<p begin="00:00:08.821" end="00:00:10.922" style="s2">- [Voiceover] So basically<br />what we're doing initially</p>
<p begin="00:00:10.922" end="00:00:13.005" style="s2">is just putting numbing medication in.</p>
<p begin="00:00:13.005" end="00:00:14.989" style="s2">And so we'll numb up<br />the skin of the breast</p>
<p begin="00:00:14.989" end="00:00:18.787" style="s2">and then the underlying breast tissue.</p>
<p begin="00:00:18.787" end="00:00:19.951" style="s2">- Do you feel this?</p>
<p begin="00:00:19.951" end="00:00:20.850" style="s2">- [Patient] A little bit.</p>
<p begin="00:00:20.850" end="00:00:21.683" style="s2">- [Doctor] A little bit, yeah,</p>
<p begin="00:00:21.683" end="00:00:23.184" style="s2">this is on the other side of it.</p>
<p begin="00:00:23.184" end="00:00:24.134" style="s2">- [Patient] On and off.</p>
<p begin="00:00:24.134" end="00:00:25.147" style="s2">- Okay.</p>
<p begin="00:00:25.147" end="00:00:27.024" style="s2">If you look up on the screen,</p>
<p begin="00:00:27.024" end="00:00:28.680" style="s2">you can see the fibroadenoma to the right.</p>
<p begin="00:00:28.680" end="00:00:31.430" style="s2">And then the numbing medication's</p>
<p begin="00:00:33.573" end="00:00:36.859" style="s2">going all the way over to the back side.</p>
<p begin="00:00:36.859" end="00:00:38.692" style="s2">And then I'm gonna put<br />some up over the top,</p>
<p begin="00:00:38.692" end="00:00:40.910" style="s2">which does two things.</p>
<p begin="00:00:40.910" end="00:00:43.628" style="s2">One is it gives us some numbing up top,</p>
<p begin="00:00:43.628" end="00:00:45.975" style="s2">but the other is, see how<br />close this fibroadenoma</p>
<p begin="00:00:45.975" end="00:00:46.808" style="s2">is to her skin.</p>
<p begin="00:00:46.808" end="00:00:50.000" style="s2">Once we start the freezing,<br />we need to protect that skin.</p>
<p begin="00:00:50.000" end="00:00:51.695" style="s2">Otherwise, she's gonna<br />get frostbite, and then</p>
<p begin="00:00:51.695" end="00:00:55.559" style="s2">it sort of defeats the purpose<br />of a nice cosmetic procedure.</p>
<p begin="00:00:55.559" end="00:00:59.222" style="s2">So in putting some numbing<br />up here, it gives you</p>
<p begin="00:00:59.222" end="00:01:02.034" style="s2">the anesthetic effect, but it<br />also drops that fibroadenoma</p>
<p begin="00:01:02.034" end="00:01:05.856" style="s2">down and gives us a little room<br />for that ice to do its job.</p>
<p begin="00:01:05.856" end="00:01:07.797" style="s2">And then the last thing I'm<br />gonna do is put some numbing</p>
<p begin="00:01:07.797" end="00:01:12.593" style="s2">actually underneath it,<br />because it's not only close</p>
<p begin="00:01:12.593" end="00:01:16.195" style="s2">to the skin, but this line down here</p>
<p begin="00:01:16.195" end="00:01:18.931" style="s2">is her pectoralis muscle underneath.</p>
<p begin="00:01:18.931" end="00:01:21.571" style="s2">So sometimes as that ice freezes, it kinda</p>
<p begin="00:01:21.571" end="00:01:23.738" style="s2">gets real cold on the pec.</p>
<p begin="00:01:25.039" end="00:01:27.622" style="s2">So we'll put some numbing down.</p>
<p begin="00:01:29.025" end="00:01:33.742" style="s2">So you probably will feel<br />this a little bit more.</p>
<p begin="00:01:33.742" end="00:01:36.609" style="s2">This is actually a step<br />we don't always do.</p>
<p begin="00:01:36.609" end="00:01:41.405" style="s2">In fact, if I've done the core<br />biopsy, this is already done.</p>
<p begin="00:01:41.405" end="00:01:43.767" style="s2">It's pretty standard when<br />you do biopsies on things</p>
<p begin="00:01:43.767" end="00:01:46.017" style="s2">to leave a marker in place.</p>
<p begin="00:01:48.604" end="00:01:51.193" style="s2">And especially with this<br />procedure because eventually</p>
<p begin="00:01:51.193" end="00:01:54.876" style="s2">the goal is gonna be that<br />the fibroadenoma goes away.</p>
<p begin="00:01:54.876" end="00:01:58.615" style="s2">We want basically a record<br />on her subsequent mammograms</p>
<p begin="00:01:58.615" end="00:02:01.367" style="s2">and images where it was.</p>
<p begin="00:02:01.367" end="00:02:03.950" style="s2">Okay, go ahead and get started.</p>
<p begin="00:02:05.035" end="00:02:06.808" style="s2">So you're gonna hear a<br />lot of noises over here,</p>
<p begin="00:02:06.808" end="00:02:08.171" style="s2">and you're gonna hear the machine turn on,</p>
<p begin="00:02:08.171" end="00:02:11.200" style="s2">and then you're gonna hear this<br />kind of chug chugging noise.</p>
<p begin="00:02:11.200" end="00:02:12.033" style="s2">Go ahead.</p>
<p begin="00:02:13.642" end="00:02:15.751" style="s2">So what you'll see if you're<br />watching on the screen,</p>
<p begin="00:02:15.751" end="00:02:17.802" style="s2">you see the probe there,<br />and you see it starting</p>
<p begin="00:02:17.802" end="00:02:19.552" style="s2">to get black behind it.</p>
<p begin="00:02:19.552" end="00:02:20.922" style="s2">That's because the ultrasound waves</p>
<p begin="00:02:20.922" end="00:02:22.216" style="s2">can't go through the ice.</p>
<p begin="00:02:22.216" end="00:02:24.021" style="s2">You'll see that double<br />white line get higher</p>
<p begin="00:02:24.021" end="00:02:25.631" style="s2">and higher and higher.</p>
<p begin="00:02:25.631" end="00:02:29.798" style="s2">And that's just as it's starting<br />to engulf the whole thing.</p>
<p begin="00:02:34.463" end="00:02:35.977" style="s2">It sort of eclipses it.</p>
<p begin="00:02:35.977" end="00:02:37.713" style="s2">As you can see, you have<br />to have the probe centered</p>
<p begin="00:02:37.713" end="00:02:40.423" style="s2">directly in the middle of the lesion.</p>
<p begin="00:02:40.423" end="00:02:43.229" style="s2">This is not something you<br />can just do by palpation</p>
<p begin="00:02:43.229" end="00:02:44.826" style="s2">or just by feel.</p>
<p begin="00:02:44.826" end="00:02:47.024" style="s2">I think there's some<br />surgeons that probably work</p>
<p begin="00:02:47.024" end="00:02:49.628" style="s2">with radiologists and<br />maybe have the radiologist</p>
<p begin="00:02:49.628" end="00:02:50.961" style="s2">place the probe.</p>
<p begin="00:02:52.218" end="00:02:54.600" style="s2">I'm not sure why then the surgeon's</p>
<p begin="00:02:54.600" end="00:02:57.100" style="s2">actually treating the patient.</p>
<p begin="00:02:58.651" end="00:03:00.815" style="s2">So you absolutely have<br />to, you just can't do</p>
<p begin="00:03:00.815" end="00:03:03.648" style="s2">this procedure without ultrasound.</p>
<p begin="00:03:04.521" end="00:03:06.983" style="s2">But the image quality is,</p>
<p begin="00:03:06.983" end="00:03:10.097" style="s2">I mean you're not gonna<br />get much better than this.</p>
<p begin="00:03:10.097" end="00:03:11.500" style="s2">No matter how much pay for the system,</p>
<p begin="00:03:11.500" end="00:03:14.408" style="s2">no matter how much it weighs.</p>
<p begin="00:03:14.408" end="00:03:16.160" style="s2">And so when you consider<br />you're getting this incredible</p>
<p begin="00:03:16.160" end="00:03:19.382" style="s2">image quality and the functionality,</p>
<p begin="00:03:19.382" end="00:03:20.617" style="s2">or I can just pack this up and take it</p>
<p begin="00:03:20.617" end="00:03:22.481" style="s2">to the operating room, throw<br />it in the trunk of my car</p>
<p begin="00:03:22.481" end="00:03:25.542" style="s2">and not have to worry about it.</p>
<p begin="00:03:25.542" end="00:03:27.841" style="s2">You don't get that with any other system.</p>
<p begin="00:03:27.841" end="00:03:32.008" style="s2">And what they've been able<br />to do is not just keep pace</p>
<p begin="00:03:32.961" end="00:03:37.129" style="s2">with everybody else, but<br />really surpass everybody else.</p>
<p begin="00:03:37.129" end="00:03:40.390" style="s2">And everybody else is<br />trying to catch up to them.</p>
<p begin="00:03:40.390" end="00:03:42.880" style="s2">When I got my 180 Plus, they<br />were the only hand-carried</p>
<p begin="00:03:42.880" end="00:03:46.047" style="s2">ultrasound on the market back in 2002.</p>
<p begin="00:03:47.777" end="00:03:49.227" style="s2">Like I said, with each generation,</p>
<p begin="00:03:49.227" end="00:03:51.439" style="s2">it just gets better and better.</p>
<p begin="00:03:51.439" end="00:03:53.937" style="s2">And I don't know what<br />GE's customer support is</p>
<p begin="00:03:53.937" end="00:03:58.035" style="s2">or anybody else, but I'm not<br />necessarily willing to try.</p>
<p begin="00:03:58.035" end="00:03:59.593" style="s2">I mean, I've got a clinical specialist</p>
<p begin="00:03:59.593" end="00:04:01.994" style="s2">that I started with back in 2002.</p>
<p begin="00:04:01.994" end="00:04:04.526" style="s2">If I have a question, Jody's here.</p>
<p begin="00:04:04.526" end="00:04:08.934" style="s2">You're not gonna get that<br />with a lot of other companies.</p>
<p begin="00:04:08.934" end="00:04:11.614" style="s2">So, from all ends, it's<br />not only that they make</p>
<p begin="00:04:11.614" end="00:04:14.606" style="s2">what I think is a superior<br />product, but they have</p>
<p begin="00:04:14.606" end="00:04:17.817" style="s2">superior customer service too.</p>
<p begin="00:04:17.817" end="00:04:21.293" style="s2">I had the opportunity<br />about a year or so ago</p>
<p begin="00:04:21.293" end="00:04:25.525" style="s2">to go and actually, I'd<br />never taken the plant visit,</p>
<p begin="00:04:25.525" end="00:04:26.746" style="s2">the assembly line and everything,</p>
<p begin="00:04:26.746" end="00:04:29.688" style="s2">and watch how they drop<br />test these and everything.</p>
<p begin="00:04:29.688" end="00:04:32.617" style="s2">We get a little nervous<br />if we kinda slip with it,</p>
<p begin="00:04:32.617" end="00:04:36.784" style="s2">but they throw all of these<br />on the floor under force.</p>
<p begin="00:04:37.668" end="00:04:38.918" style="s2">You doing okay?</p>
<p begin="00:04:39.915" end="00:04:41.915" style="s2">Minute 12 seconds to go.</p>
<p begin="00:04:43.819" end="00:04:45.751" style="s2">And they warranty them.</p>
<p begin="00:04:45.751" end="00:04:47.780" style="s2">There's a five-year warranty on these</p>
<p begin="00:04:47.780" end="00:04:50.407" style="s2">that basically covers everything.</p>
<p begin="00:04:50.407" end="00:04:53.453" style="s2">You're not gonna get that<br />with too many other products.</p>
<p begin="00:04:53.453" end="00:04:54.819" style="s2">And not only do they replace it,</p>
<p begin="00:04:54.819" end="00:04:57.986" style="s2">they FedEx it to you the next morning.</p>
<p begin="00:04:59.292" end="00:05:00.953" style="s2">If there were any technical issues,</p>
<p begin="00:05:00.953" end="00:05:02.995" style="s2">we never had a technical<br />problem with the MicroMaxx,</p>
<p begin="00:05:02.995" end="00:05:05.191" style="s2">and we've not had one with our Turbo yet.</p>
<p begin="00:05:05.191" end="00:05:08.008" style="s2">But if there were, all I have<br />to do is make a phone call</p>
<p begin="00:05:08.008" end="00:05:10.513" style="s2">and I've got one the next morning.</p>
<p begin="00:05:10.513" end="00:05:12.121" style="s2">Because, again, I can't<br />practice without it.</p>
<p begin="00:05:12.121" end="00:05:13.788" style="s2">They recognize that.</p>
<p begin="00:05:15.695" end="00:05:17.230" style="s2">And if I really needed<br />it by that afternoon,</p>
<p begin="00:05:17.230" end="00:05:19.424" style="s2">they'd probably figure<br />out a way to do that too.</p>
<p begin="00:05:19.424" end="00:05:20.257" style="s2">How much?</p>
<p begin="00:05:20.257" end="00:05:21.090" style="s2">Okay.</p>

<p begin="00:00:00.419" end="00:00:03.836" style="s2">(light percussion music)</p>
<p begin="00:00:05.024" end="00:00:06.632" style="s2">- [Voiceover] When<br />performing a deep nerve block</p>
<p begin="00:00:06.632" end="00:00:09.653" style="s2">at a steep angle of approach<br />with ultrasound guidance</p>
<p begin="00:00:09.653" end="00:00:12.592" style="s2">seeing the needle in the<br />ultrasound image and being able</p>
<p begin="00:00:12.592" end="00:00:15.369" style="s2">to keep the needle in<br />plane while advancing it</p>
<p begin="00:00:15.369" end="00:00:16.881" style="s2">can be challenging.</p>
<p begin="00:00:16.881" end="00:00:19.445" style="s2">- When you're trying to get<br />a needle down to a nerve,</p>
<p begin="00:00:19.445" end="00:00:22.293" style="s2">let's say three, four centimeters deep,</p>
<p begin="00:00:22.293" end="00:00:24.286" style="s2">and you have a steep needle angle,</p>
<p begin="00:00:24.286" end="00:00:27.097" style="s2">the needle almost becomes invisible.</p>
<p begin="00:00:27.097" end="00:00:28.932" style="s2">So if you don't know where<br />your needle is you have</p>
<p begin="00:00:28.932" end="00:00:31.796" style="s2">a higher chance of hitting<br />things you don't want to</p>
<p begin="00:00:31.796" end="00:00:34.134" style="s2">or placing the needle in<br />places you don't want to.</p>
<p begin="00:00:34.134" end="00:00:35.894" style="s2">- [Voiceover] To help<br />track the advancing needle,</p>
<p begin="00:00:35.894" end="00:00:39.254" style="s2">anesthesiologists often<br />use surrogate markers.</p>
<p begin="00:00:39.254" end="00:00:42.233" style="s2">- We have to move the<br />needle, jiggle the needle,</p>
<p begin="00:00:42.233" end="00:00:44.272" style="s2">see tissue moving but we<br />really don't know where</p>
<p begin="00:00:44.272" end="00:00:45.703" style="s2">the tip of the needle is.</p>
<p begin="00:00:45.703" end="00:00:48.192" style="s2">For the deep block, for<br />something that's difficult</p>
<p begin="00:00:48.192" end="00:00:50.641" style="s2">to see a needle, I would<br />say it doubles the time</p>
<p begin="00:00:50.641" end="00:00:52.190" style="s2">to do a nerve block.</p>
<p begin="00:00:52.190" end="00:00:54.272" style="s2">- [Voiceover] In the past,<br />these challenges have kept</p>
<p begin="00:00:54.272" end="00:00:57.009" style="s2">some anesthesiologists<br />from seeing the advantages</p>
<p begin="00:00:57.009" end="00:01:00.405" style="s2">of ultrasound guided nerve<br />blocks on deep targets.</p>
<p begin="00:01:00.405" end="00:01:02.281" style="s2">- When people start using ultrasound,</p>
<p begin="00:01:02.281" end="00:01:04.119" style="s2">if you can't see the needle,</p>
<p begin="00:01:04.119" end="00:01:06.853" style="s2">it's hard to adopt a new technology.</p>
<p begin="00:01:06.853" end="00:01:09.134" style="s2">- [Voiceover] Sonosite's<br />advanced needle visualization</p>
<p begin="00:01:09.134" end="00:01:13.297" style="s2">has improved the ability to<br />see steep needles dramatically.</p>
<p begin="00:01:13.297" end="00:01:17.460" style="s2">- This new needle visualization<br />technology allows me to see</p>
<p begin="00:01:17.460" end="00:01:21.480" style="s2">the needle probably three<br />to four times brighter</p>
<p begin="00:01:21.480" end="00:01:23.482" style="s2">than if it wasn't there.</p>
<p begin="00:01:23.482" end="00:01:26.255" style="s2">Many times when we turn the algorithm off</p>
<p begin="00:01:26.255" end="00:01:28.418" style="s2">we don't see the needle at all.</p>
<p begin="00:01:28.418" end="00:01:31.656" style="s2">You can see that needle at<br />steep angles, in shallow angles,</p>
<p begin="00:01:31.656" end="00:01:35.777" style="s2">and so you can approach those<br />targets with more confidence.</p>
<p begin="00:01:35.777" end="00:01:37.818" style="s2">- [Voiceover] Sonosite's<br />approach to advanced needle</p>
<p begin="00:01:37.818" end="00:01:41.626" style="s2">visualization maintains the<br />image quality and clarity</p>
<p begin="00:01:41.626" end="00:01:44.739" style="s2">of both the target structure<br />and the surrounding anatomy.</p>
<p begin="00:01:44.739" end="00:01:47.177" style="s2">- When you turn on the needle<br />visualization technology</p>
<p begin="00:01:47.177" end="00:01:50.192" style="s2">it doesn't degrade the rest of<br />the ultrasound image at all.</p>
<p begin="00:01:50.192" end="00:01:53.097" style="s2">- So, if you're trying to<br />see a nerve and you have</p>
<p begin="00:01:53.097" end="00:01:56.605" style="s2">small blood vessels and<br />muscles around that nerve</p>
<p begin="00:01:56.605" end="00:01:58.974" style="s2">we want to see those in a normal picture.</p>
<p begin="00:01:58.974" end="00:02:02.287" style="s2">This new needle visualization<br />technology allows us to see</p>
<p begin="00:02:02.287" end="00:02:06.093" style="s2">that needle and doesn't<br />change our background picture.</p>
<p begin="00:02:06.093" end="00:02:08.428" style="s2">- [Voiceover] Sonosite's<br />advanced visualization</p>
<p begin="00:02:08.428" end="00:02:10.321" style="s2">is also very simple to use.</p>
<p begin="00:02:10.321" end="00:02:13.543" style="s2">Other advanced needle visualization<br />products can be bulky,</p>
<p begin="00:02:13.543" end="00:02:14.732" style="s2">timely to set up,</p>
<p begin="00:02:14.732" end="00:02:18.173" style="s2">and use costly disposable<br />echogenic needles.</p>
<p begin="00:02:18.173" end="00:02:20.598" style="s2">- I want to turn the machine on,</p>
<p begin="00:02:20.598" end="00:02:21.923" style="s2">put the ultrasound probe on,</p>
<p begin="00:02:21.923" end="00:02:23.843" style="s2">put the needle in, and see the needle.</p>
<p begin="00:02:23.843" end="00:02:26.415" style="s2">If I have to spend an extra<br />five, ten minutes setting</p>
<p begin="00:02:26.415" end="00:02:30.050" style="s2">something up or even if I have<br />one of my techs doing that,</p>
<p begin="00:02:30.050" end="00:02:32.012" style="s2">that takes away from their other tasks.</p>
<p begin="00:02:32.012" end="00:02:35.703" style="s2">With this new needle visualization<br />technology we're able</p>
<p begin="00:02:35.703" end="00:02:39.171" style="s2">to not have a disposable,<br />you can use it every time</p>
<p begin="00:02:39.171" end="00:02:42.575" style="s2">for every block and it<br />doesn't add to the cost</p>
<p begin="00:02:42.575" end="00:02:44.169" style="s2">of each nerve block.</p>
<p begin="00:02:44.169" end="00:02:46.615" style="s2">- [Voiceover] Advanced needle<br />visualization is a cost</p>
<p begin="00:02:46.615" end="00:02:50.408" style="s2">effective upgrade requiring no<br />new or additional equipment.</p>
<p begin="00:02:50.408" end="00:02:52.496" style="s2">- Not having to change<br />anything, not having to buy</p>
<p begin="00:02:52.496" end="00:02:56.928" style="s2">a new machine, not having<br />to add parts to the machine,</p>
<p begin="00:02:56.928" end="00:03:01.176" style="s2">is a real benefit to this<br />needle visualization algorithm.</p>
<p begin="00:03:01.176" end="00:03:04.121" style="s2">- This is an excellent<br />teaching tool as it will help</p>
<p begin="00:03:04.121" end="00:03:07.190" style="s2">residents, especially new<br />residents, who are still</p>
<p begin="00:03:07.190" end="00:03:10.205" style="s2">relatively unfamiliar with<br />ultrasound and the skill that</p>
<p begin="00:03:10.205" end="00:03:14.168" style="s2">it requires to be able to<br />easily visualize the needle.</p>
<p begin="00:03:14.168" end="00:03:16.137" style="s2">- Seeing the needle is<br />something that's very important</p>
<p begin="00:03:16.137" end="00:03:19.889" style="s2">anytime you stick a needle<br />in somebody under ultrasound.</p>
<p begin="00:03:19.889" end="00:03:22.829" style="s2">And so, if you're doing any procedure,</p>
<p begin="00:03:22.829" end="00:03:25.641" style="s2">whether it be a nerve<br />block, vascular access,</p>
<p begin="00:03:25.641" end="00:03:28.906" style="s2">seeing that needle is<br />gonna be a game changer,</p>
<p begin="00:03:28.906" end="00:03:31.823" style="s2">especially with those steep angles.</p>

<p begin="00:00:02.929" end="00:00:03.820" style="s2">disappearing</p>
<p begin="00:00:03.820" end="00:00:08.090" style="s2">needle phenomenon has been around for a<br />while it is a problem when the</p>
<p begin="00:00:08.090" end="00:00:11.220" style="s2">target is deep I'm into Steve</p>
<p begin="00:00:11.220" end="00:00:14.309" style="s2">Neil use can see a doctor it's not there</p>
<p begin="00:00:14.309" end="00:00:17.840" style="s2">June so the challenge that we but to our<br />engineers was</p>
<p begin="00:00:17.840" end="00:00:21.220" style="s2">solving the problem the embassy in a lil<br />mining claims</p>
<p begin="00:00:21.220" end="00:00:24.390" style="s2">but making a really simple to use and<br />actually decreasing the amount of time</p>
<p begin="00:00:24.390" end="00:00:26.230" style="s2">it takes you on examinations</p>
<p begin="00:00:26.230" end="00:00:29.830" style="s2">improving the workbook what they came<br />back with was a simple</p>
<p begin="00:00:29.830" end="00:00:34.659" style="s2">technique to press a button Anthony<br />magically appears at citibank is</p>
<p begin="00:00:34.659" end="00:00:39.440" style="s2">in the tissue in our effort to provide<br />better visualization for the meal</p>
<p begin="00:00:39.440" end="00:00:42.469" style="s2">Adams deep knee length goals we do not<br />compromise</p>
<p begin="00:00:43.030" end="00:00:47.229" style="s2">any other system parameters that affect<br />fishing spot with the the softer</p>
<p begin="00:00:47.229" end="00:00:48.229" style="s2">enhancement</p>
<p begin="00:00:48.229" end="00:00:52.030" style="s2">it really gives you a view of the Neil<br />from entry into the skin</p>
<p begin="00:00:52.030" end="00:00:55.909" style="s2">down into the structure that you're<br />trying to target it's a very polite</p>
<p begin="00:00:55.909" end="00:01:00.109" style="s2">paper coated wait long that the even<br />troopers</p>
<p begin="00:01:00.109" end="00:01:04.409" style="s2">consumes patience that it had an<br />injection using the old software</p>
<p begin="00:01:04.409" end="00:01:07.350" style="s2">would notice it took less time may be<br />less painful even because we were the</p>
<p begin="00:01:07.350" end="00:01:08.350" style="s2">target a structure</p>
<p begin="00:01:08.350" end="00:01:11.620" style="s2">much more actually in my opinion the<br />speed of the injection is something that</p>
<p begin="00:01:11.620" end="00:01:12.690" style="s2">everyone appreciates</p>
<p begin="00:01:12.690" end="00:01:16.990" style="s2">the softer surprisingly easy you just<br />pushing one button</p>
<p begin="00:01:16.990" end="00:01:20.020" style="s2">allows me to see the very very clearly</p>
<p begin="00:01:20.020" end="00:01:23.380" style="s2">say makes it so easy to visualize the<br />needle that the learning curve is</p>
<p begin="00:01:23.380" end="00:01:24.640" style="s2">shortened significantly</p>
<p begin="00:01:24.640" end="00:01:27.880" style="s2">thing has to do with race issue<br />technology is a softer and brave</p>
<p begin="00:01:27.880" end="00:01:32.060" style="s2">there's no extract equipment or<br />specialty me does that have to be</p>
<p begin="00:01:32.060" end="00:01:35.860" style="s2">after the procedure our technology works<br />with any real out there</p>
<p begin="00:01:35.860" end="00:01:39.890" style="s2">and is basically available at pushing<br />the button when you question it as any</p>
<p begin="00:01:39.890" end="00:01:43.090" style="s2">number of injections will notice an<br />immediate improvement in their accuracy</p>
<p begin="00:01:43.090" end="00:01:44.730" style="s2">a decrease in our patients pain</p>
<p begin="00:01:44.730" end="00:01:48.140" style="s2">and those are things that are well worth<br />any additional expense and it's a</p>
<p begin="00:01:48.140" end="00:01:49.520" style="s2">marginal expense feeling</p>
<p begin="00:01:49.520" end="00:01:52.800" style="s2">there's really no other competitor that<br />has anything quite like</p>
<p begin="00:01:52.800" end="00:01:56.260" style="s2">what we're doing most of the other<br />products that I using that I'm familiar</p>
<p begin="00:01:56.260" end="00:01:56.900" style="s2">with</p>
<p begin="00:01:56.900" end="00:02:00.960" style="s2">a crier significantly more set up time<br />there's more parameters that you have to</p>
<p begin="00:02:00.960" end="00:02:01.930" style="s2">decide in this</p>
<p begin="00:02:01.930" end="00:02:05.700" style="s2">a significantly longer learning curve is<br />just not a simple everything in one</p>
<p begin="00:02:05.700" end="00:02:07.280" style="s2">package is very hopeful</p>
<p begin="00:02:07.280" end="00:02:10.789" style="s2">to not have to turn on or setup he'd<br />issue</p>
<p begin="00:02:10.789" end="00:02:14.739" style="s2">equipment is important to increase your<br />accuracy in</p>
<p begin="00:02:14.739" end="00:02:18.450" style="s2">it believed you get to choose that you<br />normally wouldn't be able to</p>
<p begin="00:02:18.450" end="00:02:22.790" style="s2">spray tan shirt also increases your<br />potential business</p>
<p begin="00:02:22.790" end="00:02:25.959" style="s2">for all those reasons it's the stable</p>
<p begin="00:02:25.959" end="00:02:29.560" style="s2">I think for any clinician that's doing<br />injections this is a critical</p>
<p begin="00:02:29.560" end="00:02:30.359" style="s2">improvements</p>
<p begin="00:02:30.359" end="00:02:34.049" style="s2">this is not one of the minor updates to<br />software</p>
<p begin="00:02:34.049" end="00:02:37.340" style="s2">that we see with other computer<br />modalities in this is something is a</p>
<p begin="00:02:37.340" end="00:02:38.290" style="s2">major change</p>
<p begin="00:02:38.290" end="00:02:43.010" style="s2">three weeks I is because now weekend for<br />the first time save that</p>
<p begin="00:02:43.010" end="00:02:46.180" style="s2">Stickney learners are no longer problem<br />Simon</p>
<p begin="00:02:50.220" end="00:02:50.250" style="s2">my</p>

<p begin="00:00:02.881" end="00:00:04.710" style="s2">- Soon as we turn on the function of the</p>
<p begin="00:00:04.710" end="00:00:09.042" style="s2">advanced neo visualization, the<br />image quality stays the same</p>
<p begin="00:00:09.042" end="00:00:13.209" style="s2">and we just see greater echos<br />when we insert the needle.</p>
<p begin="00:00:19.386" end="00:00:21.172" style="s2">So I haven't noted any decrement to the</p>
<p begin="00:00:21.172" end="00:00:23.864" style="s2">image resolution and quality.</p>
<p begin="00:00:23.864" end="00:00:26.957" style="s2">In my practice it's really<br />added increased speed.</p>
<p begin="00:00:26.957" end="00:00:30.492" style="s2">I'm getting to the target<br />more directly with less time.</p>
<p begin="00:00:30.492" end="00:00:33.267" style="s2">Getting in and out, which<br />always makes the patient happier</p>
<p begin="00:00:33.267" end="00:00:35.589" style="s2">and certainly it reduces<br />the amount of pain</p>
<p begin="00:00:35.589" end="00:00:38.063" style="s2">that might be involved in a procedure.</p>
<p begin="00:00:38.063" end="00:00:40.614" style="s2">- So the ability to see the<br />needle going through tissue</p>
<p begin="00:00:40.614" end="00:00:43.197" style="s2">makes their clinical procedures safer,</p>
<p begin="00:00:43.197" end="00:00:46.169" style="s2">makes it faster, obviously<br />better for the patient.</p>
<p begin="00:00:46.169" end="00:00:49.649" style="s2">- It appears maybe two,<br />three, four times brighter.</p>
<p begin="00:00:49.649" end="00:00:52.315" style="s2">Seems to have a better echo<br />during the entire procedure.</p>
<p begin="00:00:52.315" end="00:00:55.471" style="s2">- Basically, the enhanced<br />visualization technology</p>
<p begin="00:00:55.471" end="00:00:58.939" style="s2">is a softer grade, and<br />it's very easy to use.</p>
<p begin="00:00:58.939" end="00:01:01.561" style="s2">There's no extra equipment<br />or specialty needles</p>
<p begin="00:01:01.561" end="00:01:04.168" style="s2">that have to be part of the procedure.</p>
<p begin="00:01:04.168" end="00:01:06.587" style="s2">Hard to close, it works<br />with any needle out there,</p>
<p begin="00:01:06.587" end="00:01:09.099" style="s2">and it's basically available<br />at the push of a button.</p>
<p begin="00:01:09.099" end="00:01:11.309" style="s2">- The beauty of it is that<br />there really is no setup time.</p>
<p begin="00:01:11.309" end="00:01:12.997" style="s2">It actually speeds up the procedure</p>
<p begin="00:01:12.997" end="00:01:14.621" style="s2">'cause it's easier to see the needle.</p>
<p begin="00:01:14.621" end="00:01:17.660" style="s2">So if anything it's a<br />time saving technique.</p>
<p begin="00:01:17.660" end="00:01:20.502" style="s2">I think it really can enhance learning</p>
<p begin="00:01:20.502" end="00:01:23.453" style="s2">and becoming competent<br />in performing aspirations</p>
<p begin="00:01:23.453" end="00:01:24.979" style="s2">and biopsies and a variety of different</p>
<p begin="00:01:24.979" end="00:01:26.977" style="s2">needle localization techniques</p>
<p begin="00:01:26.977" end="00:01:29.690" style="s2">in a much quicker, safer fashion.</p>
<p begin="00:01:29.690" end="00:01:31.370" style="s2">- There's really no<br />other competitor that has</p>
<p begin="00:01:31.370" end="00:01:33.840" style="s2">anything quite like what we're doing.</p>
<p begin="00:01:33.840" end="00:01:35.199" style="s2">There's a few technologies out there</p>
<p begin="00:01:35.199" end="00:01:37.569" style="s2">that try to help see the needle tip.</p>
<p begin="00:01:37.569" end="00:01:39.070" style="s2">The bigger issue I see with those</p>
<p begin="00:01:39.070" end="00:01:41.149" style="s2">is that they take a long time to set up,</p>
<p begin="00:01:41.149" end="00:01:42.569" style="s2">and they're also expensive.</p>
<p begin="00:01:42.569" end="00:01:44.094" style="s2">There's hardware involved.</p>
<p begin="00:01:44.094" end="00:01:46.232" style="s2">This was a proprietary software algorithm</p>
<p begin="00:01:46.232" end="00:01:49.735" style="s2">that we can upgrade any turbo<br />or S system on the market.</p>
<p begin="00:01:49.735" end="00:01:51.977" style="s2">- You get all the visualization<br />that you really need</p>
<p begin="00:01:51.977" end="00:01:53.971" style="s2">and you don't need to<br />use any special needles,</p>
<p begin="00:01:53.971" end="00:01:56.041" style="s2">you don't need to use a larger needle.</p>
<p begin="00:01:56.041" end="00:01:57.848" style="s2">The larger the caliber of the needle,</p>
<p begin="00:01:57.848" end="00:02:00.593" style="s2">the more painful and the more<br />potential for complications</p>
<p begin="00:02:00.593" end="00:02:04.488" style="s2">so I get great visualization<br />with a 25 gauge needle.</p>
<p begin="00:02:04.488" end="00:02:07.485" style="s2">- The reason we're excited<br />is because now we can</p>
<p begin="00:02:07.485" end="00:02:10.264" style="s2">for the first time say<br />that stick needle angles</p>
<p begin="00:02:10.264" end="00:02:13.201" style="s2">are no longer a problem<br />for ultrasound imaging.</p>
<p begin="00:02:13.201" end="00:02:14.587" style="s2">- I think it's one of our biggest</p>
<p begin="00:02:14.587" end="00:02:16.362" style="s2">breakthroughs in a long time,</p>
<p begin="00:02:16.362" end="00:02:17.843" style="s2">and again it meets the criteria.</p>
<p begin="00:02:17.843" end="00:02:19.925" style="s2">It addresses a real<br />problem that our customers</p>
<p begin="00:02:19.925" end="00:02:22.706" style="s2">and our clinicians are<br />dealing with every day.</p>
<p begin="00:02:22.706" end="00:02:26.026" style="s2">It's inexpensive, it's<br />simple, and it works.</p>
<p begin="00:02:26.026" end="00:02:28.350" style="s2">- It is a game changer in the market</p>
<p begin="00:02:28.350" end="00:02:31.017" style="s2">of ultrasound guided procedures.</p>
<p begin="00:02:31.886" end="00:02:34.553" style="s2">It's the speed, the ease of use,</p>
<p begin="00:02:35.700" end="00:02:39.602" style="s2">the reduction of time to<br />completion of the procedure,</p>
<p begin="00:02:39.602" end="00:02:42.084" style="s2">the safety features, all of those are</p>
<p begin="00:02:42.084" end="00:02:46.167" style="s2">a win-win situation for<br />doctor and patient alike.</p>

<p begin="00:00:03.281" end="00:00:05.698">(rock music)</p>
<p begin="00:01:15.873" end="00:01:19.123">(faint acoustic music)</p>
<p begin="00:01:20.238" end="00:01:23.453">- What actually goes on<br />in a hostile situation</p>
<p begin="00:01:23.453" end="00:01:26.735">you cannot imagine, unless<br />you're putting that in front.</p>
<p begin="00:01:26.735" end="00:01:28.540">When they're maneuvering,</p>
<p begin="00:01:28.540" end="00:01:29.605">that's where they're getting hurt.</p>
<p begin="00:01:29.605" end="00:01:31.251">The battlefield's very<br />fluid, it's very mobile.</p>
<p begin="00:01:31.251" end="00:01:32.649">You don't go set up somewhere,</p>
<p begin="00:01:32.649" end="00:01:34.091">and then take care of patients.</p>
<p begin="00:01:34.091" end="00:01:35.490">You have to follow divisions.</p>
<p begin="00:01:35.490" end="00:01:37.879">You would get, you know, up to 10, 12, 14.</p>
<p begin="00:01:37.879" end="00:01:40.216">The most we got was 17 casualties at once,</p>
<p begin="00:01:40.216" end="00:01:41.731">I only have two operating tables.</p>
<p begin="00:01:41.731" end="00:01:44.318">So, when I can take a piece of technology</p>
<p begin="00:01:44.318" end="00:01:47.069">that weighs six pounds that<br />I can tuck under my arm,</p>
<p begin="00:01:47.069" end="00:01:48.427">or throw it in the back of my Humvee</p>
<p begin="00:01:48.427" end="00:01:50.115">and not worry about it again,</p>
<p begin="00:01:50.115" end="00:01:52.455">that's something you need.</p>
<p begin="00:01:52.455" end="00:01:54.222">I like the guy who comes<br />in who had a problem,</p>
<p begin="00:01:54.222" end="00:01:55.489">who doesn't have a problem anymore.</p>
<p begin="00:01:55.489" end="00:01:58.673">You've made their lifestyle better.</p>
<p begin="00:01:58.673" end="00:02:00.632">That's worth a million bucks.</p>
<p begin="00:02:00.632" end="00:02:03.382">(acoustic music)</p>
<p begin="00:02:09.279" end="00:02:11.252">- There are definitely, some<br />of the patients come in,</p>
<p begin="00:02:11.252" end="00:02:12.732">that they just really get to you.</p>
<p begin="00:02:12.732" end="00:02:15.979">- So it was, "Merry Christmas,<br />you have breast cancer."</p>
<p begin="00:02:15.979" end="00:02:17.174">- And I get off the phone, I'm like,</p>
<p begin="00:02:17.174" end="00:02:18.655">she just thanked me for telling me, I,</p>
<p begin="00:02:18.655" end="00:02:20.590">for me telling her that she had cancer.</p>
<p begin="00:02:20.590" end="00:02:22.724">- We kidded around,<br />and that's what I need.</p>
<p begin="00:02:22.724" end="00:02:25.357">I need somebody that can say, "Yeah,</p>
<p begin="00:02:25.357" end="00:02:27.577">"you're gonna need a good<br />glass of wine tonight."</p>
<p begin="00:02:27.577" end="00:02:28.974">- If I was not using ultrasound,</p>
<p begin="00:02:28.974" end="00:02:31.068">she came in with her<br />mammograms and ultrasounds,</p>
<p begin="00:02:31.068" end="00:02:32.596">I would look at them on the viewbox,</p>
<p begin="00:02:32.596" end="00:02:33.873">say, "Yeah, there's your tumor."</p>
<p begin="00:02:33.873" end="00:02:35.314">But I can't feel anything,</p>
<p begin="00:02:35.314" end="00:02:38.068">and the radiologist is<br />gonna stick a wire there</p>
<p begin="00:02:38.068" end="00:02:39.694">and we'll know for sure<br />that we got it out.</p>
<p begin="00:02:39.694" end="00:02:44.104">- She just was very sure<br />of what was going on,</p>
<p begin="00:02:44.104" end="00:02:46.081">and what was gonna happen to me.</p>
<p begin="00:02:46.081" end="00:02:48.220">- Now what I can do is<br />scan them in the office.</p>
<p begin="00:02:48.220" end="00:02:49.293">She's here with her husband,</p>
<p begin="00:02:49.293" end="00:02:50.733">they both see the pictures,</p>
<p begin="00:02:50.733" end="00:02:52.132">they look exactly like the pictures</p>
<p begin="00:02:52.132" end="00:02:53.823">that the radiologist took.</p>
<p begin="00:02:53.823" end="00:02:55.881">And they know then that<br />I'm gonna take this</p>
<p begin="00:02:55.881" end="00:02:59.540">to the operating room, and actually remove</p>
<p begin="00:02:59.540" end="00:03:01.106">what needs to be removed.</p>
<p begin="00:03:01.106" end="00:03:02.791">- Milestones are really important to me.</p>
<p begin="00:03:02.791" end="00:03:05.091">Like, let's say we're<br />at doctor's graduation.</p>
<p begin="00:03:05.091" end="00:03:07.241">- I love what I do.</p>
<p begin="00:03:07.241" end="00:03:09.412">This is pretty much my life.</p>
<p begin="00:03:09.412" end="00:03:10.433">- And like we were saying before,</p>
<p begin="00:03:10.433" end="00:03:12.126">I guess I'm really just really thankful</p>
<p begin="00:03:12.126" end="00:03:14.280">I was born in this time,</p>
<p begin="00:03:14.280" end="00:03:16.218">that we have doctors that do what they do</p>
<p begin="00:03:16.218" end="00:03:18.491">and medicine that does what it does.</p>
<p begin="00:03:18.491" end="00:03:21.600">- The fact that I don't have<br />to rely on a radiologist</p>
<p begin="00:03:21.600" end="00:03:23.903">allows me to just do what I need to do,</p>
<p begin="00:03:23.903" end="00:03:28.070">and I think it allows me to<br />take better care of my patients.</p>
<p begin="00:03:30.757" end="00:03:34.924">- It'd just be really<br />grateful that I'm still here.</p>
<p begin="00:03:37.740" end="00:03:40.096">- And that gives me<br />actually a lot of strength</p>
<p begin="00:03:40.096" end="00:03:41.749">and a lot of satisfaction to see</p>
<p begin="00:03:41.749" end="00:03:44.271">what they're able to go through.</p>
<p begin="00:03:44.271" end="00:03:45.745">I'm not sure I could do that.</p>
<p begin="00:03:45.745" end="00:03:48.745">(alternative music)</p>
<p begin="00:03:53.939" end="00:03:56.171">- Sometimes it's overwhelming.</p>
<p begin="00:03:56.171" end="00:03:58.855">Some days we have<br />patients sick everywhere,</p>
<p begin="00:03:58.855" end="00:04:00.554">you have to prioritize who's the sickest.</p>
<p begin="00:04:00.554" end="00:04:02.496">Your way of seeing life is different</p>
<p begin="00:04:02.496" end="00:04:04.476">when you have a<br />30-year-old, 20-year-old guy</p>
<p begin="00:04:04.476" end="00:04:06.293">that dies almost into your hands.</p>
<p begin="00:04:06.293" end="00:04:08.230">You know, when you take your<br />car and you go back home,</p>
<p begin="00:04:08.230" end="00:04:09.880">you don't have the same way of looking at</p>
<p begin="00:04:09.880" end="00:04:12.402">what you're doing or looking<br />at your kids or family.</p>
<p begin="00:04:12.402" end="00:04:14.504">Dealing with patients and their families,</p>
<p begin="00:04:14.504" end="00:04:15.991">you see them happy.</p>
<p begin="00:04:15.991" end="00:04:17.846">You have to pronounce people dead,</p>
<p begin="00:04:17.846" end="00:04:19.292">tell their family.</p>
<p begin="00:04:19.292" end="00:04:22.670">Young people, old people,<br />you have to live with them</p>
<p begin="00:04:22.670" end="00:04:24.602">these moments that are unique.</p>
<p begin="00:04:24.602" end="00:04:27.944">And the arrival of bedside<br />ultrasound in the ICU</p>
<p begin="00:04:27.944" end="00:04:31.077">or any acute care<br />environment is a revolution.</p>
<p begin="00:04:31.077" end="00:04:32.486">But when you're at the bedside,</p>
<p begin="00:04:32.486" end="00:04:34.425">you really wanna have an answer</p>
<p begin="00:04:34.425" end="00:04:35.953">to a specific question,</p>
<p begin="00:04:35.953" end="00:04:39.138">so you need to have<br />something that will help you</p>
<p begin="00:04:39.138" end="00:04:40.336">go a bit further.</p>
<p begin="00:04:40.336" end="00:04:42.941">We image the patient<br />and if we see something,</p>
<p begin="00:04:42.941" end="00:04:43.972">or we don't see it.</p>
<p begin="00:04:43.972" end="00:04:47.639">But when you find it,<br />that's quite a thrill.</p>
<p begin="00:04:48.904" end="00:04:51.297">So, yeah, so this<br />44-year-old guy was in the</p>
<p begin="00:04:51.297" end="00:04:53.824">emergency room, has a big heart attack.</p>
<p begin="00:04:53.824" end="00:04:55.763">He has three other sick vessels,</p>
<p begin="00:04:55.763" end="00:04:58.868">so we send this patient<br />for emergent bypass.</p>
<p begin="00:04:58.868" end="00:05:00.516">He has four of them.</p>
<p begin="00:05:00.516" end="00:05:01.766">He gets better,</p>
<p begin="00:05:02.622" end="00:05:04.342">in the recovery room.</p>
<p begin="00:05:04.342" end="00:05:07.309">He goes to the ICU, he's<br />doing okay initially.</p>
<p begin="00:05:07.309" end="00:05:09.000">And then a few hours after,</p>
<p begin="00:05:09.000" end="00:05:10.899">he started having problems<br />with his breathing.</p>
<p begin="00:05:10.899" end="00:05:13.422">Short of breath, oxygen level going down,</p>
<p begin="00:05:13.422" end="00:05:15.323">down, down, down,</p>
<p begin="00:05:15.323" end="00:05:17.460">so we tried to stabilize him,</p>
<p begin="00:05:17.460" end="00:05:18.867">but we cannot move the patient</p>
<p begin="00:05:18.867" end="00:05:22.286">while they are on this<br />high frequency ventilation.</p>
<p begin="00:05:22.286" end="00:05:25.344">So I did a bedside ultrasound<br />on him, of his heart.</p>
<p begin="00:05:25.344" end="00:05:26.625">- At one point he just said to me,</p>
<p begin="00:05:26.625" end="00:05:29.100">"Has he been on a trip recently?"</p>
<p begin="00:05:29.100" end="00:05:30.717">- So because he has clots in the arteries</p>
<p begin="00:05:30.717" end="00:05:33.600">of his lungs, the blood<br />cannot go there easily,</p>
<p begin="00:05:33.600" end="00:05:35.165">and the oxygen level is low.</p>
<p begin="00:05:35.165" end="00:05:37.446">And the treatment is very different</p>
<p begin="00:05:37.446" end="00:05:39.533">than what we were doing.</p>
<p begin="00:05:39.533" end="00:05:43.369">So we had the suspicion of that<br />with the bedside ultrasound.</p>
<p begin="00:05:43.369" end="00:05:46.101">Sent him for the test,<br />found that he had that,</p>
<p begin="00:05:46.101" end="00:05:48.700">and completely changed his therapeutics.</p>
<p begin="00:05:48.700" end="00:05:52.044">Four or five days after, he<br />was off of the ventilator.</p>
<p begin="00:05:52.044" end="00:05:54.812">He was extubated, talking to us.</p>
<p begin="00:05:54.812" end="00:05:56.729">This guy has five kids,</p>
<p begin="00:05:57.945" end="00:05:59.682">very charming wife.</p>
<p begin="00:05:59.682" end="00:06:01.580">- And that's when I went,<br />just went back to the hospital</p>
<p begin="00:06:01.580" end="00:06:04.136">for a monthly blood test.</p>
<p begin="00:06:04.136" end="00:06:06.695">The nurse said, "You're<br />lucky you have Dr. Beaulieu</p>
<p begin="00:06:06.695" end="00:06:07.598">"as your doctor."</p>
<p begin="00:06:07.598" end="00:06:08.767">I said, "You don't have to tell me that."</p>
<p begin="00:06:08.767" end="00:06:10.748">- When I saw him, two, three<br />weeks ago in my office,</p>
<p begin="00:06:10.748" end="00:06:13.423">he was coming back from<br />Cuba, scuba diving.</p>
<p begin="00:06:13.423" end="00:06:15.811">And I saw him, half-dead.</p>
<p begin="00:06:15.811" end="00:06:18.378">One huge week with this guy<br />and in the outpatient clinic,</p>
<p begin="00:06:18.378" end="00:06:20.890">you're like, that's worth it.</p>
<p begin="00:06:20.890" end="00:06:23.890">(alternative music)</p>
<p begin="00:06:31.510" end="00:06:33.206">- [Voiceover] We had a 100-year-old guy</p>
<p begin="00:06:33.206" end="00:06:35.312">come in at around midnight last night.</p>
<p begin="00:06:35.312" end="00:06:39.647">He and his wife have<br />been married 77 years.</p>
<p begin="00:06:39.647" end="00:06:41.835">Very pleasant, friendly guy,</p>
<p begin="00:06:41.835" end="00:06:45.186">with a horrible wrist fracture.</p>
<p begin="00:06:45.186" end="00:06:47.302">As an anesthesiologist,<br />immediately when you meet someone,</p>
<p begin="00:06:47.302" end="00:06:50.227">you think, what's the anesthetic<br />I'm gonna do with this guy?</p>
<p begin="00:06:50.227" end="00:06:51.627">As I'm talking to him, I'm thinking,</p>
<p begin="00:06:51.627" end="00:06:53.649">I'm running through<br />the options in my head,</p>
<p begin="00:06:53.649" end="00:06:54.803">the more I thought, you know,</p>
<p begin="00:06:54.803" end="00:06:58.186">I think my best bet here<br />is to give him nothing.</p>
<p begin="00:06:58.186" end="00:07:00.506">And I'm just gonna block the arm.</p>
<p begin="00:07:00.506" end="00:07:02.696">I want him as lucid as possible,</p>
<p begin="00:07:02.696" end="00:07:04.845">and I wanna be able to wake him up.</p>
<p begin="00:07:04.845" end="00:07:05.917">We went into the operating room,</p>
<p begin="00:07:05.917" end="00:07:07.322">and I looked at the guy.</p>
<p begin="00:07:07.322" end="00:07:09.426">Normally I would do an<br />infraclavicular brachial plexus block</p>
<p begin="00:07:09.426" end="00:07:10.909">which goes through all the muscles,</p>
<p begin="00:07:10.909" end="00:07:12.192">you're close to the lung,</p>
<p begin="00:07:12.192" end="00:07:13.675">you're thinking about all those things.</p>
<p begin="00:07:13.675" end="00:07:15.615">And he was kind of slouched in like this.</p>
<p begin="00:07:15.615" end="00:07:16.771">So I thought, okay, this is gonna be</p>
<p begin="00:07:16.771" end="00:07:18.586">a little more technically challenging,</p>
<p begin="00:07:18.586" end="00:07:21.353">and I got him on the<br />table and took a look.</p>
<p begin="00:07:21.353" end="00:07:23.624">And he, amazingly enough and thank God,</p>
<p begin="00:07:23.624" end="00:07:25.933">he had this beautiful<br />artery that I could see,</p>
<p begin="00:07:25.933" end="00:07:27.417">and gorgeous brachial plexis.</p>
<p begin="00:07:27.417" end="00:07:28.988">I could see all the cords.</p>
<p begin="00:07:28.988" end="00:07:32.045">So I could see it just<br />flooding the lateral cord.</p>
<p begin="00:07:32.045" end="00:07:34.237">The posterior cord, and the lateral cord.</p>
<p begin="00:07:34.237" end="00:07:35.433">You know, we did this all on the gurney</p>
<p begin="00:07:35.433" end="00:07:37.583">before we even transferred<br />him over to the OR bed.</p>
<p begin="00:07:37.583" end="00:07:39.523">Cause I asked him preop<br />if he had any pain,</p>
<p begin="00:07:39.523" end="00:07:40.843">and he looked at me and he goes,</p>
<p begin="00:07:40.843" end="00:07:43.448">"Not as long as you don't touch it."</p>
<p begin="00:07:43.448" end="00:07:44.724">And I said, "Okay, don't worry about it.</p>
<p begin="00:07:44.724" end="00:07:45.755">"We're not gonna touch it."</p>
<p begin="00:07:45.755" end="00:07:48.015">So I didn't move him at<br />all, we did the block,</p>
<p begin="00:07:48.015" end="00:07:50.158">I said, "Does it hurt now?"</p>
<p begin="00:07:50.158" end="00:07:51.888">And he looked at me, and<br />the orthopedic surgeon</p>
<p begin="00:07:51.888" end="00:07:53.536">was there too, and I<br />was like, I paid the guy</p>
<p begin="00:07:53.536" end="00:07:55.307">a hundred bucks, and he goes,</p>
<p begin="00:07:55.307" end="00:07:58.242">"No, feels a whole lot better now."</p>
<p begin="00:07:58.242" end="00:07:59.314">And I looked him and I said,</p>
<p begin="00:07:59.314" end="00:08:01.126">"You just made my day!</p>
<p begin="00:08:01.126" end="00:08:02.691">"That was great!"</p>
<p begin="00:08:02.691" end="00:08:05.691">(alternative music)</p>
<p begin="00:08:11.344" end="00:08:13.511">- I see tragedy every day.</p>
<p begin="00:08:14.629" end="00:08:17.023">You could say it's a specialty of tragedy.</p>
<p begin="00:08:17.023" end="00:08:18.915">- People are sort of at death's door.</p>
<p begin="00:08:18.915" end="00:08:21.271">- You've got people yelling and screaming,</p>
<p begin="00:08:21.271" end="00:08:22.446">and in that type of environment,</p>
<p begin="00:08:22.446" end="00:08:26.254">you've gotta tell somebody<br />about your personal history,</p>
<p begin="00:08:26.254" end="00:08:28.149">about personal things<br />that you don't talk about</p>
<p begin="00:08:28.149" end="00:08:30.705">with everybody every day.</p>
<p begin="00:08:30.705" end="00:08:33.432">And to get somebody to talk<br />about those types of things,</p>
<p begin="00:08:33.432" end="00:08:37.071">cause they're very important<br />in treating a patient,</p>
<p begin="00:08:37.071" end="00:08:37.904">is an art.</p>
<p begin="00:08:37.904" end="00:08:40.085">- You see the fabric of society.</p>
<p begin="00:08:40.085" end="00:08:43.097">- And you see people and<br />how we treat each other</p>
<p begin="00:08:43.097" end="00:08:43.930">in real life.</p>
<p begin="00:08:43.930" end="00:08:44.786">- My neighbors always ask me,</p>
<p begin="00:08:44.786" end="00:08:45.619">"Did you see anything cool?"</p>
<p begin="00:08:45.619" end="00:08:46.452">I'm like,</p>
<p begin="00:08:47.479" end="00:08:48.427">"I don't remember.</p>
<p begin="00:08:48.427" end="00:08:50.163">"It was just a blur."</p>
<p begin="00:08:50.163" end="00:08:51.192">- To save that person's life,</p>
<p begin="00:08:51.192" end="00:08:53.215">I don't have time to call the radiologist</p>
<p begin="00:08:53.215" end="00:08:55.485">who's probably at home at<br />4 o'clock in the morning,</p>
<p begin="00:08:55.485" end="00:08:57.751">say, "Can you come and do<br />the ultrasound for me?"</p>
<p begin="00:08:57.751" end="00:08:58.784">- [Chris] If you could<br />look right through the body</p>
<p begin="00:08:58.784" end="00:08:59.653">at the organs you're interested in,</p>
<p begin="00:08:59.653" end="00:09:01.142">why the heck would you not do it?</p>
<p begin="00:09:01.142" end="00:09:04.065">- I'm sure he would really<br />be happy if he could say,</p>
<p begin="00:09:04.065" end="00:09:05.384">"Dr. Saylor, why don't you do that,</p>
<p begin="00:09:05.384" end="00:09:07.243">"and save the patient and let me know</p>
<p begin="00:09:07.243" end="00:09:08.938">"how it turns out in the morning?"</p>
<p begin="00:09:08.938" end="00:09:10.259">- [Chris] There's been a<br />lot of moments like that,</p>
<p begin="00:09:10.259" end="00:09:13.092">with ultrasound where I say, "Wow.</p>
<p begin="00:09:13.941" end="00:09:15.459">"This guy would have died."</p>
<p begin="00:09:15.459" end="00:09:18.520">Or, as a physician you think to yourself,</p>
<p begin="00:09:18.520" end="00:09:20.620">"I almost killed this lady."</p>
<p begin="00:09:20.620" end="00:09:23.508">- But now you've got a<br />patient here tomorrow.</p>
<p begin="00:09:23.508" end="00:09:25.943">Are you gonna be able to save<br />this person's life tomorrow?</p>
<p begin="00:09:25.943" end="00:09:28.671">- Just the other day, I<br />had a tragic drowning case</p>
<p begin="00:09:28.671" end="00:09:29.791">that I was involved with.</p>
<p begin="00:09:29.791" end="00:09:33.958">An 18-month-old that was<br />found at the bottom of a pool,</p>
<p begin="00:09:35.094" end="00:09:39.014">and we were able to<br />get her heartbeat back.</p>
<p begin="00:09:39.014" end="00:09:40.043">The child did die.</p>
<p begin="00:09:40.043" end="00:09:43.224">- I've gotta be just that<br />much better tomorrow.</p>
<p begin="00:09:43.224" end="00:09:45.922">Because something else is<br />coming through that door</p>
<p begin="00:09:45.922" end="00:09:47.149">that I may need it for.</p>
<p begin="00:09:47.149" end="00:09:51.742">- As a specialty, we get it<br />right about 80% of the time.</p>
<p begin="00:09:51.742" end="00:09:53.481">We're sort of 80%-ers.</p>
<p begin="00:09:53.481" end="00:09:56.979">And a lot of people aren't comfortable</p>
<p begin="00:09:56.979" end="00:09:58.594">not getting to 100%.</p>
<p begin="00:09:58.594" end="00:10:00.808">And so that drives some<br />emergency physicians crazy</p>
<p begin="00:10:00.808" end="00:10:01.641">and out of the field.</p>
<p begin="00:10:01.641" end="00:10:04.021">- As a father and with many other people</p>
<p begin="00:10:04.021" end="00:10:06.544">in the resuscitation<br />team that were parents,</p>
<p begin="00:10:06.544" end="00:10:08.853">to see that sort of case,</p>
<p begin="00:10:08.853" end="00:10:10.186">that was pretty,</p>
<p begin="00:10:12.166" end="00:10:14.642">that was a big impact case.</p>
<p begin="00:10:14.642" end="00:10:16.745">- And, at the end of the day,</p>
<p begin="00:10:16.745" end="00:10:17.737">can you sit back and say,</p>
<p begin="00:10:17.737" end="00:10:20.213">"I did everything I<br />could for that person?"</p>
<p begin="00:10:20.213" end="00:10:21.536">- Within minutes, I have to then go back</p>
<p begin="00:10:21.536" end="00:10:22.777">and see a sprained ankle.</p>
<p begin="00:10:22.777" end="00:10:24.929">- Hopefully I have a good outcome.</p>
<p begin="00:10:24.929" end="00:10:26.536">- Hmm.</p>
<p begin="00:10:26.536" end="00:10:28.453">Is it more outer signs?</p>
<p begin="00:10:30.005" end="00:10:32.194">It's a good amount of art.</p>
<p begin="00:10:32.194" end="00:10:34.999">It's a good amount of art.</p>
<p begin="00:10:34.999" end="00:10:37.416">(rock music)</p>