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因此在腔室下肋下我们让患者仰卧 so in the subcostal for chamber view we have the patient in the supine position
平躺，在这个位置，我们想要换能器，并且我们想要 lying flat and in this position we want to have the transducer and we want to
首先将其置于剑突下约2至3厘米 first put it about two to three centimeters below the xiphoid process
好，将其对准患者的左肩，让我们自己定位 okay and direct it towards the patient's left shoulder so let's orient ourselves
在这里好吧，所以请注意，这就是我们的传感器好了，我们有 here okay so notice that this right here is our transducer okay and we have the
患者的右侧在这里，这将是他们的右肩，这将是 patient's right side here so this will be their right shoulder this would be
他们的左肩还可以，然后我们在这里要做的是 their left shoulder okay and then what we're doing here is we have the
剑突下约2至3厘米的换能器 transducer below the xiphoid process about 2 to 3 centimeters we have it
对准病人的左肩好吧，我们想要的是 directed towards the patient's left shoulder okay and what we want is the
换能器上的标记朝着3点左右方向移动，这样可以 marker on the transducer going towards about 3 o'clock okay so that would be
就在这里，所以标记在这里，所以黄色 right here so the markers this here and yellow so
请注意，在黄色处有标记，因此将在其中放置一个M并注意 notice that in yellow we have the marker so this will put an M there and notice
快到三点钟和三点钟的意思了 it's going towards the 3 o'clock okay and three o'clock meaning if you imagine
一个时钟，这是12，那是3，这是6，这是9 a clock this is 12 that's three this is six this is nine we have it going
到这三点，好吧，我们要把换能器的诗压下来 towards this three o'clock here okay we want to hold the transducer poem down
这有助于促进头颅和成角度的深度 and this helps facilitate the cephalad and angulation the depth should be about
在这种情况下为16到24厘米，我们说这是14的次级成本 16 to 24 centimeters in this case and we are saying this is a sub cost of 14
回顾一下会议厅，因为我们将能够看到四个会议厅 review so for chambers because we're gonna be able to see the four chambers
好的，让我们看一下我们在这里实际看到的内容，因此请注意， of the heart okay so let's look at what we actually see here so notice that this
这是肝脏还可以，如果您看一下我们的漫画 down here is the liver okay that's the liver and if you look at our cartoon
图像这是换能器，在这里并使标记变黄 image this being the transducer this here and yellow the marker okay the
换能器会坐在这里，然后这就是标记与 transducer would sit here and then this right here is the marker same thing with
这个传感器在它的标记中再次指向三点钟 this transducer in the marker of it again directed towards three o'clock we
剑突下移至患者左侧 have a just below the xiphoid process going towards the patient's left
注意到我们开始看到肝脏出现了，这就是 shoulder notice that we're starting to see the liver show up okay that's the
肝脏部分，你可以看到那里还可以，这就是这里 liver portion you could see there okay and that would be this here would be
肝脏部分覆盖了该区域，就可以了 that liver portion as it covers that area and this is it here okay so
请注意，第一个区域是我们将看到的心脏最前部 notice that the first area the most anterior portion of the heart we'll see
我们的右心室还可以，请注意，这就是我们的右心室 our right ventricle okay and notice that that's this here the right ventricle our
V，我们可以看到在此图像中，我们还可以看到左侧 V and we can see that here in this image we're also getting to see the left
心室好吧，所以这是左心室，左心室就是这部分，你 ventricle alright so here's the left ventricle the LV is this portion and you
可以看到那里现在有了心房，好的心房在这里 could see that there now we have the atria okay the right atria which is here
这张图片中的右心房是好的，那里是那里， the right atrium is in this image is there okay and there's where it is and
那么左心房几乎是该图像的最后部，或者 then the left atrium pretty much the most posterior portion of this image or
左心房的下部，注意我们可以看到瓣膜 a lower portion that's the left atrium and notice that we can see the valves
在心脏的左右两侧之间，左侧之间也可以 between both the right and left side of the heart okay on the between the left
心房和左心室，我们有二尖瓣，这部分 atrium and the left ventricle we have the mitral valve which is this portion
在这里，这将是二尖瓣，您可以看到，然后我们有了 here so this would be the mitral valve you can see that and then we have the
在右心室右心房之间的三尖瓣，这是 tricuspid valve between the right atrium in the right ventricle so this is the
看到那里的三尖瓣还好，所以希望这是合理的四个 tricuspid valve seen there okay so hopefully that makes sense the four
我们可以看到心房和心室之间的瓣膜 chambers we can see the valves between both the atria and the ventricles
在那里也可以，所以我们可以评估它们的大小和功能 present there as well okay so in these we can assess the size and the function
左心室和右心室的左心房右心房往往是 of the left ventral and right ventricle the left atrium right atrium tend to be
更好地在心尖四相机视图中评估，但您可以在此处看到它们 better assessed in the apical four camera view but you can see them here as
好，我们可以看一下运动，如果二尖瓣有反流 well we can look at the motion and if there's any regurgitation at the mitral
或三尖瓣正常，所以对于任何二尖瓣反流或三尖瓣 or tricuspid valves okay so for any mitral regurgitation or tricuspid
反流，还可以看到心包 regurgitation and you can also see the pericardium okay the outer layer of the
心脏周围可能有心包积液，我们可能会看到 heart is there any pericardial fluid maybe surrounding it here we may see it
像黑色的一样，意思是流体围绕在心脏之间 as black okay meaning that it's fluid that's surrounding the heart between the
心包囊中的心包，所以希望现在有道理 pericardial in the pericardial sac so hopefully that makes sense now I'll
删除这些标签，以便您可以在此处看到它们，好吧，这是同一件事，所以 remove these labels so you can see them here okay it's same thing in this one so
希望这对我们正在考虑的事情有意义，所以让我们 hopefully that makes sense what we're looking at okay so let's just
回顾一下我们在这里结束之前讨论的内容，所以在这个职位上 kind of review what we discussed before we end here so in this position I'll
在这里擦除它，好吧，我们要做的就是把传感器放在下面 erase this here okay what we want to do is take that transducer put it below
剑突将其指向患者的左肩， that xiphoid process direct it towards the patient's left shoulder and
换能器指向三点钟，好了，所以三点钟 the transducer towards the three o'clock here okay so three o'clock and at that
位置，我们非常想按住换能器手掌并尝试 position we're pretty much want to hold the transducer palm down and try to
方便头颅成角度，以查看腔室的状况 facilitate that cephalad angulation in order to see the Chamber's okay you can
通常在16到24厘米之间调整深度应该足够，但是您 adjust the depth often between 16 and 24 centimeters should be sufficient but you
可以根据患者的情况做到这一点 can do that based on the patient what we can see art as the name implies the sub
肋骨视图或获得四个腔室，所以我们看到了正确的心室 costal view or getting the four chambers so we saw the right ventricle okay which
是我们看到的最前面的部分是左心室，右心房和 is that most anterior portion we saw the left ventricle the right atrium and the
左心房，然后我们看到心房和心室之间的瓣膜 left atrium and then we saw the valves between the atria and the ventricles
好吧，这里的二尖瓣和三尖瓣之间 between okay the mitral valve here and the tricuspid valve and remember that we
让我们的肝脏位于这个前部就可以了 have our liver that sits right in this anterior portion okay that on the top
您可以看到肝脏所涉及的部分，因此希望 portion you can see the liver that's involved there so hopefully that makes
感觉还不错，非常适合评估左心室的大小和功能 sense okay so great for assessing size and function of the ventricles the left
和右心室，我们可以看到左心房，右心房，但通常更好 and right ventricle we can see the left atrium right atrium but often better
在心房视图的顶端进行评估，我们可以评估运动和反流 assess in the apical for chamber view we can assess motion and regurgitation of
特别是二尖瓣和三尖瓣的誓言，​​我们可以寻找 the vows of the mitral and tricuspid valve specifically and we can look for
心包周围或周围有融合或心包积液的任何证据 any evidence of a fusion or pericardial effusion around and in that pericardial
囊袋好，所以希望这讲得通，这就是本课的结束 sac okay so hopefully that makes sense well that's the end of this lecture I
希望您现在学到了一些东西，只是要记住我们的课程材料 hope you learned something now just to keep you in mind of our course material
如果您访问我们的网站，我们将会再次提供，所以WWE kg MD好的，所以这 that we have available so again if you go to our website WWE kg MD okay so this
是我们的网站，您会注意到，如果您在这里参加心电图课程 is our website and what you'll notice is that if you go to the EKG course here
好的，您会发现不同的东西，所以请注意，我们有许多 okay you'll find stuff that's separate so notice that we have a number of
主题练习材料讲座是您贡献的一种方式，这是 topics practice material lectures a way for you to contribute and this is the
当然在这里，所以您会注意到我们有300多个视频左右，这就是 course here over here so you'll notice we have over 300 videos or so and that's
在YouTube上还有更多100多个，大约200个视频 more on YouTube there's another 100 more than 100 about 200 videos that are
本课程可以使用，所以这些是本课程中的独立视频 available with the course so those are separate videos in this course is really
旨在将您从初学者带入高级中级 designed to take you from a beginner to advanced intermediate
好吧，所以与您免费上网完全分开吧 okay so completely separate from what you're getting online for free okay
这些是随附的课程材料，因此请注意您有一本书 these are course material that comes with it so notice that you have a book
好的，然后您也可以使用袖珍指南，以便选择 okay and then you also have the pocket guide available so you can choose which
它们在口袋里的指南格式不同 format they are the same thing both these book in the pocket guide different
格式我真的很喜欢这个小格式，因为您可以将其保持白色 formats I really like this small one because you can keep it in your white
如果您在诊所或口袋里，这件外套真的很适合 coat if you're in the clinic or in your pocket and it's really available on the
现在去看书，你也会得到视频，所以 go now with the book you also get videos so
请注意，这些视频还可以，并且每页都有一个视频 notice these are the videos okay and these are a video for every single page
在那本书中，所以有30多个小时的视频练习 in that book so it's over 30 hours of video there's number of practice
我继续上传到那里的材料好吧，我们会有练习题 material that I continue to upload there okay we'll have practice questions
即将推出，因此所有功能都可以再次使用，这与所有免费功能分开 coming soon so all of that's available again this is separate from all the free
您已经可以使用的材料，所以这是更高产量的材料 material that you get already okay so this is more high-yield stuff this is
我们过去在这里教我们的技术人员和我们的学生的方式 what we used to teach our technicians here and our students here at Mayo
诊所，许多机构现在都在使用它，所以现在检查一下 Clinic and it's used now among many institutions so used check that out now
它也包括我们的卡尺，所以是的，您可以通过本课程获得卡尺 what it also includes our calipers so yes you get calipers with this course
好吧，我不认识其他提供这种服务的人，但是我确实得到了卡尺 okay I don't know anyone else that offers that but you do get calipers I
认为它们非常有帮助，如果您知道如何使用它们，您可以知道吗 think they're very helpful and they can you know if you know how to use them
正确地帮助识别正在发生的不同的心律失常，并且 correctly can help to identify different arrhythmias that are going on okay and
然后您还可以获得我们的袖珍心电图参考好的，这是我们 then you also get our pocket EKG reference ok this was something we've
当我们为同伴们开发课程时，将它们放在一起，这是 put together as we were developing course for the fellows and this is
真的很不错，正如您先前看到的，它的每件外套都很小 really nice it has every coat as you saw earlier laid out they're very small
可提供的袖珍指南我曾与同事博士合作过。 Peter Noseworthy是谁 pocket guide available I had help with my colleague dr. Peter Noseworthy who's
Mayo Clinic的EKG实验室负责人并对其进行编辑，所以这是 the head of the EKG lab here at Mayo Clinic and editing it so this is
我们使用过的东西对我们很有帮助，所以请转到心电图课程 something that we use and we found very helpful so go to the EKG course you'll
看讲座的例子好，为什么我们要发展这个好，很多 see examples of lectures ok why we develop this ok a lot of it came about
从自己努力学习jeez的父亲 from myself struggling with learning jeez having a father that was an
介入心脏病学家，你知道我还在努力，所以我的努力​​是 interventional cardiologist and you know still struggling so my struggle is a
我不想让你学习它们的斗争好吧，你可以阅读所有 struggle that I don't want you to have in learning them okay you can read all
那些入门书籍，但说实话，还不够好，您会发现 those introductory books but honestly they are not enough okay and you find
自己使用其他资源，这是学习过程的一部分 yourself using other resources which is part of the learning process
我想为您加快该过程，并降低其效率。 I wanted to expedite that process for you and make it less inefficient in
我通过心电图学习所经历的几乎是什么，所以再次从 pretty much what I struggled with going and learning through EKGs so again from
通过本课程的初学者到高级，您将获得有关卡尺的书 beginner to advanced level with this course you get the book the calipers the
编码参考视频访问正常，现在我们提供25％的优惠25％的优惠 coding reference video access okay and now we're offering 25% off 25% off put
该代码在结帐时输入，您将获得25％的折扣，即使是 that code in on checkout and you'll have yourself 25% off that will even it's
几乎涵盖了我们用来打印材料的成本，因此我们不会 pretty much covers the cost of what we use to print the material so we don't
确实可以赚很多钱，更多的是可以帮助我们的学习者成长并真正成为 really make much off it it's more to help our learners grow and really be
能够为患者护理做出贡献，这就是我们这样做并且我们喜欢这样做的原因 able to contribute to patient care that's why we do this and we love doing
非常感谢您的支持，如果您有任何疑问，请离开 it so thank you so much for your support if you have any questions just leave
他们在下面，我们很乐意回答他们，祝您有愉快的一天 them below and we're happy to answer them alright have a great day
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