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因此，我们已经通过教区转身访问方式查看了不同的 so we've made our way through the parish turn along access view the different
我们可以在胸骨旁近视视图中看到的视图，现在我们正在制作 views that we can see in the parasternal short access view and now we're making
我们到达顶端40的方法还可以，所以在这种情况下，请记住 our way to the apical 40 more view okay so in this case remember with a
胸骨旁长的互联网访问意见，我们曾经 parasternal long internet access views where we had
我们的病人在左侧卧位，我们还将 our patient in the left lateral decubitus position we'll also have the
在这种情况下，病人处于这个位置好了，尽管我们要移动 patient in this position in this case all right although we're gonna move the
换能器好吧，我们要把换能器移到或靠近点 transducer okay we're gonna move the transducer to or near the point of
最大的使用冲动可以吗？ maximal employed impulse okay the apical impulse and where that
是关于心脏的顶点在这里，我们要做的是 is is about here at the apex of the heart and what we're also going to do is
我们希望换能器上的标记朝这个方向 we want the marker on the transducer directed in this direction where the
箭头没问题，所以如果您想象这是六点，那么大约是三点钟 arrow is going okay and so this is about three o'clock if you imagine this is six
九点十二点，你可以看到这是斜倚，所以换能器 o'clock nine o'clock twelve o'clock you can see this is to recline so transducer
您知道朝该方向的三点钟时，我们要倾斜 you know about three o'clock directed in that direction we want to tilt the
换能器朝向患者的左髋好，所以朝向患者的左 transducer towards the patient's left hip okay so towards the patient's left
髋关节请记住，如果这是患者的右侧，那么这是患者的左侧 hip remember if this is the right side of the patient this is the left side of
我们要去的病人这是向病人左边的箭头 the patient we're going to here's this arrow going towards the patient's left
髋关节，我们将要引导超声波束穿过 hip and we're going to want to direct the ultrasound beam going through the
心脏的长轴可以吗 long axis of the heart okay the long axis of the heart you can
看到这个方向的光束好吧，所以我们再次将换能器放在 see the beam here in this direction okay so again we have the transducer on the
指向三点钟的心尖冲动是记号笔的位置 apical impulse directed towards the three o'clock is where the marker will
是的，我们将其向患者的左髋倾斜，深度可以 be and we're going to tilt it towards the patient's left hip and the depth can
大约是14到18厘米，我们可以调整患者的底座，所以我 be about 14 to 18 centimeter and we can adjust the base on the patient so I
猜猜我们在这种视图中看到的是什么，为什么室视图的根尖以及 guess what are we seeing in this view so why the apical for chamber view well as
该名称暗示了腔室视图的顶端，并为我们提供了四个视图 the name implies the apical for chamber view and gives us a view of the four
心脏的两个心房和两个心室，因此请再次注意 chambers of the heart the two atria and the two ventricles so notice here again
这是我们标记的图像，所以这是这里标记的好，这是 here is our labeled image so this one here is labeled okay this is the
未标记的图像，这更像是卡通 unlabeled image and this is more of the kind of cartoon
它的描述还可以，所以您可以通过三种不同的方式查看它，我希望您能够 depiction of it okay so three different ways you can look at it I want you to
您知道要确保您能以不同的方式看到，因为我希望 you know make sure you can see in different ways because I hope one of
它们实际上是粘着的，所以请注意，在标签视图中，我们左边 them actually sticks so notice here in the labeled view we have the left
脑室在这个位置，这意味着这里可以，如果你看 ventricle in this position that would mean this one here okay and if you look
在获得此卡通的那个上，这是左心室记住 at the one that's got this cartoon this is the left ventricle remember between
从左心室也有左心房，所以这是左 from the left ventricle you also have the left atrium so this is the left
左心房和左心室之间的心房有二尖瓣 atrium between the left atrium and the left ventricle you have the mitral valve
想象一下，这是左心房，这是二尖瓣，这是我们的 so imagine this is the left atrium this is the mitral valve look here here's our
左心房位于二尖瓣，还可以看到肺动脉瓣右 left atrium in the mitral valve okay you can also see the pulmonary valve right
这里好PV，在这种情况下，然后我们也有权利 here okay PV so that would be in this case and then we also have the right
在心脏的一侧，您可以看到右心房和右心室，这样 side of the heart you can see the right atrium and the right ventricle so this
是右心房，也可以看到右心室，在这里是对的 is the right atrium the right ventricle can also be seen and here it is right
心房右心室，我们知道它们之间有三尖瓣 atrium right ventricle and we know between them we have the tricuspid valve
可以的，这是这里的一种，所以您可以通过多种方式 which would be this one here okay so again multiple ways that you can
查看它，因此我将其中的一些内容删除，以便您可以看到它，因此请注意我们 view it so I'll erase some of this so you can see it so notice that we're
看到四个腔室，我们还可以看到二尖瓣之间的瓣膜 seeing the four chambers and we can also see the valves between them the mitral
三尖瓣中的瓣膜，所以这又是换能器， valve in the tricuspid valve so again this is the transducer just so you're
知道这是换能器，这应该在顶部，这是 aware this is the transducer here it'd be at the top okay and this here is
这样标记为黄色的标记是可以的，请记住标记是 the marker so labeled and yellow is the marker okay and remember the marker is
指向三点，所以希望这是有道理的，那么可以 directed towards three o'clock so hopefully that makes sense so what can
我们评估良好，我们可以评估它的左心室右室大小 we assess well we can assess it the chamber size of the left ventricle right
心室左心房右心房我们可以评估左心室和右心室 ventricle left atrium right atrium we can assess the left ventricle and right
心室功能，我们可以看到那里有运动，有什么运动 ventricles function and we can see it is there how is the motion and is there any
二尖瓣或三尖瓣反流的证据还可以 evidence of regurgitation at the mitral valve or the tricuspid valve okay
记住这里是我们的二尖瓣，这是我们的三尖瓣，所以我们可以 remember here's our mitral valve and this is our tricuspid valve so we can
评估他们，看看他们的运动如何有二尖瓣反流 evaluate them to see how the motion of them is there any mitral regurgitation
或三尖瓣关闭不全目前还可以，所以希望这很有意义 or tricuspid regurgitation present okay so hopefully that makes sense all right
让我们回顾一下，否则我们将在这里结束 let's recap or we end here so again the apical for
腔室视图好，所以现在我们从左胸骨移动传感器 chamber view okay so now we're moving our transducer from the left sternal
好吧，第三或第四肋间到顶端的冲动就近了 okay that third or fourth intercostal space to the apical impulse that near
最大脉冲或PMI的点还可以，所以这就是我们想要的 the point of maximal impulse or PMI okay so that's this point here we want the
换能器将标记指向我们想要的三点钟 transducer directed the marker directed towards that three o'clock we want to
向患者的左髋倾斜，好吧，我们要做的就是 tilt it down towards the patient's left hip okay and what we want to do is get
较长的si进入心脏的深度可以在40到18之间 the long si access view of the heart the depth can be between 40 and 18
厘米再次根据患者调整，我们希望他们在左侧 centimeters again adjusted based on the patient again we want them in the left
侧卧位，所以我们没有改变胸骨旁的位置 lateral decubitus position so we haven't changed position from the parasternal
长期访问或短期访问，我们说我们可以评估一下，因为该名称暗示了这四个 long or short access view and we said we can assess as the name implies the four
左心房和右心房的心房大小都可以 chambers okay the size of the atria the left atrium and the right atrium okay
记得我们看到了那些，我们也可以评估心室的大小，所以 remember we saw those we can also assess the size of the ventricles okay so
这是左心房，右心房，左心室，右心室，我们说过 here's the left atrium right atrium left ventricle right ventricle and we said we
可以看一下运动或者在水平上是否有反流的迹象 can look at the motion or if there's any evidence of regurgitation at the level
二尖瓣和三尖瓣之间的位置 of the mitral valve and the tricuspid valve between their respective
我们的心室心室好吧，我们也想知道肺动脉瓣 ventricles our chambers okay we also want to know there's the pulmonary valve
你可以在这里看到那个站，有时候你也可以看到 that you can see here that station there that you may sometimes see as well okay
您可能能够很好地抓住肺动脉瓣 the pulmonary valve is something you may be able to catch on this view well
到此为止，我希望你现在学到一些东西，以保持 that's the end of this lecture I hope you learned something now just to keep
请记住我们的课程资料，如果您转到 you in mind of our course material that we have available so again if you go to
我们的网站WWE kg MD好的，所以这是我们的网站，您会注意到 our web site WWE kg MD okay so this is our web site and what you'll notice is
如果您在这里参加心电图课程，那么您会发现与众不同的东西 that if you go to the EKG course here okay you'll find stuff that's separate
所以请注意，我们有许多主题都可以通过某种方式练习材料讲座 so notice that we have a number of topics practice material lectures a way
为您做出贡献，这是这里的课程，所以您会注意到 for you to contribute and this is the course here over here so you'll notice
我们大约有300多个视频，而YouTube上还有更多的视频 we have over 300 videos or so and that's more on YouTube there's another hundred
超过一百个大约200个可用的视频 more than a hundred about 200 videos that are available
当然，这些是本课程中的独立视频 the course so those are separate videos in this course is really designed to
将您从初学者带到高级口译人员，好吧，所以完全分开 take you from a beginner to advanced interpreter okay so completely separate
从您免费获得的网络上可以，这些都是课程材料 from what you're getting online for free okay these are course material that
附带它，所以请注意您有一本书还可以 comes with it so notice that you have a book okay
然后您还可以获得袖珍指南，因此可以选择哪种格式 and then you also have the pocket guide available so you can choose which format
它们是同一本书，它们在口袋里的指南格式不同 they are the same thing both these book in the pocket guide different formats I
非常喜欢这个小东西，因为如果您 really like this small one because you can keep it in your white coat if you're
在诊所或口袋里，随时随地都可以使用 in the clinic or in your pocket and it's really available on the go
现在有了这本书，您还将获得视频，所以请注意这些视频还可以， now with the book you also get videos so notice these are the videos okay and
这些是该书中每页的视频，因此超过30小时 these are a video for every single page in that book so it's over 30 hours of
视频中有很多练习材料，我会继续上传 video there's a number of practice material that I continue to upload there
好吧，我们很快就会有练习题，所以都可以使用 okay we'll have practice questions coming soon so all of that's available
同样，这与您已经可以的所有免费材料分开，所以 again this is separate from all the free material that you get already okay so
这是高产量的东西这就是我们用来教技术人员的东西 this is more high-yield stuff this is what we used to teach our technicians
在这里和我们的学生在Mayo诊所，现在已经在许多人中使用 here and our students here at Mayo Clinic and it's used now among many
如此使用过的机构现在检查一下它也包括我们的卡尺 institutions so used check that out now what it also includes our calipers so
是的，您可以在本课程中找到卡尺，好吧，我不认识其他人 yes you get calipers with this course okay I don't know anyone else that
提供，但您确实可以使用卡尺，我认为它们非常有帮助，他们可以 offers that but you do get calipers I think they're very helpful and they can
如果您知道如何正确使用它们，可以帮助您识别不同的 you know if you know how to use them correctly can help to identify different
心律失常持续下去，然后您也可以得到我们的心电图 arrhythmias that are going on okay and then you also get our pocket EKG
好的，这是我们在开发过程中总结的东西 reference ok this was something we've put together as we were developing
当然适合同伴，这真是太好了 course for the fellows and this is really nice it has every coat as you saw
早些时候在那里列出了非常小的口袋指南，在我的帮助下 earlier laid out there very small pocket guide available I had help with my
同事博士梅奥诊所EKG实验室负责人Peter Noseworthy colleague dr. Peter Noseworthy who's the head of the EKG lab here at Mayo Clinic
并对其进行编辑，所以这是我们使用的东西，我们发现非常有帮助，所以 and editing it so this is something that we use and we found very helpful so go
在EKG课程中，您会看到一些演讲示例 to the EKG course you'll see examples of lecture
好吧，为什么我们开发这种好吧，很多原因是我自己挣扎 okay why we developed this okay a lot of it came about from myself struggling
学习心电图，父亲是介入心脏病专家， with learning EKGs having a father that was an interventional cardiologist and
你知道仍然在挣扎，所以我的挣扎是一种挣扎，我不想你 you know still struggling so my struggle is a struggle that I don't want you to
有学习的知识，可以阅读所有这些入门书籍，但是 have in learning them okay you can read all those introductory books but
老实说，它们还不够好，您会发现自己在使用其他资源 honestly they are not enough okay and you find yourself using other resources
这是我要加快学习过程的一部分， which is part of the learning process I wanted to expedite that process for
你，使我在努力奋斗的过程中效率降低 you and make it less inefficient in pretty much what I struggled with going
并通过心电图学习，因此从初学者到高级 and learning through EKGs so again from beginner to advanced level with this
当然，您会得到这本书，卡尺编码参考视频访问也可以， course you get the book the calipers the coding reference video access okay and
现在我们提供25％的折扣，可在结帐时输入25％的折扣，您将获得 now we're offering 25% off 25% off put that code in on checkout and you'll have
让自己有25％的折扣，这甚至可以覆盖我们的成本 yourself 25% off that will even it's pretty much covers the cost of what we
用来打印材料，所以我们并没有做太多事情，更多的是 use to print the material so we don't really make much off it it's more to
帮助我们的学习者成长并真正能够为患者护理做出贡献 help our learners grow and really be able to contribute to patient care
这就是为什么我们这样做，我们喜欢这样做 that's why we do this and we love doing it
因此，非常感谢您的支持。 so thank you so much for your support if you have any questions just leave them
下面，我们很乐意回答他们，祝您有美好的一天 below and we're happy to answer them alright have a great day
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