<p begin="00:00:08.150" end="00:00:15.179" style="s2">welcome to the help video performing an</p>
<p begin="00:00:11.340" end="00:00:18.180" style="s2">exam in this video we will explain how</p>
<p begin="00:00:15.179" end="00:00:21.990" style="s2">to select an exam type adjust parameters</p>
<p begin="00:00:18.180" end="00:00:25.769" style="s2">such as depth overall gain near and far</p>
<p begin="00:00:21.990" end="00:00:29.609" style="s2">gained optimization and change the scan</p>
<p begin="00:00:25.769" end="00:00:32.279" style="s2">mode using I've is to select an exam</p>
<p begin="00:00:29.609" end="00:00:34.829" style="s2">type while you're scanning tap the exam</p>
<p begin="00:00:32.279" end="00:00:38.100" style="s2">type drop-down menu and select a</p>
<p begin="00:00:34.829" end="00:00:40.170" style="s2">different exam type the control wheel</p>
<p begin="00:00:38.100" end="00:00:43.559" style="s2">options are specific to the mode that</p>
<p begin="00:00:40.170" end="00:00:47.219" style="s2">you're in you can adjust the depth by</p>
<p begin="00:00:43.559" end="00:00:50.250" style="s2">tapping depth on the control wheel by</p>
<p begin="00:00:47.219" end="00:00:52.890" style="s2">tapping the plus or minus icons you can</p>
<p begin="00:00:50.250" end="00:00:56.489" style="s2">increase or decrease the scanning depth</p>
<p begin="00:00:52.890" end="00:01:02.699" style="s2">or tap one of the dots for a specific</p>
<p begin="00:00:56.489" end="00:01:05.129" style="s2">depth the overall gain is adjusted by</p>
<p begin="00:01:02.699" end="00:01:08.100" style="s2">tapping overall gain on the control</p>
<p begin="00:01:05.129" end="00:01:11.670" style="s2">wheel and then moving the blue dot up</p>
<p begin="00:01:08.100" end="00:01:18.030" style="s2">and down the slider or by tapping a</p>
<p begin="00:01:11.670" end="00:01:20.729" style="s2">specific spot on the wheel your near and</p>
<p begin="00:01:18.030" end="00:01:24.659" style="s2">far gain can be adjusted by toggling</p>
<p begin="00:01:20.729" end="00:01:27.780" style="s2">between near and far to set the gain</p>
<p begin="00:01:24.659" end="00:01:32.430" style="s2">move the blue dot up and down the slider</p>
<p begin="00:01:27.780" end="00:01:35.579" style="s2">to adjust your imaging frequencies slide</p>
<p begin="00:01:32.430" end="00:01:38.579" style="s2">the control wheel to opt which stands</p>
<p begin="00:01:35.579" end="00:01:44.340" style="s2">for optimization this allows you to</p>
<p begin="00:01:38.579" end="00:01:47.189" style="s2">change between res pen or thi you can</p>
<p begin="00:01:44.340" end="00:01:50.340" style="s2">adjust other 2d options such as dynamic</p>
<p begin="00:01:47.189" end="00:01:53.229" style="s2">range and orientation by sliding the</p>
<p begin="00:01:50.340" end="00:01:56.690" style="s2">wheel with your thumb</p>
<p begin="00:01:53.229" end="00:02:00.200" style="s2">Toodee is the default scan mode to</p>
<p begin="00:01:56.690" end="00:02:04.009" style="s2">change to M mode press and hold the 2d</p>
<p begin="00:02:00.200" end="00:02:06.320" style="s2">button on the control wheel slide the M</p>
<p begin="00:02:04.009" end="00:02:11.180" style="s2">line to the desired spot on the screen</p>
<p begin="00:02:06.320" end="00:02:15.280" style="s2">and then tap update to activate tap</p>
<p begin="00:02:11.180" end="00:02:18.770" style="s2">update again to return to live scanning</p>
<p begin="00:02:15.280" end="00:02:23.390" style="s2">press and hold the M button to toggle</p>
<p begin="00:02:18.770" end="00:02:27.140" style="s2">back to 2d tap color on the control</p>
<p begin="00:02:23.390" end="00:02:29.540" style="s2">wheel while in 2d from here you can</p>
<p begin="00:02:27.140" end="00:02:45.620" style="s2">adjust other color parameters such as</p>
<p begin="00:02:29.540" end="00:02:49.670" style="s2">box size placement color gain scale flow</p>
<p begin="00:02:45.620" end="00:02:53.900" style="s2">as well as switch between color velocity</p>
<p begin="00:02:49.670" end="00:02:58.220" style="s2">Doppler and color power doppler color</p>
<p begin="00:02:53.900" end="00:03:00.709" style="s2">Doppler toggles on and off for more</p>
<p begin="00:02:58.220" end="00:03:03.940" style="s2">information about exams refer to the</p>
<p begin="00:03:00.709" end="00:03:03.940" style="s2">IV's user guide</p>
<p begin="00:03:09.270" end="00:03:11.330" style="s2">you</p>

<p begin="00:00:07.929" end="00:00:10.513" region="r2" style="s2">
- [Voiceover] Welcome to the help video,</p>
<p begin="00:00:10.513" end="00:00:13.572" region="r3" style="s2">
Creating a New Patient Study.</p>
<p begin="00:00:13.572" end="00:00:16.375" region="r4" style="s2">
In this video, we will<br />
show you the different ways</p>
<p begin="00:00:16.375" end="00:00:20.213" region="r5" style="s2">
you can start a new<br />
Patient study using iViz.</p>
<p begin="00:00:20.213" end="00:00:23.680" region="r6" style="s2">
There are three ways to<br />
start a new Patient study.</p>
<p begin="00:00:23.680" end="00:00:26.823" region="r7" style="s2">
You can select a Patient<br />
from the Scheudled list</p>
<p begin="00:00:26.823" end="00:00:30.279" region="r2" style="s2">
or enter a new study from a search menu.</p>
<p begin="00:00:30.279" end="00:00:32.713" region="r8" style="s2">
You can also start a new Patient study</p>
<p begin="00:00:32.713" end="00:00:35.147" region="r9" style="s2">
after completing a scan.</p>
<p begin="00:00:35.147" end="00:00:37.995" region="r7" style="s2">
To start a new study<br />
from the Scheduled list,</p>
<p begin="00:00:37.995" end="00:00:42.162" region="r4" style="s2">
from the Home screen, tap<br />
Patient, and then Schedule.</p>
<p begin="00:00:45.546" end="00:00:49.960" region="r10" style="s2">
You can press the Refresh button<br />
to update the Patient list.</p>
<p begin="00:00:49.960" end="00:00:52.396" region="r11" style="s2">
Select a Patient from the list.</p>
<p begin="00:00:52.396" end="00:00:56.449" region="r12" style="s2">
The Patient's information<br />
automatically populates the form.</p>
<p begin="00:00:56.449" end="00:00:58.398" region="r13" style="s2">
Notice that you can also start</p>
<p begin="00:00:58.398" end="00:01:02.075" region="r7" style="s2">
a new Patient study from<br />
this screen as well.</p>
<p begin="00:01:02.075" end="00:01:05.158" region="r14" style="s2">
To start scanning, tap the scan icon.</p>
<p begin="00:01:06.571" end="00:01:09.667" region="r15" style="s2">
To start a new study from the Search menu,</p>
<p begin="00:01:09.667" end="00:01:12.500" region="r16" style="s2">
from the Home screen, tap Paitent.</p>
<p begin="00:01:14.758" end="00:01:17.675" region="r17" style="s2">
From the Search tab, tap New Study.</p>
<p begin="00:01:20.364" end="00:01:24.072" region="r18" style="s2">
Notice that iViz prompts you<br />
to close the current study</p>
<p begin="00:01:24.072" end="00:01:26.916" region="r19" style="s2">
before starting a new one.</p>
<p begin="00:01:26.916" end="00:01:28.733" region="r9" style="s2">
From the Patient Screen,</p>
<p begin="00:01:28.733" end="00:01:32.900" region="r18" style="s2">
type the Patient information<br />
in the appropriate fields.</p>
<p begin="00:01:37.541" end="00:01:41.208" region="r20" style="s2">
To close the keyboard,<br />
press the down arrow.</p>
<p begin="00:01:43.036" end="00:01:45.369" region="r16" style="s2">
Scroll down to make you've entered</p>
<p begin="00:01:45.369" end="00:01:47.869" region="r13" style="s2">
all the necessary information.</p>
<p begin="00:01:50.661" end="00:01:54.828" region="r4" style="s2">
Tap Save, or the Scan icon,<br />
to save the Patient form.</p>
<p begin="00:01:58.340" end="00:02:02.101" region="r5" style="s2">
And finally, you can also<br />
enter Patient information</p>
<p begin="00:02:02.101" end="00:02:04.568" region="r13" style="s2">
after you've completed a scan,</p>
<p begin="00:02:04.568" end="00:02:06.588" region="r21" style="s2">
by tapping the Patient field</p>
<p begin="00:02:06.588" end="00:02:09.338" region="r22" style="s2">
and then tapping the Patient tab.</p>
<p begin="00:02:16.017" end="00:02:19.400" region="r23" style="s2">
For more information about<br />
managing Patients and Studies,</p>
<p begin="00:02:19.400" end="00:02:21.817" region="r3" style="s2">
refer to the iViz User Guide.</p>

<p begin="00:00:08.150" end="00:00:14.790" style="s2">welcome to the help video configuring</p>
<p begin="00:00:11.219" end="00:00:16.949" style="s2">IVs and Android settings in this video</p>
<p begin="00:00:14.790" end="00:00:19.289" style="s2">we will walk you through the difference</p>
<p begin="00:00:16.949" end="00:00:22.910" style="s2">between configuring the Android device</p>
<p begin="00:00:19.289" end="00:00:25.980" style="s2">settings and the I've is system settings</p>
<p begin="00:00:22.910" end="00:00:29.160" style="s2">Google Android is the operating system</p>
<p begin="00:00:25.980" end="00:00:31.650" style="s2">that the I've is software runs on the</p>
<p begin="00:00:29.160" end="00:00:33.750" style="s2">Android operating system manages and</p>
<p begin="00:00:31.650" end="00:00:36.840" style="s2">monitors things like wireless</p>
<p begin="00:00:33.750" end="00:00:40.160" style="s2">connectivity date and time and battery</p>
<p begin="00:00:36.840" end="00:00:42.899" style="s2">charge most Android settings will be</p>
<p begin="00:00:40.160" end="00:00:45.329" style="s2">pre-configured by Fujifilm so no site</p>
<p begin="00:00:42.899" end="00:00:48.450" style="s2">but there are several Android functions</p>
<p begin="00:00:45.329" end="00:00:50.730" style="s2">that you can configure to open the</p>
<p begin="00:00:48.450" end="00:00:55.890" style="s2">settings menu from the Home screen tap</p>
<p begin="00:00:50.730" end="00:00:58.170" style="s2">the Android apps icon then settings from</p>
<p begin="00:00:55.890" end="00:01:01.969" style="s2">this screen you can configure things</p>
<p begin="00:00:58.170" end="00:01:05.010" style="s2">like Wi-Fi and Bluetooth settings sound</p>
<p begin="00:01:01.969" end="00:01:14.509" style="s2">display settings such as brightness and</p>
<p begin="00:01:05.010" end="00:01:17.909" style="s2">sleep mode and the system date and time</p>
<p begin="00:01:14.509" end="00:01:20.250" style="s2">to configure your IV's settings return</p>
<p begin="00:01:17.909" end="00:01:23.490" style="s2">to the home screen and tap the IV's</p>
<p begin="00:01:20.250" end="00:01:28.189" style="s2">Settings icon from here you can adjust</p>
<p begin="00:01:23.490" end="00:01:32.280" style="s2">the preferences oby calculations labels</p>
<p begin="00:01:28.189" end="00:01:37.079" style="s2">DICOM profiles patient search parameters</p>
<p begin="00:01:32.280" end="00:01:39.000" style="s2">and EMR settings for more information</p>
<p begin="00:01:37.079" end="00:01:43.460" style="s2">about configuring your system settings</p>
<p begin="00:01:39.000" end="00:01:43.460" style="s2">refer to the IV's user guide</p>
<p begin="00:01:49.720" end="00:01:51.780" style="s2">you</p>

<p begin="00:00:08.300" end="00:00:14.340" style="s2">welcome to the help video getting</p>
<p begin="00:00:10.920" end="00:00:16.680" style="s2">started in this video we will show you</p>
<p begin="00:00:14.340" end="00:00:19.439" style="s2">how to install the battery put the</p>
<p begin="00:00:16.680" end="00:00:23.100" style="s2">system in its protective case turn it on</p>
<p begin="00:00:19.439" end="00:00:27.539" style="s2">plug in the transducer use the kickstand</p>
<p begin="00:00:23.100" end="00:00:30.630" style="s2">and turn off the system properly i've is</p>
<p begin="00:00:27.539" end="00:00:33.000" style="s2">comes with three batteries before using</p>
<p begin="00:00:30.630" end="00:00:36.750" style="s2">the system you must install a charged</p>
<p begin="00:00:33.000" end="00:00:38.730" style="s2">battery to do this simply click the</p>
<p begin="00:00:36.750" end="00:00:44.969" style="s2">battery into place on the back of the</p>
<p begin="00:00:38.730" end="00:00:45.570" style="s2">system the protective case does two</p>
<p begin="00:00:44.969" end="00:00:47.730" style="s2">things</p>
<p begin="00:00:45.570" end="00:00:49.980" style="s2">it helps protect the system from</p>
<p begin="00:00:47.730" end="00:00:53.640" style="s2">breaking if it is dropped and it also</p>
<p begin="00:00:49.980" end="00:00:55.920" style="s2">makes it easier to hold in one hand put</p>
<p begin="00:00:53.640" end="00:00:58.710" style="s2">the system in the case by inserting the</p>
<p begin="00:00:55.920" end="00:01:01.199" style="s2">system into the end and then bringing</p>
<p begin="00:00:58.710" end="00:01:05.280" style="s2">the opposite case ends over the system</p>
<p begin="00:01:01.199" end="00:01:07.200" style="s2">to hold it in place now let's turn on</p>
<p begin="00:01:05.280" end="00:01:10.560" style="s2">the system by pressing the power button</p>
<p begin="00:01:07.200" end="00:01:13.650" style="s2">the green light indicates that the</p>
<p begin="00:01:10.560" end="00:01:17.070" style="s2">system is powering up when the day and</p>
<p begin="00:01:13.650" end="00:01:20.909" style="s2">time appears swipe the lock icon up and</p>
<p begin="00:01:17.070" end="00:01:23.729" style="s2">the IV's home screen appears to turn on</p>
<p begin="00:01:20.909" end="00:01:26.909" style="s2">Wi-Fi from the Home screen tap the</p>
<p begin="00:01:23.729" end="00:01:30.060" style="s2">Android apps icon tap the Android</p>
<p begin="00:01:26.909" end="00:01:35.790" style="s2">Settings icon and then slide the Wi-Fi</p>
<p begin="00:01:30.060" end="00:01:38.310" style="s2">button to on tap Wi-Fi to select a</p>
<p begin="00:01:35.790" end="00:01:43.439" style="s2">network and enter the password if one is</p>
<p begin="00:01:38.310" end="00:01:47.310" style="s2">required now you are connected next plug</p>
<p begin="00:01:43.439" end="00:01:49.979" style="s2">in the transducer on the back of the</p>
<p begin="00:01:47.310" end="00:01:52.740" style="s2">case is a retractable kickstand if</p>
<p begin="00:01:49.979" end="00:01:55.799" style="s2">desired you can flip out the kickstand</p>
<p begin="00:01:52.740" end="00:01:58.469" style="s2">to place the system on a flat surface</p>
<p begin="00:01:55.799" end="00:02:00.750" style="s2">when you're done using the system you</p>
<p begin="00:01:58.469" end="00:02:03.570" style="s2">can either press the power button to put</p>
<p begin="00:02:00.750" end="00:02:06.929" style="s2">it to sleep or press and hold the power</p>
<p begin="00:02:03.570" end="00:02:12.769" style="s2">button to power down completely when</p>
<p begin="00:02:06.929" end="00:02:12.769" style="s2">prompted tap power off and then tap ok</p>
<p begin="00:02:13.190" end="00:02:18.660" style="s2">to remove the case</p>
<p begin="00:02:15.330" end="00:02:21.420" style="s2">unplug the transducer then bring the</p>
<p begin="00:02:18.660" end="00:02:24.780" style="s2">case ends back over the system and lift</p>
<p begin="00:02:21.420" end="00:02:26.940" style="s2">the system out of the case for more</p>
<p begin="00:02:24.780" end="00:02:30.329" style="s2">detailed information about setting up</p>
<p begin="00:02:26.940" end="00:02:33.049" style="s2">and configuring IVs refer to the IV's</p>
<p begin="00:02:30.329" end="00:02:33.049" style="s2">user guide</p>
<p begin="00:02:38.050" end="00:02:40.110" style="s2">you</p>

<p begin="00:00:08.179" end="00:00:13.740" style="s2">welcome to I've is a whole new world of</p>
<p begin="00:00:11.550" end="00:00:14.370" style="s2">ultrasound that fits in the palm of your</p>
<p begin="00:00:13.740" end="00:00:17.990" style="s2">hand</p>
<p begin="00:00:14.370" end="00:00:23.670" style="s2">the IV's system has three main modules</p>
<p begin="00:00:17.990" end="00:00:29.189" style="s2">patient scan and learn to start scanning</p>
<p begin="00:00:23.670" end="00:00:32.130" style="s2">just tap scan spin the wheel to select</p>
<p begin="00:00:29.189" end="00:00:35.880" style="s2">the scanning option you want there are</p>
<p begin="00:00:32.130" end="00:00:39.600" style="s2">two press and hold modes in I've is to</p>
<p begin="00:00:35.880" end="00:00:44.100" style="s2">switch between 2d and M mode just press</p>
<p begin="00:00:39.600" end="00:00:49.170" style="s2">and hold the 2d button then press and</p>
<p begin="00:00:44.100" end="00:00:51.899" style="s2">hold the M button to return to 2d then</p>
<p begin="00:00:49.170" end="00:00:56.600" style="s2">when you're scanning you can press and</p>
<p begin="00:00:51.899" end="00:00:56.600" style="s2">hold the Save button to record a clip to</p>
<p begin="00:00:57.980" end="00:01:07.740" style="s2">save an image just tap save tap color to</p>
<p begin="00:01:04.799" end="00:01:11.549" style="s2">go into color mode and tap it again to</p>
<p begin="00:01:07.740" end="00:01:14.040" style="s2">turn it off you can select a different</p>
<p begin="00:01:11.549" end="00:01:18.420" style="s2">exam type from the drop down list in the</p>
<p begin="00:01:14.040" end="00:01:21.990" style="s2">upper right hand corner and you can also</p>
<p begin="00:01:18.420" end="00:01:25.540" style="s2">select a guided protocol</p>
<p begin="00:01:21.990" end="00:01:29.340" style="s2">if an image is frozen the tool drawer</p>
<p begin="00:01:25.540" end="00:01:32.590" style="s2">contains measurements and text labels</p>
<p begin="00:01:29.340" end="00:01:35.560" style="s2">while viewing a guided protocol in live</p>
<p begin="00:01:32.590" end="00:01:38.170" style="s2">scan mode you can pull out the wheel and</p>
<p begin="00:01:35.560" end="00:01:45.040" style="s2">change different options such as depth</p>
<p begin="00:01:38.170" end="00:01:48.700" style="s2">or gain then slide the wheel back in to</p>
<p begin="00:01:45.040" end="00:01:51.280" style="s2">continue if you are taking measurements</p>
<p begin="00:01:48.700" end="00:01:57.010" style="s2">while an image is frozen you can pull</p>
<p begin="00:01:51.280" end="00:01:59.410" style="s2">open the cine to change the view then</p>
<p begin="00:01:57.010" end="00:02:04.030" style="s2">just close it again to go back to</p>
<p begin="00:01:59.410" end="00:02:06.520" style="s2">measurements at any time you can review</p>
<p begin="00:02:04.030" end="00:02:11.380" style="s2">your saved images and clips by tapping</p>
<p begin="00:02:06.520" end="00:02:14.790" style="s2">the patient field in the patient module</p>
<p begin="00:02:11.380" end="00:02:19.230" style="s2">you can review and update patient data</p>
<p begin="00:02:14.790" end="00:02:22.060" style="s2">create reports and search for a patient</p>
<p begin="00:02:19.230" end="00:02:25.959" style="s2">when you are finished you can quickly</p>
<p begin="00:02:22.060" end="00:02:29.230" style="s2">return to your scan and remember</p>
<p begin="00:02:25.959" end="00:02:31.830" style="s2">whenever you get lost just tap home and</p>
<p begin="00:02:29.230" end="00:02:34.510" style="s2">you will go back to the home screen now</p>
<p begin="00:02:31.830" end="00:02:37.870" style="s2">it's time for you to explore on your own</p>
<p begin="00:02:34.510" end="00:02:40.810" style="s2">tap learn to find out more about IVs in</p>
<p begin="00:02:37.870" end="00:02:43.170" style="s2">either the help videos or the IVs user</p>
<p begin="00:02:40.810" end="00:02:43.170" style="s2">guide</p>
<p begin="00:02:47.900" end="00:02:49.959" style="s2">you</p>

<p begin="00:00:00.340" end="00:00:02.923">(bright music)</p>

<p begin="00:00:07.540" end="00:00:08.810">- So we'll just put a little bit more</p>
<p begin="00:00:08.810" end="00:00:10.500">alcohol on the skin surface</p>
<p begin="00:00:10.500" end="00:00:12.740">to get a better image quality.</p>
<p begin="00:00:12.740" end="00:00:13.967">Again,</p>
<p begin="00:00:13.967" end="00:00:15.683">we'll place the transducer</p>
<p begin="00:00:15.683" end="00:00:16.667">over the lateral side</p>
<p begin="00:00:16.667" end="00:00:18.130">of the biceps femoris muscle.</p>
<p begin="00:00:18.130" end="00:00:20.870">We can see the shadow of the femur.</p>
<p begin="00:00:20.870" end="00:00:23.420">We can move caudally with the transducer</p>
<p begin="00:00:24.350" end="00:00:26.670">and we try and Center that sciatic nerve</p>
<p begin="00:00:26.670" end="00:00:28.320">right in the middle of our screen</p>
<p begin="00:00:29.290" end="00:00:30.570">and place the needle we are using an</p>
<p begin="00:00:30.570" end="00:00:33.780">insulated Regional anesthesia needle</p>
<p begin="00:00:33.780" end="00:00:36.655">which allows us to also assess</p>
<p begin="00:00:36.655" end="00:00:38.690">the identity of what we think</p>
<p begin="00:00:38.690" end="00:00:40.310">the target nerve is</p>
<p begin="00:00:40.310" end="00:00:42.250">by using a low electrical current</p>
<p begin="00:00:42.250" end="00:00:45.120">to stimulate the motor<br />component of the nerve</p>
<p begin="00:00:45.120" end="00:00:47.230">and when we do so we will see</p>
<p begin="00:00:47.230" end="00:00:51.913">some extension and flexion<br />of the tarsal joint.</p>
<p begin="00:00:53.010" end="00:00:54.140">Distally,</p>
<p begin="00:00:54.140" end="00:00:55.860">place that needle first.</p>
<p begin="00:00:55.860" end="00:00:57.180">These are nice blunt needles,</p>
<p begin="00:00:57.180" end="00:00:58.650">which means that</p>
<p begin="00:00:58.650" end="00:00:59.500">they're a little bit tricky</p>
<p begin="00:00:59.500" end="00:01:01.370">to get through the skin.</p>
<p begin="00:01:01.370" end="00:01:03.348">But once you're through the skin</p>
<p begin="00:01:03.348" end="00:01:06.220">it allows you with that more blunt bevel</p>
<p begin="00:01:06.220" end="00:01:07.190">and the tip of the needle</p>
<p begin="00:01:07.190" end="00:01:08.940">to actually appreciate different tissues</p>
<p begin="00:01:08.940" end="00:01:09.983">as you penetrate.</p>
<p begin="00:01:11.560" end="00:01:13.760">So once the needle is placed</p>
<p begin="00:01:13.760" end="00:01:15.140">adjacent to the Target nerve</p>
<p begin="00:01:15.140" end="00:01:17.430">we see the Twitches that are corresponding</p>
<p begin="00:01:17.430" end="00:01:19.530">to the stimulation of the two components</p>
<p begin="00:01:19.530" end="00:01:21.270">of the sciatic nerve.</p>
<p begin="00:01:21.270" end="00:01:22.960">Once we get to that point.</p>
<p begin="00:01:22.960" end="00:01:24.660">It's a matter of just using very fine</p>
<p begin="00:01:24.660" end="00:01:26.193">manipulations on the needle.</p>
<p begin="00:01:27.430" end="00:01:28.263">Typically,</p>
<p begin="00:01:28.263" end="00:01:30.510">we try and inject some<br />of the local anesthetic</p>
<p begin="00:01:31.633" end="00:01:32.820">deep to the sciatic nerve first.</p>
<p begin="00:01:32.820" end="00:01:35.850">So on the below the nerve</p>
<p begin="00:01:35.850" end="00:01:37.700">on the image that we're seeing</p>
<p begin="00:01:37.700" end="00:01:39.253">on the ultrasound screen.</p>
<p begin="00:01:40.600" end="00:01:43.335">So we inject just a fraction</p>
<p begin="00:01:43.335" end="00:01:45.010">of the patients dose</p>
<p begin="00:01:45.010" end="00:01:46.540">initially at that area.</p>
<p begin="00:01:46.540" end="00:01:47.530">And typically what you'll see</p>
<p begin="00:01:47.530" end="00:01:50.020">is the local anesthetic spreading.</p>
<p begin="00:01:50.020" end="00:01:54.250">So is a hypo or anechoic black volume</p>
<p begin="00:01:54.250" end="00:01:55.480">that you can see</p>
<p begin="00:01:55.480" end="00:01:57.550">as it spreads around the nerve</p>
<p begin="00:01:57.550" end="00:01:59.180">deep to the nerve.</p>
<p begin="00:01:59.180" end="00:02:00.760">Once we get good spread</p>
<p begin="00:02:00.760" end="00:02:01.900">underneath the nerve</p>
<p begin="00:02:01.900" end="00:02:05.410">we'll usually pull the<br />needle back slightly</p>
<p begin="00:02:05.410" end="00:02:08.020">and try and use the local anesthetic</p>
<p begin="00:02:08.020" end="00:02:09.930">that we're injecting to dissect</p>
<p begin="00:02:09.930" end="00:02:12.900">between the nerve and the fascia that lies</p>
<p begin="00:02:12.900" end="00:02:14.950">underneath the biceps femoris.</p>
<p begin="00:02:14.950" end="00:02:16.660">We don't always get good spread</p>
<p begin="00:02:16.660" end="00:02:18.400">on the top of the nerve.</p>
<p begin="00:02:18.400" end="00:02:19.710">So usually we are happy</p>
<p begin="00:02:19.710" end="00:02:20.930">if we get a good spread</p>
<p begin="00:02:20.930" end="00:02:23.900">underneath the nerve as best as we can.</p>
<p begin="00:02:23.900" end="00:02:25.234">After that,</p>
<p begin="00:02:25.234" end="00:02:26.960">we just scan again with our transducer</p>
<p begin="00:02:26.960" end="00:02:28.580">just evaluating the extent</p>
<p begin="00:02:28.580" end="00:02:30.530">of that local anesthetic spread</p>
<p begin="00:02:30.530" end="00:02:32.530">making sure that it looks appropriate</p>
<p begin="00:02:32.530" end="00:02:34.160">to the dose that we've given</p>
<p begin="00:02:34.160" end="00:02:35.030">that we haven't lost</p>
<p begin="00:02:35.030" end="00:02:37.281">that local anesthetic injection</p>
<p begin="00:02:37.281" end="00:02:38.630">to other areas inadvertently.</p>
<p begin="00:02:38.630" end="00:02:41.443">Typically the dose we use for this block</p>
<p begin="00:02:41.443" end="00:02:45.600">is between 0.05 and 0.1<br />milliliters per kilogram</p>
<p begin="00:02:45.600" end="00:02:47.920">of our local anesthetic solution.</p>
<p begin="00:02:47.920" end="00:02:49.930">And when we're happy with the</p>
<p begin="00:02:49.930" end="00:02:51.740">spread of the local anesthetic,</p>
<p begin="00:02:51.740" end="00:02:53.190">we are simply going to remove</p>
<p begin="00:02:53.190" end="00:02:55.300">the needle from the patient.</p>
<p begin="00:02:55.300" end="00:02:56.133">And at this point</p>
<p begin="00:02:56.133" end="00:02:58.560">if we have a good sciatic nerve block,</p>
<p begin="00:02:58.560" end="00:02:59.850">the patient should have</p>
<p begin="00:03:00.860" end="00:03:02.430">be a very stable aesthetic</p>
<p begin="00:03:02.430" end="00:03:05.140">as the surgery is being performed</p>
<p begin="00:03:05.140" end="00:03:06.510">distal to the point of the block.</p>
<p begin="00:03:06.510" end="00:03:08.620">So typically stifle surgeries,</p>
<p begin="00:03:08.620" end="00:03:10.050">tarsal surgeries,</p>
<p begin="00:03:10.050" end="00:03:11.153">digital surgeries.</p>

<p begin="00:00:05.770" end="00:00:10.530">- So we identify the biceps femoris muscle</p>
<p begin="00:00:10.530" end="00:00:12.810">as our main soft tissue landmark.</p>
<p begin="00:00:12.810" end="00:00:14.460">We're gonna place the transducer</p>
<p begin="00:00:16.140" end="00:00:20.240">with the marker on the<br />cranial side of that muscle,</p>
<p begin="00:00:20.240" end="00:00:24.930">so that the left side of the<br />ultrasound monitor is cranial,</p>
<p begin="00:00:24.930" end="00:00:28.580">and the right side of the<br />ultrasound monitor is caudal.</p>
<p begin="00:00:28.580" end="00:00:31.500">So the first landmark that<br />is easy to identify is</p>
<p begin="00:00:33.330" end="00:00:35.460">this large round structure,</p>
<p begin="00:00:35.460" end="00:00:37.110">and that's going to be the femur.</p>
<p begin="00:00:40.100" end="00:00:42.650">As we move the transducer caudally,</p>
<p begin="00:00:42.650" end="00:00:45.523">we can see this is the<br />biceps femoris muscle.</p>
<p begin="00:00:46.830" end="00:00:51.160">So it's kind of a rounded<br />triangular shape facing down</p>
<p begin="00:00:51.160" end="00:00:53.880">and at the deepest part<br />of that biceps femoris</p>
<p begin="00:00:53.880" end="00:00:56.450">is this round structure that almost looks</p>
<p begin="00:00:56.450" end="00:00:57.640">like a pair of eyeglasses.</p>
<p begin="00:00:57.640" end="00:00:59.240">It's got two little round circles,</p>
<p begin="00:00:59.240" end="00:01:01.370">that are almost like a figure eight,</p>
<p begin="00:01:01.370" end="00:01:03.410">that are kind of hyper, or pardon me,</p>
<p begin="00:01:03.410" end="00:01:07.010">hypo or anechoic structures,<br />and that's the sciatic nerve.</p>
<p begin="00:01:07.010" end="00:01:09.500">So that's the target<br />that we're looking for.</p>
<p begin="00:01:09.500" end="00:01:10.370">You can see</p>
<p begin="00:01:12.690" end="00:01:15.000">that the more caudal structure</p>
<p begin="00:01:16.200" end="00:01:19.120">is a little bit larger<br />than the cranial piece</p>
<p begin="00:01:19.120" end="00:01:20.790">of the sciatic nerve.</p>
<p begin="00:01:20.790" end="00:01:23.710">That's the tibial component,<br />is the one caudally,</p>
<p begin="00:01:23.710" end="00:01:26.900">and the peroneal component<br />is the one more cranial.</p>
<p begin="00:01:26.900" end="00:01:28.420">So that's the structure we're looking for,</p>
<p begin="00:01:28.420" end="00:01:31.890">and as we move up and<br />down the leg a little bit,</p>
<p begin="00:01:31.890" end="00:01:34.810">you can see that that is<br />a continuous structure</p>
<p begin="00:01:34.810" end="00:01:36.830">that we can identify<br />at that deepest point.</p>
<p begin="00:01:36.830" end="00:01:38.930">So here is the skin surface</p>
<p begin="00:01:38.930" end="00:01:41.660">where the transducer is<br />being applied to the patient.</p>
<p begin="00:01:41.660" end="00:01:44.256">At the deepest part,<br />underneath the biceps femoris,</p>
<p begin="00:01:44.256" end="00:01:46.070">is going to be where we look for</p>
<p begin="00:01:46.070" end="00:01:51.070">that very obvious structure<br />that's the sciatic nerve.</p>
<p begin="00:01:51.190" end="00:01:52.810">Deep to that structure,</p>
<p begin="00:01:52.810" end="00:01:56.570">these are the adductors, AD ductor muscles</p>
<p begin="00:01:56.570" end="00:01:58.463">and as we move caudally,</p>
<p begin="00:02:00.310" end="00:02:01.200">we get up into an area</p>
<p begin="00:02:01.200" end="00:02:04.930">where the semitendinosus<br />and semimembranosus muscles</p>
<p begin="00:02:04.930" end="00:02:06.450">are gonna be located.</p>
<p begin="00:02:06.450" end="00:02:07.750">This is gonna be the target, here,</p>
<p begin="00:02:07.750" end="00:02:10.390">is this really obvious little structure</p>
<p begin="00:02:10.390" end="00:02:12.683">with the two circle components.</p>
<p begin="00:02:14.090" end="00:02:17.003">So as we place our needle<br />from a caudal direction,</p>
<p begin="00:02:17.940" end="00:02:20.460">you can see my finger just gently pushing</p>
<p begin="00:02:20.460" end="00:02:22.321">on the surface of the dog here,</p>
<p begin="00:02:22.321" end="00:02:24.600">so the needle is going to be entering from</p>
<p begin="00:02:26.610" end="00:02:28.660">the right side of the screen,</p>
<p begin="00:02:28.660" end="00:02:30.050">and we're gonna be looking here</p>
<p begin="00:02:30.050" end="00:02:31.480">on the depth markers.</p>
<p begin="00:02:31.480" end="00:02:33.340">On the right hand side you can see</p>
<p begin="00:02:33.340" end="00:02:34.173">that the very bottom</p>
<p begin="00:02:34.173" end="00:02:37.043">of the ultrasound monitor<br />is 4.9 centimeters.</p>
<p begin="00:02:38.120" end="00:02:41.910">So if we find the sciatic nerve<br />in the middle of our image,</p>
<p begin="00:02:41.910" end="00:02:44.610">and we look at where that<br />corresponding depth would be,</p>
<p begin="00:02:44.610" end="00:02:47.149">we're looking at approximately one, two,</p>
<p begin="00:02:47.149" end="00:02:51.350">maybe two, 2 1/2 centimeters<br />from the skin surface.</p>
<p begin="00:02:51.350" end="00:02:53.510">So when we place our needle<br />from a caudal direction,</p>
<p begin="00:02:53.510" end="00:02:55.800">we're gonna be coming in caudally</p>
<p begin="00:02:55.800" end="00:02:57.530">and you're gonna see<br />that needle enter from</p>
<p begin="00:02:57.530" end="00:02:58.950">the right side of the screen.</p>
<p begin="00:02:58.950" end="00:03:00.940">We're gonna be placing<br />that needle in-plane</p>
<p begin="00:03:00.940" end="00:03:02.850">underneath the ultrasound beam</p>
<p begin="00:03:02.850" end="00:03:05.070">and we're gonna see that<br />needle as it comes across</p>
<p begin="00:03:05.070" end="00:03:08.114">from the right side of the<br />screen, until we get it located</p>
<p begin="00:03:08.114" end="00:03:11.173">right adjacent to that sciatic nerve.</p>

<p begin="00:00:00.650" end="00:00:03.233">(gentle music)</p>
<p begin="00:00:39.190" end="00:00:40.450">- All right welcome.</p>
<p begin="00:00:40.450" end="00:00:42.168">Today we're gonna be doing a demonstration</p>
<p begin="00:00:42.168" end="00:00:45.240">of an ultrasound-guided<br />sciatic nerve block</p>
<p begin="00:00:45.240" end="00:00:46.520">in a dog.</p>
<p begin="00:00:46.520" end="00:00:48.773">This procedure is used to provide</p>
<p begin="00:00:48.773" end="00:00:51.550">local anesthesia, regional anesthesia</p>
<p begin="00:00:51.550" end="00:00:53.280">and postoperative analgesia</p>
<p begin="00:00:53.280" end="00:00:55.580">for procedures typically distal</p>
<p begin="00:00:55.580" end="00:00:57.228">to the stifle in the dog.</p>
<p begin="00:00:57.228" end="00:01:00.070">The anatomy we're looking at today,</p>
<p begin="00:01:00.070" end="00:01:01.790">we've already pre-clipped this animal</p>
<p begin="00:01:01.790" end="00:01:05.963">for the sake of showing you that anatomy.</p>
<p begin="00:01:05.963" end="00:01:08.160">Typically the animal would be clipped</p>
<p begin="00:01:08.160" end="00:01:10.960">for its surgery, relevant to the procedure</p>
<p begin="00:01:10.960" end="00:01:13.546">that's gonna be performed on the animal,</p>
<p begin="00:01:13.546" end="00:01:15.300">but what we've pre-clipped</p>
<p begin="00:01:15.300" end="00:01:18.610">for the demonstration<br />today is just an area</p>
<p begin="00:01:18.610" end="00:01:22.042">distal to two bony landmarks.</p>
<p begin="00:01:22.042" end="00:01:25.170">Typically we palpate<br />the greater trochanter</p>
<p begin="00:01:25.170" end="00:01:29.490">of the femur and the ischiatic tuberosity</p>
<p begin="00:01:29.490" end="00:01:33.227">on the pelvis and anything<br />distal to that area.</p>
<p begin="00:01:33.227" end="00:01:37.430">We also find this muscle<br />on the lateral side</p>
<p begin="00:01:37.430" end="00:01:38.910">of the thigh, which is called</p>
<p begin="00:01:38.910" end="00:01:41.630">the biceps femoris muscle and this is</p>
<p begin="00:01:41.630" end="00:01:43.680">the main landmark that we're gonna palpate</p>
<p begin="00:01:43.680" end="00:01:45.650">and try and appreciate as we place</p>
<p begin="00:01:45.650" end="00:01:47.863">the ultrasound transducer.</p>
<p begin="00:01:47.863" end="00:01:49.430">So what we've clipped today</p>
<p begin="00:01:49.430" end="00:01:51.826">is just an area over the target,</p>
<p begin="00:01:51.826" end="00:01:54.470">so we have the biceps femoris muscle</p>
<p begin="00:01:54.470" end="00:01:56.560">in the center and in this</p>
<p begin="00:01:56.560" end="00:01:59.310">particular regional anesthetic approach,</p>
<p begin="00:01:59.310" end="00:02:01.030">the needle that we're going to be using</p>
<p begin="00:02:01.030" end="00:02:02.560">to deliver the local anesthetic</p>
<p begin="00:02:02.560" end="00:02:06.670">is going to be entering<br />from a caudal direction,</p>
<p begin="00:02:06.670" end="00:02:08.290">so we've clipped the animal</p>
<p begin="00:02:08.290" end="00:02:09.770">around the back of the thigh</p>
<p begin="00:02:09.770" end="00:02:13.510">to allow that entry for the needle.</p>
<p begin="00:02:13.510" end="00:02:16.260">We've already done a sterile prep,</p>
<p begin="00:02:16.260" end="00:02:18.220">so we've used three different scrubs</p>
<p begin="00:02:18.220" end="00:02:20.130">of chlorhexidine and a final prep</p>
<p begin="00:02:20.130" end="00:02:21.483">of alcohol at this point.</p>

<p begin="00:00:05.650" end="00:00:07.580">- Okay, so right now we are in the nerve,</p>
<p begin="00:00:07.580" end="00:00:10.480">we localize, we turned off the stimulator</p>
<p begin="00:00:10.480" end="00:00:11.500">so it stopped moving,</p>
<p begin="00:00:11.500" end="00:00:12.630">but I have already the needle</p>
<p begin="00:00:12.630" end="00:00:14.300">right by the nerve.</p>
<p begin="00:00:14.300" end="00:00:15.570">We aspirate it to make sure</p>
<p begin="00:00:15.570" end="00:00:17.900">we don't hit that circumflex</p>
<p begin="00:00:17.900" end="00:00:19.421">and we're coat now the nerve</p>
<p begin="00:00:19.421" end="00:00:22.220">with the local anesthetic and you can see</p>
<p begin="00:00:22.220" end="00:00:24.730">we're creating a pool of local anesthetic</p>
<p begin="00:00:24.730" end="00:00:25.910">around the nerve,</p>
<p begin="00:00:25.910" end="00:00:27.220">which will make the nerve a little</p>
<p begin="00:00:27.220" end="00:00:28.820">easier to see and you're gonna see</p>
<p begin="00:00:28.820" end="00:00:31.300">that now the nerve is quite a bit detached</p>
<p begin="00:00:31.300" end="00:00:32.820">from every structure around.</p>
<p begin="00:00:32.820" end="00:00:34.280">You see the circumflex out</p>
<p begin="00:00:34.280" end="00:00:37.330">to removing more superficial.</p>
<p begin="00:00:37.330" end="00:00:39.380">And then you can see a little bit better</p>
<p begin="00:00:39.380" end="00:00:40.593">the femoral nerve.</p>
<p begin="00:00:43.200" end="00:00:44.930">And that is an alternative</p>
<p begin="00:00:44.930" end="00:00:49.930">to another technique that you can use</p>
<p begin="00:00:50.140" end="00:00:51.618">on the iliopsoas muscles</p>
<p begin="00:00:51.618" end="00:00:54.960">and I find that the<br />lateral circumflex artery,</p>
<p begin="00:00:54.960" end="00:00:56.975">iliac artery really helps in finding</p>
<p begin="00:00:56.975" end="00:00:58.503">that femoral nerve.</p>
<p begin="00:00:59.920" end="00:01:02.150">And once you inject all<br />the local anesthetic,</p>
<p begin="00:01:02.150" end="00:01:02.983">you're pretty much done.</p>
<p begin="00:01:02.983" end="00:01:04.570">You do your sciatic nerve block</p>
<p begin="00:01:04.570" end="00:01:06.870">and your legs are gonna be blocked</p>
<p begin="00:01:06.870" end="00:01:08.263">for the procedure.</p>