1
00:00:10,080 --> 00:00:13,570
hey Mark what's going on hey dr. Kafka
嘿马克， 嘿，博士。卡夫卡

2
00:00:13,570 --> 00:00:15,638
I'm just looking at this EKG I'm a new
 我只是看着这个EKG我是一个新人

3
00:00:15,638 --> 00:00:17,469
patient I admit it I think they're
病人我承认，我认为他们是

4
00:00:17,469 --> 00:00:19,149
having an acute MI and I'm pretty sure
 有急性MI，我很确定

5
00:00:19,149 --> 00:00:20,769
there's ST elevation what do you think
 有ST升高您的想法是什么？

6
00:00:20,769 --> 00:00:22,329
well let me take a look
 好吧，让我来看看

7
00:00:22,329 --> 00:00:24,070
you know I am worried about acute
你知道我很担心

8
00:00:24,070 --> 00:00:25,539
myocardial infarction in this patient
该患者的心肌梗死

9
00:00:25,539 --> 00:00:27,579
let me call the cath lab and then we'll
让我打电话给导管实验室然后我们会

10
00:00:27,579 --> 00:00:28,778
discuss the ECG findings a little
讨论心电图检查结果

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further great
进一步大

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00:00:33,119 --> 00:00:35,950
st-elevation myocardial infarction or a
 st-elevation心肌梗死或a

13
00:00:35,950 --> 00:00:38,079
STEMI is basically the complete
 STEMI 基本上是完整的

14
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occlusion of a quarter ii artery in the
 阻塞四分之一的动脉

15
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heart and rapid identification of this
 心脏并迅速识别这一点

16
00:00:42,789 --> 00:00:44,859
can literally save your patients heart
可以从字面上拯救患者的心脏

17
00:00:44,859 --> 00:00:47,740
muscle or their life now let's take a
肌肉或他们的生活现在让我们采取一个

18
00:00:47,740 --> 00:00:50,229
look at this on the form of an EKG and
 以EKG和EKG的形式来看待这个

19
00:00:50,229 --> 00:00:52,899
the EKG here we're gonna be looking for
 我们将在这里寻找 EKG

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00:00:52,899 --> 00:00:55,929
one millimeter or more ST elevation and
 一个毫米或更多的ST高程和

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00:00:55,929 --> 00:01:00,880
two or more consecutive leads hey doctor
两个或多个连续导致嘿医生

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chemica where should we be looking on
 chemica 我们应该在哪里看

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00:01:02,859 --> 00:01:04,900
the ST segment for the elevated portion
升高部分的ST段

24
00:01:04,900 --> 00:01:06,609
that's a great question mark so we're
这是一个很好的问号所以我们是

25
00:01:06,609 --> 00:01:07,989
looking for something called the J point
 寻找一种叫做J点的东西

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which is right here
 就在这里

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now the J point is at the end of the QRS
现在J点位于QRS的末尾

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segment and at the onset of the ST
段和ST的开始

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segment okay and what are we comparing
细分可以和我们比较什么

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the J point to so if the J point is here
如果J点在这里，J指向如此

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we're gonna compare the PR segment as
我们要把公关部门比作

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our baseline which is right here okay so
我们的基线就在这里，好吧

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00:01:23,978 --> 00:01:26,379
one millimeter or more of St elevation
 St高程一毫米或更多

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at the J point compared to the PR
 在J点与PR相比

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segment does the shape of the ST segment
 segment 执行ST段的形状

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00:01:31,000 --> 00:01:32,349
matter at all that's actually extremely
 实际上非常重要

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important so you have many different
 很重要，所以你有很多不同

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00:01:34,810 --> 00:01:36,939
reasons to have st elevations some
 有一些升高的 原因

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00:01:36,939 --> 00:01:39,640
examples are early repolarization left
例子是早期复极离开

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ventricular hypertrophy or pericarditis
 心室肥大或心包炎

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00:01:41,019 --> 00:01:42,759
so how do we know that we're having
 那我们 怎么知道我们有

42
00:01:42,759 --> 00:01:45,399
acute occlusion of a coronary artery so
 因此 ， 冠状动脉急性闭塞

43
00:01:45,399 --> 00:01:48,340
one if I'm looking at the normal end of
一个， 如果我正在看正常结束

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00:01:48,340 --> 00:01:49,989
the J point right here and if it's
 J点就在这里，如果是的话

45
00:01:49,989 --> 00:01:52,780
rising over one millimeter and it's
 超过一毫米，它是

46
00:01:52,780 --> 00:01:55,719
either horizontally going across or if
 无论是水平穿越还是如果

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00:01:55,719 --> 00:01:57,609
it's merging with the T wave and forming
它与T波合并并形成

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00:01:57,609 --> 00:02:00,579
a convex or Tombstone finding that's
凸起或墓碑发现的

49
00:02:00,579 --> 00:02:02,349
more concerning for an ST elevation
更多关于为ST段抬高

50
00:02:02,349 --> 00:02:05,409
myocardial infarction okay so if that's
心肌梗塞好吧，如果那样的话

51
00:02:05,409 --> 00:02:08,439
convex that means that this one in front
凸起意味着这一个在前面

52
00:02:08,439 --> 00:02:10,419
of me is concave and this would be less
 我是凹的，这会少

53
00:02:10,419 --> 00:02:12,669
concerning for an MI you got it but
关于MI，你得到了它但是

54
00:02:12,669 --> 00:02:14,229
always remember to fight clinically
永远记得在临床上战斗

55
00:02:14,229 --> 00:02:16,810
correlate these findings okay I think I
关联这些发现好吧我想我

56
00:02:16,810 --> 00:02:18,219
understand that's the elevation a little
明白这是海拔高度

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00:02:18,219 --> 00:02:19,990
better let's talk about consecutive
更好的让我们谈谈连续

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00:02:19,990 --> 00:02:23,990
leads
引线

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00:02:23,990 --> 00:02:26,060
hey dr. Kafka I heard you talking on
嘿博士卡夫卡， 我听说你在谈论

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00:02:26,060 --> 00:02:27,979
rounds the other day about consecutive
关于连续几天的回合

61
00:02:27,979 --> 00:02:30,199
leads what are those and why are they
领导那些是什么，为什么他们

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00:02:30,199 --> 00:02:32,000
important well first of all I'm
重要的是首先我是

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00:02:32,000 --> 00:02:32,750
impressed that you were actually
印象深刻的是，你实际上是

64
00:02:32,750 --> 00:02:33,800
listening on rounds
 听着回合

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00:02:33,800 --> 00:02:36,560
that's a first consecutive leads or
这是第一个连续的领先优势

66
00:02:36,560 --> 00:02:39,439
contiguous leads are an ECGs version of
连续导联是ECG的版本

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00:02:39,439 --> 00:02:42,050
the anatomic portions of the heart okay
心脏的解剖部分还可以

68
00:02:42,050 --> 00:02:44,030
and I heard you mentioned before that we
 我听说你之前提到过我们

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00:02:44,030 --> 00:02:45,800
need two or more consecutively it's
 需要两个或更多的连续它的

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00:02:45,800 --> 00:02:48,169
involved or an acute MI exactly we're
 我们确实涉及或是急性心肌梗死

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00:02:48,169 --> 00:02:49,729
trying to take a look at a snapshot of
试着看一下快照

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00:02:49,729 --> 00:02:51,860
something in two different leads or two
 两个不同的线索或两个的东西

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00:02:51,860 --> 00:02:54,860
different camera viewpoints okay so if
不同的相机观点好吧如果

74
00:02:54,860 --> 00:02:58,009
we had an inferior infarct which leads
我们有一个较低的梗塞导致

75
00:02:58,009 --> 00:02:59,780
would be involved so that would be two
 会参与，所以这将是两个

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00:02:59,780 --> 00:03:04,009
three and ABF okay what about lateral
 三，ABF还好横向

77
00:03:04,009 --> 00:03:08,180
infarct lateral in parks r1 AVL v5 and
在公园r1AVL v5和

78
00:03:08,180 --> 00:03:12,110
v6 okay and what about anterior septal
 v6 好吧，前房间隔怎么办？

79
00:03:12,110 --> 00:03:15,969
Anto septal is going to be v1 and v2
 Anto septal将成为v1和v2

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00:03:15,969 --> 00:03:19,250
okay and lastly what about interior
 好的，最后内部怎么样

81
00:03:19,250 --> 00:03:21,949
apical answer or apical in parks are
 公园的顶端答案或顶端是

82
00:03:21,949 --> 00:03:25,699
going to be v3 and v4 okay I think I
将是v3和v4 好吧我想我

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00:03:25,699 --> 00:03:26,930
understand consecutive leads a little
了解连续领先一点

84
00:03:26,930 --> 00:03:29,030
bit better let's talk about reciprocal
 更好的让我们谈谈互惠

85
00:03:29,030 --> 00:03:33,800
changes okay now that we understand
现在我们明白了改变

86
00:03:33,800 --> 00:03:35,240
consecutive leads a little bit better
连续带领一点点好转

87
00:03:35,240 --> 00:03:37,310
let's talk about the term reciprocal
 让我们来谈谈互惠一词

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00:03:37,310 --> 00:03:39,169
changes so what does that mean and why
改变那是什么意思和原因

89
00:03:39,169 --> 00:03:41,330
is that important so reciprocal changes
是那么重要， 所以互惠的变化

90
00:03:41,330 --> 00:03:43,819
are basically looking at the ECG on the
基本上是看心电图了

91
00:03:43,819 --> 00:03:45,169
opposite side from where you're having
 你所在的对面

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00:03:45,169 --> 00:03:46,849
the current of injury and they're
 伤害的当前 和他们

93
00:03:46,849 --> 00:03:48,370
usually in the form of an ST depression
通常以ST抑郁症的形式出现

94
00:03:48,370 --> 00:03:51,800
okay so if we had an anterior ST
 好吧，如果我们有一个前ST

95
00:03:51,800 --> 00:03:54,500
elevation mi we would expect a posterior
海拔mi 我们期待后路

96
00:03:54,500 --> 00:03:57,349
change logically that makes sense but
 逻辑上改变，但有意义

97
00:03:57,349 --> 00:03:58,759
remember your heart is irregularly
记住你的心脏是不规则的

98
00:03:58,759 --> 00:04:00,370
shaped so when we're talking about
 当我们谈论时，我们就这样塑造了

99
00:04:00,370 --> 00:04:02,930
anterior ST elevation we're actually
 我们实际上是前部ST段抬高

100
00:04:02,930 --> 00:04:04,969
looking at the inferior portion for ST
看着ST的下部

101
00:04:04,969 --> 00:04:08,300
depressions okay and likewise if you had
沮丧，如果你有，也可以

102
00:04:08,300 --> 00:04:11,240
an inferior mi you would expect changes
一个劣等的mi你会期待变化

103
00:04:11,240 --> 00:04:13,430
anteriorly that's correct so if you're
前面那是正确的，所以如果你是

104
00:04:13,430 --> 00:04:16,310
having ST elevations and leads to three
 ST升高并导致三个

105
00:04:16,310 --> 00:04:18,529
and a VF you're actually gonna be
 你实际上是一个VF

106
00:04:18,529 --> 00:04:20,988
looking anteriorly for ST depressions
 向前看ST洼地

107
00:04:20,988 --> 00:04:23,449
and leads v1 all the way up to possibly
并引导v1一直到可能

108
00:04:23,449 --> 00:04:25,310
v4 oh okay
 v4 哦没关系

109
00:04:25,310 --> 00:04:27,410
and what about if you had an ST
 如果你有一个ST怎么样？

110
00:04:27,410 --> 00:04:29,449
elevation in the lateral wall so the
 因此，侧壁的高度

111
00:04:29,449 --> 00:04:31,250
lateral wall is a little challenging
侧壁有点挑战性

112
00:04:31,250 --> 00:04:32,810
there in your standard 12-lead ECG
 在您的标准12导联心电图中

113
00:04:32,810 --> 00:04:36,779
there's no great opposite side okay
对方没有好的

114
00:04:36,779 --> 00:04:38,519
I think our patient earlier must have
 我认为我们的患者早些时候必须有

115
00:04:38,519 --> 00:04:40,860
had an anterior STEMI how did she do
有一个前STEMI 她是怎么做的

116
00:04:40,860 --> 00:04:42,540
she's actually doing really well they
 她居然做得非常好，他们

117
00:04:42,540 --> 00:04:44,069
were able to open up her corners and
能够打开她的角落

118
00:04:44,069 --> 00:04:45,418
she's recovering in the CCU
她正在CCU康复

119
00:04:45,418 --> 00:04:48,060
great thank goodness we knew how to read
非常感谢我们知道如何阅读

120
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EKGs as well
 心电图也是如此