<p begin="00:00:00.250" end="00:00:03.360" style="s2">[Music]</p>
<p begin="00:00:01.520" end="00:00:06.080" style="s2">we see you</p>
<p begin="00:00:03.360" end="00:00:08.240" style="s2">searching for clear answers</p>
<p begin="00:00:06.080" end="00:00:11.040" style="s2">when seconds count</p>
<p begin="00:00:08.240" end="00:00:14.400" style="s2">when all hands are on deck</p>
<p begin="00:00:11.040" end="00:00:17.920" style="s2">when patient access is paramount</p>
<p begin="00:00:14.400" end="00:00:20.720" style="s2">when touch and tactile replace sight</p>
<p begin="00:00:17.920" end="00:00:22.400" style="s2">when confidence is essential</p>
<p begin="00:00:20.720" end="00:00:24.080" style="s2">we see you</p>
<p begin="00:00:22.400" end="00:00:26.480" style="s2">ever evolving</p>
<p begin="00:00:24.080" end="00:00:28.160" style="s2">always exploring ways to advance your</p>
<p begin="00:00:26.480" end="00:00:31.620" style="s2">use of ultrasound</p>
<p begin="00:00:28.160" end="00:00:42.350" style="s2">to improve patient outcomes</p>
<p begin="00:00:31.620" end="00:00:42.350" style="s2">[Music]</p>
<p begin="00:00:43.840" end="00:00:48.559" style="s2">introducing the all-new sonosite lx</p>
<p begin="00:00:46.879" end="00:00:51.760" style="s2">designed for you</p>
<p begin="00:00:48.559" end="00:00:55.399" style="s2">sonasite lx optimal access</p>
<p begin="00:00:51.760" end="00:00:55.399" style="s2">unlimited potential</p>

<p begin="00:00:07.300" end="00:00:08.950">- [Narrator] A phased array transducer</p>
<p begin="00:00:08.950" end="00:00:11.310">with a cardiac or abdomen preset,</p>
<p begin="00:00:11.310" end="00:00:13.940">is used to perform an<br />ultrasound examination</p>
<p begin="00:00:13.940" end="00:00:17.690">of the inferior vena cava<br />to determine volume status.</p>
<p begin="00:00:17.690" end="00:00:20.190">Alternatively, a curved array transducer</p>
<p begin="00:00:20.190" end="00:00:23.040">with an abdominal preset may be used.</p>
<p begin="00:00:23.040" end="00:00:25.950">The patient is placed<br />in a supine position.</p>
<p begin="00:00:25.950" end="00:00:28.600">The transducer is placed longitudinally</p>
<p begin="00:00:28.600" end="00:00:31.820">below the xiphoid process,<br />with the orientation marker</p>
<p begin="00:00:31.820" end="00:00:34.000">directed toward the patient's head.</p>
<p begin="00:00:34.000" end="00:00:38.120">The liver is seen as a<br />homogeneous echogenic structure.</p>
<p begin="00:00:38.120" end="00:00:39.510">The diaphragm is seen</p>
<p begin="00:00:39.510" end="00:00:42.750">as a thin, hyperechoic<br />curvilinear structure</p>
<p begin="00:00:42.750" end="00:00:45.180">at the cranial surface of the liver.</p>
<p begin="00:00:45.180" end="00:00:47.650">The inferior vena cava is seen</p>
<p begin="00:00:47.650" end="00:00:50.190">as a dark, hyperechoic structure within</p>
<p begin="00:00:50.190" end="00:00:52.200">the posterior segment of the liver</p>
<p begin="00:00:52.200" end="00:00:55.200">that changes in diameter with respiration.</p>
<p begin="00:00:55.200" end="00:00:57.540">The aorta, which lies to the left side</p>
<p begin="00:00:57.540" end="00:00:58.750">of the patient's body,</p>
<p begin="00:00:58.750" end="00:01:01.860">can be visualized as a<br />dark, pulsatile structure</p>
<p begin="00:01:01.860" end="00:01:03.790">next to the vena cava.</p>
<p begin="00:01:03.790" end="00:01:06.530">The inferior vena cava<br />should be visualized</p>
<p begin="00:01:06.530" end="00:01:08.680">as it enters the right atrium.</p>
<p begin="00:01:08.680" end="00:01:12.070">The hepatic veins can be<br />seen as anechoic vessels,</p>
<p begin="00:01:12.070" end="00:01:13.540">coursing through the liver,</p>
<p begin="00:01:13.540" end="00:01:16.590">and draining into the inferior vena cava.</p>
<p begin="00:01:16.590" end="00:01:19.580">The transducer should be<br />swept from right to left</p>
<p begin="00:01:19.580" end="00:01:23.070">to identify the largest<br />anterioposterior diameter</p>
<p begin="00:01:23.070" end="00:01:24.750">of the vena cava.</p>
<p begin="00:01:24.750" end="00:01:28.540">The transducer is then placed<br />in a transverse orientation</p>
<p begin="00:01:28.540" end="00:01:30.680">below the xiphoid process.</p>
<p begin="00:01:30.680" end="00:01:32.710">The orientation marker is directed</p>
<p begin="00:01:32.710" end="00:01:34.630">towards the patient's right.</p>
<p begin="00:01:34.630" end="00:01:37.650">The transducer is angled<br />up toward the chest</p>
<p begin="00:01:37.650" end="00:01:41.190">to obtain a sub-xiphoid cardiac<br />view of the right atrium,</p>
<p begin="00:01:41.190" end="00:01:43.730">into which the vena cava drains.</p>
<p begin="00:01:43.730" end="00:01:46.600">The transducer is slowly<br />angled towards the spine</p>
<p begin="00:01:46.600" end="00:01:48.070">to follow the vena cava,</p>
<p begin="00:01:48.070" end="00:01:51.460">which will appear as an<br />anechoic circular structure.</p>
<p begin="00:01:51.460" end="00:01:55.050">The hepatic veins will be seen<br />draining into the vena cava</p>
<p begin="00:01:55.050" end="00:01:58.260">in a pattern similar to bunny ears.</p>
<p begin="00:01:58.260" end="00:02:00.400">The diameter, collapsibility,</p>
<p begin="00:02:00.400" end="00:02:03.300">and distensibility of<br />the vena cava can be used</p>
<p begin="00:02:03.300" end="00:02:05.920">to assess hemodynamic status.</p>
<p begin="00:02:05.920" end="00:02:09.580">There is wide variability in<br />the diameter of the vena cava.</p>
<p begin="00:02:09.580" end="00:02:13.500">However, in general, a maximal<br />caval diameter less than</p>
<p begin="00:02:13.500" end="00:02:17.470">1.5 centimeters is consistent<br />with low volume status.</p>
<p begin="00:02:17.470" end="00:02:20.580">And a diameter greater<br />than 2.5 centimeters</p>
<p begin="00:02:20.580" end="00:02:24.780">is associated with fluid<br />overload or obstructive shock.</p>
<p begin="00:02:24.780" end="00:02:27.780">To obtain the caval<br />diameter in long access,</p>
<p begin="00:02:27.780" end="00:02:31.140">the image is frozen during<br />expiration when the vena cava</p>
<p begin="00:02:31.140" end="00:02:33.320">is at its largest diameter.</p>
<p begin="00:02:33.320" end="00:02:37.860">The caval diameter should also<br />be evaluated in short access.</p>
<p begin="00:02:37.860" end="00:02:41.540">The diameter of the vena<br />cava changes up to 50%</p>
<p begin="00:02:41.540" end="00:02:43.470">with inspiration in normal,</p>
<p begin="00:02:43.470" end="00:02:45.980">spontaneously breathing patients.</p>
<p begin="00:02:45.980" end="00:02:48.980">Complete collapse of the<br />vena cava during inspiration</p>
<p begin="00:02:48.980" end="00:02:51.560">is associated with hypovolemia.</p>
<p begin="00:02:51.560" end="00:02:54.860">While patients with obstructive<br />or cardiogenic shock</p>
<p begin="00:02:54.860" end="00:02:57.843">exhibit minimal variation<br />during inspiration.</p>
<p begin="00:02:57.843" end="00:03:01.410">The inferior vena cava<br />collapsibility index</p>
<p begin="00:03:01.410" end="00:03:03.930">is a dynamic, non-invasive parameter</p>
<p begin="00:03:03.930" end="00:03:07.540">to evaluate the potential<br />benefit of volume expansion.</p>
<p begin="00:03:07.540" end="00:03:09.790">It is calculated as the difference between</p>
<p begin="00:03:09.790" end="00:03:13.250">the maximum diameter and the<br />minimum diameter of the cava,</p>
<p begin="00:03:13.250" end="00:03:16.510">divided by the maximum of the two values.</p>
<p begin="00:03:16.510" end="00:03:19.360">M-mode can be used to<br />obtain the caval index</p>
<p begin="00:03:19.360" end="00:03:22.340">by placing the M-mode<br />cursor though the vena cava,</p>
<p begin="00:03:22.340" end="00:03:25.150">one to two centimeters<br />distal to its junction</p>
<p begin="00:03:25.150" end="00:03:26.440">with the hepatic veins</p>
<p begin="00:03:26.440" end="00:03:28.930">to obtain an M-mode tracing.</p>
<p begin="00:03:28.930" end="00:03:32.420">If minimal variation is seen,<br />the patient can be instructed</p>
<p begin="00:03:32.420" end="00:03:34.920">to take a quick inspiration or sniff</p>
<p begin="00:03:34.920" end="00:03:36.770">during the M-mode recording.</p>
<p begin="00:03:36.770" end="00:03:39.670">The caval diameter should<br />be seen to rapidly change</p>
<p begin="00:03:39.670" end="00:03:41.840">in diameter with this maneuver.</p>
<p begin="00:03:41.840" end="00:03:45.450">A high caval index is<br />associated with hypovolemia</p>
<p begin="00:03:45.450" end="00:03:47.490">or a distributive shock.</p>
<p begin="00:03:47.490" end="00:03:50.080">A low caval index can be seen in patients</p>
<p begin="00:03:50.080" end="00:03:52.070">with acute congestive heart failure,</p>
<p begin="00:03:52.070" end="00:03:55.050">cardiac tamponade, tension pneumothorax,</p>
<p begin="00:03:55.050" end="00:03:57.509">or massive pulmonary embolism.</p>
<p begin="00:03:57.509" end="00:04:00.980">Caval diameter in mechanically<br />ventilated patients</p>
<p begin="00:04:00.980" end="00:04:03.623">does not accurately reflect volume status.</p>

<p begin="00:00:00.670" end="00:00:02.040">- My name is Dr. Steve Schneider,</p>
<p begin="00:00:02.040" end="00:00:04.080">I'm President of Saint Mary's Hospital,</p>
<p begin="00:00:04.080" end="00:00:06.440">we're located in Waterbury, Connecticut.</p>
<p begin="00:00:06.440" end="00:00:10.610" tts:origin="0% 0%">We've been in Waterbury<br />for over 100 years,</p>
<p begin="00:00:10.610" end="00:00:12.670">we are a faith based organization</p>
<p begin="00:00:12.670" end="00:00:16.500">that serves a population<br />of about 300,000 people.</p>
<p begin="00:00:16.500" end="00:00:18.753" tts:origin="0% 0%">- Saint Mary's Hospital is<br />a level two trauma center.</p>
<p begin="00:00:18.753" end="00:00:23.560" tts:origin="0% 0%">We do anywhere between<br />3,000 to 5,000 surgeries</p>
<p begin="00:00:23.560" end="00:00:24.600">on a yearly basis.</p>
<p begin="00:00:24.600" end="00:00:26.670">- The thing I love about Saint Mary's</p>
<p begin="00:00:26.670" end="00:00:28.680" tts:origin="0% 0%">is we don't wanna just<br />take care of people now,</p>
<p begin="00:00:28.680" end="00:00:30.990" tts:origin="0% 0%">we wanna learn how they<br />should be taken care of</p>
<p begin="00:00:30.990" end="00:00:33.130">a couple of years from now<br />and the only way to do that</p>
<p begin="00:00:33.130" end="00:00:34.720">is to embrace the technology</p>
<p begin="00:00:34.720" end="00:00:36.690">that's out there, like ultrasound.</p>
<p begin="00:00:36.690" end="00:00:41.370" tts:origin="0% 0%">- Certainly ultrasound is<br />one of the most important</p>
<p begin="00:00:41.370" end="00:00:45.500">functionalities that we<br />as anesthesiologists use.</p>
<p begin="00:00:45.500" end="00:00:47.770">- The way we've used ultrasound<br />for enhanced recovery</p>
<p begin="00:00:47.770" end="00:00:50.934">has revolutionized any<br />kind of surgery that I do.</p>
<p begin="00:00:50.934" end="00:00:53.650">- One patient was really terrified,</p>
<p begin="00:00:53.650" end="00:00:56.770">not about her condition,<br />but she was more concerned</p>
<p begin="00:00:56.770" end="00:00:59.030">about the narcotic use.</p>
<p begin="00:00:59.030" end="00:01:02.470" tts:origin="0% 0%">- I had enough to worry<br />about, just being scared</p>
<p begin="00:01:02.470" end="00:01:04.380" tts:origin="0% 0%">of having that tumor, having cancer,</p>
<p begin="00:01:04.380" end="00:01:05.810">and having to go through chemo,</p>
<p begin="00:01:05.810" end="00:01:08.510">I didn't want something<br />else to have to worry about.</p>
<p begin="00:01:08.510" end="00:01:10.749">- Alicia is a lot younger than the typical</p>
<p begin="00:01:10.749" end="00:01:13.870">colon cancer patient, the<br />thing that really concerned her</p>
<p begin="00:01:13.870" end="00:01:16.080">about her surgery though,<br />is that she had somebody</p>
<p begin="00:01:16.080" end="00:01:18.890">that she loved who<br />became a narcotic addict</p>
<p begin="00:01:18.890" end="00:01:21.110">several years before after a car accident.</p>
<p begin="00:01:21.110" end="00:01:22.810">- So, when I went to see Dr. Corvo,</p>
<p begin="00:01:22.810" end="00:01:24.580">he let me know that<br />there was an alternative</p>
<p begin="00:01:24.580" end="00:01:26.710">to narcotics, using nerve block.</p>
<p begin="00:01:26.710" end="00:01:29.360">- [Philip] Our anesthesiologists<br />will do something</p>
<p begin="00:01:29.360" end="00:01:32.240">called a TAP block and<br />under ultrasound guidance,</p>
<p begin="00:01:32.240" end="00:01:34.710">they will put a bolus of this medication</p>
<p begin="00:01:34.710" end="00:01:35.900">right on top of the nerve.</p>
<p begin="00:01:35.900" end="00:01:38.120">And our patients wake up sometimes feeling</p>
<p begin="00:01:38.120" end="00:01:39.570">absolutely no pain at all.</p>
<p begin="00:01:39.570" end="00:01:41.830">- [Alicia] It was a short<br />stay, which was great.</p>
<p begin="00:01:41.830" end="00:01:45.090">- It's basically a trade off<br />of doing a 10 minute procedure</p>
<p begin="00:01:45.090" end="00:01:47.680">just before we operate and<br />yet the patient goes home</p>
<p begin="00:01:47.680" end="00:01:48.920">four days earlier.</p>
<p begin="00:01:48.920" end="00:01:50.774">So the trade off is 10<br />minutes for four days,</p>
<p begin="00:01:50.774" end="00:01:53.280">I don't think I've ever<br />seen a return on investment</p>
<p begin="00:01:53.280" end="00:01:54.230">that good anywhere.</p>
<p begin="00:01:54.230" end="00:01:56.677">- Ultrasound enables us to do that safely</p>
<p begin="00:01:56.677" end="00:01:59.060">and efficiently and effectively.</p>
<p begin="00:01:59.060" end="00:02:00.830">- It was a great<br />experience with Dr. Corvo,</p>
<p begin="00:02:00.830" end="00:02:04.290">he's an amazing doctor, I think<br />he's an angel from heaven,</p>
<p begin="00:02:04.290" end="00:02:05.631">he saved my life you know.</p>
<p begin="00:02:05.631" end="00:02:07.920">Everything went well and really great,</p>
<p begin="00:02:07.920" end="00:02:09.520">just a great experience overall.</p>
<p begin="00:02:11.180" end="00:02:14.780">- There is a new metric<br />that Medicare is following,</p>
<p begin="00:02:14.780" end="00:02:17.490">something called an ORAE, which stands for</p>
<p begin="00:02:17.490" end="00:02:20.120">an opioid‐related adverse event.</p>
<p begin="00:02:20.120" end="00:02:23.050">The first full year that we actually had</p>
<p begin="00:02:23.050" end="00:02:25.210">this enhanced protocol in place,</p>
<p begin="00:02:25.210" end="00:02:28.140">our ORAE complication rate was so low</p>
<p begin="00:02:28.140" end="00:02:29.830">that it was incalculable.</p>
<p begin="00:02:29.830" end="00:02:31.800">- Sonosite's been a great<br />partner to work with,</p>
<p begin="00:02:31.800" end="00:02:36.450">our patient satisfaction<br />scores are directly tied to</p>
<p begin="00:02:36.450" end="00:02:39.640">how patients feel about<br />their experience here</p>
<p begin="00:02:39.640" end="00:02:41.890">and this has been a<br />real patient satisfyer.</p>
<p begin="00:02:41.890" end="00:02:44.816">- Infection rate goes lower,<br />patient satisfaction's better,</p>
<p begin="00:02:44.816" end="00:02:47.080">safety is significantly better,</p>
<p begin="00:02:47.080" end="00:02:50.430">and, unlike almost every other<br />new technology out there,</p>
<p begin="00:02:50.430" end="00:02:51.710">we make make money doing it.</p>
<p begin="00:02:51.710" end="00:02:56.200">- Sonosite ultrasound makes my<br />job easier, really every day.</p>
<p begin="00:02:56.200" end="00:02:58.670">The image quality is superior</p>
<p begin="00:02:58.670" end="00:03:01.380">and the ultrasound machine is portable.</p>
<p begin="00:03:01.380" end="00:03:02.550">- [Philip] So that if we have a patient</p>
<p begin="00:03:02.550" end="00:03:04.560">in the emergency room that ends up going</p>
<p begin="00:03:04.560" end="00:03:06.310">to the operating room, we<br />can follow them with it.</p>
<p begin="00:03:06.310" end="00:03:07.950">If there's any education that we use,</p>
<p begin="00:03:07.950" end="00:03:11.190">Sonosite is right there<br />willing to be partners with us.</p>
<p begin="00:03:11.190" end="00:03:14.690">- It's an investment, not<br />only in the technology,</p>
<p begin="00:03:14.690" end="00:03:18.053">but in better care of the<br />patients and better outcomes.</p>
<p begin="00:03:19.230" end="00:03:21.650">- [Steven] Saint Mary's is<br />a very interesting hospital</p>
<p begin="00:03:21.650" end="00:03:24.280">to be in, because it has a rich tradition.</p>
<p begin="00:03:24.280" end="00:03:27.290">It was founded by nuns<br />almost 120 years ago,</p>
<p begin="00:03:27.290" end="00:03:29.170">some of the buildings we still operate in</p>
<p begin="00:03:29.170" end="00:03:31.390">are 75 to 100 years old.</p>
<p begin="00:03:31.390" end="00:03:34.230">That is a really wonderful part, is to see</p>
<p begin="00:03:34.230" end="00:03:38.070">that side by side contrast<br />between the rich tradition</p>
<p begin="00:03:38.070" end="00:03:40.615">and the use of modern technology.</p>
<p begin="00:03:40.615" end="00:03:43.198">(upbeat music)</p>

<p begin="00:00:00.408" end="00:00:02.720">(gentle music)</p>
<p begin="00:00:02.720" end="00:00:04.720">- [Man] If we're going to use<br />the technology for anything,</p>
<p begin="00:00:04.720" end="00:00:07.290">we have to have a clear list of reasons</p>
<p begin="00:00:07.290" end="00:00:09.061">why there's benefits to it.</p>
<p begin="00:00:09.061" end="00:00:11.670">(upbeat music)</p>
<p begin="00:00:11.670" end="00:00:14.490">And using point-of-care<br />Sonosite Ultrasound,</p>
<p begin="00:00:14.490" end="00:00:17.363">almost any technique that<br />we do ends up being safer.</p>
<p begin="00:00:20.666" end="00:00:22.600">- Currently there's an opioid crisis.</p>
<p begin="00:00:22.600" end="00:00:23.640">Patients are afraid</p>
<p begin="00:00:23.640" end="00:00:26.780">that they're going to get<br />addicted to narcotics.</p>
<p begin="00:00:26.780" end="00:00:29.870">- Anything we can do to<br />minimize side effects</p>
<p begin="00:00:29.870" end="00:00:32.870">through an opioid sparing<br />technique is ideal.</p>
<p begin="00:00:32.870" end="00:00:35.500">Regional techniques play<br />a huge role in that,</p>
<p begin="00:00:35.500" end="00:00:38.420">and ultrasound enables us to do that</p>
<p begin="00:00:38.420" end="00:00:39.883">safely and efficiently.</p>
<p begin="00:00:40.960" end="00:00:43.710">(triumphant music)</p>
<p begin="00:00:43.710" end="00:00:46.770">- Putting the patient first,<br />giving them the best care,</p>
<p begin="00:00:46.770" end="00:00:49.270">the best technology, and the best staff</p>
<p begin="00:00:49.270" end="00:00:52.890">that we can deliver to them is<br />really the soundest strategy</p>
<p begin="00:00:52.890" end="00:00:53.973">to be successful.</p>
<p begin="00:00:55.752" end="00:00:58.335" tts:origin="0% 0%">(gentle music)</p>

<p begin="00:00:00.148" end="00:00:02.648">(calm music)</p>

<p begin="00:00:00.235" end="00:00:03.735">(bright electronic music)</p>
<p begin="00:00:09.950" end="00:00:13.058">- [Robert] The ejection<br />fraction method is cumbersome</p>
<p begin="00:00:13.058" end="00:00:14.400">and quite involved.</p>
<p begin="00:00:14.400" end="00:00:17.600">That anterior mitral-valve<br />leaflet effectively comes up</p>
<p begin="00:00:17.600" end="00:00:19.903">and touches the interventricular septum.</p>
<p begin="00:00:20.770" end="00:00:25.350">Now, here are the four<br />broad classifications</p>
<p begin="00:00:25.350" end="00:00:30.350">side-by-side for you to once<br />again look at and review</p>
<p begin="00:00:30.590" end="00:00:33.003">that the right heart may be failing.</p>

<p begin="00:00:05.215" end="00:00:07.798" region="r2" style="s2">
(upbeat music)</p>
<p begin="00:00:24.522" end="00:00:27.605" region="r3" style="s2">
(music intensifies)</p>

<p begin="00:00:00.238" end="00:00:03.905">(traditional African music)</p>
<p begin="00:00:14.380" end="00:00:17.140" tts:origin="0% 0%">- It's always hard for me to<br />pick my most memorable moments,</p>
<p begin="00:00:17.140" end="00:00:19.897" tts:origin="0% 0%">'cause there's so many<br />interesting pieces, I guess.</p>
<p begin="00:00:19.897" end="00:00:22.480">(upbeat music)</p>
<p begin="00:00:24.620" end="00:00:27.140">We focus on the most rural,</p>
<p begin="00:00:27.140" end="00:00:29.650">under-serviced parts of the population,</p>
<p begin="00:00:29.650" end="00:00:32.820">and so those are the people<br />that are often forgotten.</p>
<p begin="00:00:32.820" end="00:00:34.940">And so what we're trying to do is come up</p>
<p begin="00:00:34.940" end="00:00:39.260">with an innovative solution to<br />bring an accurate diagnosis,</p>
<p begin="00:00:39.260" end="00:00:41.200">and health care in<br />general, to those people</p>
<p begin="00:00:41.200" end="00:00:43.420">in those rural areas where getting access</p>
<p begin="00:00:43.420" end="00:00:45.500" tts:origin="0% 0%">to good medicine is just impossible.</p>
<p begin="00:00:45.500" end="00:00:47.200" tts:origin="0% 0%">- For the people we're working with</p>
<p begin="00:00:47.200" end="00:00:49.930" tts:origin="0% 0%">in rural Uganda and rural Kenya,</p>
<p begin="00:00:49.930" end="00:00:52.730">they don't really have the<br />choice between ultrasound</p>
<p begin="00:00:52.730" end="00:00:55.630">or another diagnostic imaging technology,</p>
<p begin="00:00:55.630" end="00:00:58.400">like CT or MRI.</p>
<p begin="00:00:58.400" end="00:01:00.180">It's really ultrasound or nothing.</p>
<p begin="00:01:00.180" end="00:01:02.520">Just being able to have<br />an ultrasound machine</p>
<p begin="00:01:02.520" end="00:01:06.273">that can be brought out<br />to them is life-changing.</p>
<p begin="00:01:06.273" end="00:01:09.356">(bright piano music)</p>

<p begin="00:00:00.454" end="00:00:03.537">(gentle piano music)</p>
<p begin="00:00:06.200" end="00:00:09.310" tts:origin="0% 0%">- So, we had a patient in the field</p>
<p begin="00:00:09.310" end="00:00:11.770" tts:origin="0% 0%">who came to one of our outreach programs</p>
<p begin="00:00:11.770" end="00:00:13.320" tts:origin="0% 0%">who was extremely sick.</p>
<p begin="00:00:13.320" end="00:00:17.940">He had a fever, was coughing<br />for a good probably two weeks</p>
<p begin="00:00:17.940" end="00:00:20.080">and developed chest<br />pain and was in and out</p>
<p begin="00:00:20.080" end="00:00:22.500">of different hospitals,<br />not really getting better</p>
<p begin="00:00:22.500" end="00:00:24.630">in spite of different types of treatments.</p>
<p begin="00:00:24.630" end="00:00:26.050">So, when he came to our clinic,</p>
<p begin="00:00:26.050" end="00:00:29.240">his blood pressure was low,<br />he was breathing really hard,</p>
<p begin="00:00:29.240" end="00:00:31.910">and he actually sort of fell<br />down in the middle of our tent.</p>
<p begin="00:00:31.910" end="00:00:34.120">So, we started giving him IV fluids,</p>
<p begin="00:00:34.120" end="00:00:37.460">and then we got an initial<br />ultrasound to look at his heart.</p>
<p begin="00:00:37.460" end="00:00:39.540">We found out that the heart looked okay.</p>
<p begin="00:00:39.540" end="00:00:40.900">Because he was having the chest pain,</p>
<p begin="00:00:40.900" end="00:00:43.150">we were worried maybe he<br />had a more rare infection</p>
<p begin="00:00:43.150" end="00:00:44.140">of the heart.</p>
<p begin="00:00:44.140" end="00:00:45.930">Then we looked at the lungs<br />and we went oh my God,</p>
<p begin="00:00:45.930" end="00:00:49.070">his lungs are full of<br />pneumonia and bacteria.</p>
<p begin="00:00:49.070" end="00:00:51.780">So, we started him on<br />intravenous antibiotics,</p>
<p begin="00:00:51.780" end="00:00:53.793">and we actually brought<br />him back to KIHEFO.</p>
<p begin="00:00:55.370" end="00:00:57.560">Then, basically once<br />he got back to KIHEFO,</p>
<p begin="00:00:57.560" end="00:01:00.340">he wasn't quite getting<br />better after the first day.</p>
<p begin="00:01:00.340" end="00:01:04.210">So, then we did another scan<br />of his lungs at that point,</p>
<p begin="00:01:04.210" end="00:01:08.200">and we realized that there<br />was really bad infection</p>
<p begin="00:01:08.200" end="00:01:10.370">all the way from top to bottom,</p>
<p begin="00:01:10.370" end="00:01:12.560">and we were trying to figure<br />out could he have fluid</p>
<p begin="00:01:12.560" end="00:01:15.960">on the lung, and unfortunately,<br />it wasn't really possible</p>
<p begin="00:01:15.960" end="00:01:18.310">to get any sort of x-ray<br />to figure that out,</p>
<p begin="00:01:18.310" end="00:01:19.700">but because we had the ultrasound,</p>
<p begin="00:01:19.700" end="00:01:22.140">we were able to make a<br />decision that he did not need</p>
<p begin="00:01:22.140" end="00:01:24.610">to have a tube put into<br />his lung to drain fluid</p>
<p begin="00:01:24.610" end="00:01:26.020">that wasn't there</p>
<p begin="00:01:26.020" end="00:01:27.340">because we couldn't hear any noises</p>
<p begin="00:01:27.340" end="00:01:29.420">when we were listening<br />with our stethoscopes.</p>
<p begin="00:01:29.420" end="00:01:31.360">So had we not had the ultrasound,</p>
<p begin="00:01:31.360" end="00:01:32.340">we might've ended up doing</p>
<p begin="00:01:32.340" end="00:01:34.053">a procedure unnecessarily for him.</p>