen.
Ghi âm giọng mình rồi so với bản gốc, chú ý các từ như lung, axis, ultrasound.

Phương Pháp Shadowing Là Gì?

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Phương pháp shadowing: đọc hướng dẫn từng bước đầy đủ →

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