跟讀練習: How To: Ultrasound for Pneumothorax Case Study Video - 通過影片學習英語口語

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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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本課的詞彙與口語要點

這節口語課以影片“How To: Ultrasound for Pneumothorax Case Study Video”為素材。影片中反覆出現的詞有：lung, pleura, pneumothorax, axis, chest。這段影片共有 91 個句子、1719 個單詞可供跟讀。講話部分時長為 9:11。說話人語速較快，每分鐘約 187 個詞，會出現較多連讀和弱讀。只有 73% 的單詞屬於英語最常用的 3,000 詞，詞彙難度較高。

影片中的重點詞彙

影片中 15 個值得學習的單詞，附發音和釋義：

單詞	發音	釋義
lung 名詞	/ˈlʌŋ/	физы, 肺
axis 名詞	/ˈæksɪs/	軸 /軸, 軸心 /軸心
ultrasound 名詞	/ʌl.tɹə.saʊnd/	超音波 /超音波, 超音波
tail 名詞	/ˈteɪ̯l/	йиба, 尾
slide 名詞	/ˈslaɪ̯d/	滑梯
comet 名詞	/ˈkɒmɪt/	彗星, 掃帚星 /掃帚星
configuration 名詞	/kənˌfɪɡ.əˈɹeɪ̯.ʃən/	編排 /編排, 配置
vertical 形容詞	/ˈvɝ.tɪ.kəl/	豎的 /豎的, 垂直
rib 名詞	/ɹɪb/	肋骨
breathe 動詞	/bɹiːð/	呼吸, 吸
examination 名詞	/ɪɡˌzæm.ɪˈneɪ.ʃən/	檢查 /檢查
layer 名詞	/ˈleɪ̯ɚ/	層 /層
absence 名詞	/ˈæb.s(ə)n̩s/	缺席, 不在
diagnosis 名詞	/daɪəɡˈnəʊsɪs/	診斷 /診斷
detect 動詞	/dɪˈtɛkt/	察覺 /察覺, 發覺 /發覺

影片中出現的短語動詞

單詞	發音	釋義
make up 動詞	/ˌmeɪk ˈʌp/	組成 /組成

影片中的語法

說話人最常用的結構，並附上影片中的原話：

結構	影片中的用法
現在完成時 have/has + 過去分詞 — 過去發生但與現在仍有關聯的事	have shown · There's been · has been found
被動語態 be + 過去分詞 — 強調發生了什麼，而不是誰做的	has been found · would be predominantly seen · is located
定語從句 who / which + 從句 — 補充說明人或事物	sliding, which is · pleura, which is · line which is

需要注意的發音

說話人用了 16 次縮略和弱讀形式，例如 we'll, we're, I'm。請按聽到的簡短形式來說。

“th” 音: breathe /bɹiːð/, pneumothorax /ˈnju.moʊˌθɔ.ɹæks/
“sh” 和 “zh” 音: configuration /kənˌfɪɡ.əˈɹeɪ̯.ʃən/, examination /ɪɡˌzæm.ɪˈneɪ.ʃən/, transition /tɹænˈzɪʃ.ən/, shadow /ˈʃædəʊ̯/, conclusion /kənˈkluːʒən/
長單詞——注意重音位置: configuration /kənˌfɪɡ.əˈɹeɪ̯.ʃən/, examination /ɪɡˌzæm.ɪˈneɪ.ʃən/, superior /sʊˈpɪɹ.i.ɚ/, horizontal /ˌhoɹəˈzɑn.təl/, inferior /ɪnˈfɪɹ.i.ɚ/

中文母語者容易讀錯的音：

/v/ — 不要讀成 /w/，上齒輕觸下唇: vertical /ˈvɝ.tɪ.kəl/, sensitive /ˈsɛn.sɪt.ɪv/, evaluate /ɪˈvaljʊeɪt/, visceral /ˈvɪsəɹəl/, swivel /ˈswɪvəl/
詞尾子音 — 要讀清楚，後面不要加母音: axis /ˈæksɪs/, ultrasound /ʌl.tɹə.saʊnd/, slide /ˈslaɪ̯d/, comet /ˈkɒmɪt/, rib /ɹɪb/
/r/ 和 /l/ 的區別: ultrasound /ʌl.tɹə.saʊnd/, lateral /ˈlætəɹəl/, linear /ˈlɪn.i.əɹ/, horizontal /ˌhoɹəˈzɑn.təl/, predominantly /pɹɪˈdɒmɪnəntli/

如何用這段影片練習

先完整聽一遍影片，不要開口，記下不認識的單詞。
先用 0.75 倍速逐句跟讀，熟練之後再回到正常速度。
錄下自己的聲音並與原聲對比，特別注意 lung, axis, ultrasound 這類單詞。

什麼是跟讀法？

跟讀法 (Shadowing) 是一種有科學依據的語言學習技巧，最初開發用於專業口譯員的培訓，並由多語言者Alexander Arguelles博士普及。這個方法簡單而強大：您在聽英語母語原聲的同時立即大聲重複——就像是一個延遲1-2秒緊跟說話者的影子。與被動聽力或語法練習不同，跟讀法強迫您的大腦和口腔肌肉同時處理並模模擬實的講話模式。研究表明它能顯著提高發音準確性，語調，節奏，連讀，聽力理解和口語流利度——使其成為雅思口語備考和真實英語交流最有效的方法之一。

影子跟讀法: 閱讀完整分步指南 →

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