肺超声诊断COVID-19（新冠讲座51）

Lung Ultrasound to Diagnose COVID-19 (Coronavirus Lecture 51)

肺部超声诊断COVID-19

Welcome to another MedCram covid-19 update.  If we look at yesterday’s, we had a total of thirty thousand new cases in the United States, and France with 5,000. Take a quick look at the United States, New York is at the top, and they are supposed to peak around April 9 or 10, California is supposed to peak around April 26.

欢迎收听MedCram Covid-19的最新课程。如果我们看昨天的情况，美国总共有3万例新病例，法国有5,000例。快速浏览一下美国，纽约居首位，他们应该在4月9日或10日左右达到顶峰，加利福尼亚应该在4月26日左右达到顶峰。

Testing has been a big issue. Here recently, if you look at the total number of tests per million population, you can see that New York is followed by Louisiana, and of course, Washington, which is really where things started in the first place. Interestingly, if you look and see where California is on the other hand, it’s way down near the bottom of the list, with only 3,313 tests per 1 million population being performed.

测试一直是一个大问题。最近，在这里，如果查看每百万人口的测试总数，你会看到纽约州第一，紧随其后是路易斯安那州，当然还有华盛顿州（疫情开始的地方）。有趣的是，如果你看一看加利福尼亚州的情况，它跌到了列表的底部，每100万人口中只有3,313测试。

If you look at where the new deaths are coming from in the States, we have the average here “USA Total”, but if you look at the death per million population, the average is around 33. Those states with a higher than average death per million population are listed here, and these states here are less than the national average. And that could very well be because of where they are in a position of surge. These states here are going to be surging later, and I’m sure there’s going to be a flip-flop of these states relative to the neighbors above the average. We will talk more about surging, and peaking and resources.

如果你看一下美国新死亡的来源，我们的平均值为“美国总数”，但是如果你查看每百万人口的死亡数，则平均值约为33。那些百万人口死亡率高于平均水平的州的列在这里，而这些州低于全国平均水平。那很可能是因为他们处于激增的位置。这些州将在稍后激增，我敢肯定，相对于高于平均水平的邻州，这些州会有一个翻转。我们将更多地讨论激增，峰值和资源。

So I want to show you this very interesting and useful website. This is put out by the University of Washington. It basically is a model that will tell you when the pandemic of Covid-19 is going to peak in terms of resources and in terms of deaths.  And it’s being constantly updated in real-time by real data.

因此，我想给大家看一下这个非常有趣且有用的网站。这是由华盛顿大学建立的。它基本上是一个模型，可以告诉你Covid-19大流行病何时将达到资源和死亡人数的高峰。而且它会根据实际数据不断进行实时更新。

The Covid-19 projections here are assuming full social distancing through May of 2020, and there’s a FAQ here. But what you can do as you can see here is you can put in the district that you like to look at. Here is the United States of America, and it will tell you here nine days until the peak resource use on April 15. It’ll show you how many beds are needed, what the bed shortage is nationally, ICU beds that are needed, the ICU bed shortage, and the number of ventilators that are needed.

这里的Covid-19预测假设到2020年5月将全部实施社交隔离，并且这里有一个常见问题解答。但是，你可以在这里看到的是你可以放入要查看的区域。这是美国，它提前9天告诉你， 资源使用会4月15日达到高峰。它将向你显示需要多少张床，全国范围的床短缺情况，需要的ICU床， ICU床短缺，以及需要的呼吸机数量。

You can actually see it here in the graph. You can click on “All Beds,” what the predicted will be, and the range of those from top to bottom, and then the number of invasive ventilators. If we scroll down, here we can see the number of deaths per day. As you can see here, the solid red line is real data. And after it, is projected data based on the models that the computers have run.

你实际上可以在图中的此处看到它。你可以单击“ All Beds”，这将是预期的值，上下的范围以及手术呼吸机的数量。如果向下滚动，则可以在这里看到每天的死亡人数。如你在此处看到的，红色实线是实际数据，之后就是根据计算机运行的模型预测的数据。

Now, of course, this is the United States of America. What we can do is we can go and see what things are like in your particular state. You can do that here on the website. Let’s go to New York, which has been in the news recently. Of course, they are ahead of us in terms of the curve.

当然这是美国的情况。我们能做的就是去看看你所在州的情况。你可以在网站上执行此操作。让我们来看一下纽约，最近的新闻有报道。当然，它们在曲线方面领先于我们。

You can also see here what happened in the state in terms of what date, so you can see here on March 22nd, for instance, was the stay-at-home order; on March 18 had educational facilities that were closed. If we look at “All Beds,” we can see that the number of beds that will be needed peak here on April 9th, which is just a few days away, then come back down.

你还可以在这里看到该州在哪一天发生了什么，因此，例如3月22日，你可以在此看到“待在家里”的命令； 3月18日，教育设施被关闭。如果我们查看“All Beds”，则可以看到需要的床铺数量在4月9日（离现在只有几天）达到顶峰，然后下降。

There is a bar which is the beds that are available, and you can see that we’re already exceeding the beds that are at least available based on the model. We can look at the number of ICU beds. The number of ICU beds far exceeded, and you can see those are the kind of issues that they’re having in New York.

这个柱形条反映的是可用的床，根据这个模型你可以看到床位现在供大于求。我们可以看看ICU病床的数量。 ICU病床的数量远远超过了需求，你可以看到纽约现在就是这样。

In terms of deaths per day, you can see where we are right now and where things are predicted to be. If we go to, for instance, my neck of the woods in California, you can see things not as severe as what’s going on in the Eastern Seaboard there. We are predicted to peak in California in terms of resources on April 14, and you can see the resources here that will be needed.

从每天的死亡人数来看，你可以看到我们现在的情况以及预计的情况。例如，如果我们去我在加利福尼亚住的地方，你会发现事情没有东部沿海地区所发生的事情那么严重。预计加利福尼亚的资源将于4月14日达到顶峰，你可以在此处看到需要的资源。

If we go to ‘All Beds,’ apparently here in California we are well under that bar, so we should be able to meet that in terms of ICU beds according to this model, we should be able to meet the demands. So we’re all watching this as participants on the front lines, as healthcare providers because we want to know exactly when this peak is going to come, and when we can expect things to subside.

如果我们看“All Beds”，显然在加利福尼亚州，我们的数值很低，因此，按照这种模式，我们应该能够满足ICU床的需求,我们应该能够满足需求。作为一线的参与者、作为医疗服务提供者，我们正在看到这一情况，因为我们想确切地知道何时将到达高峰，何时可以期待疫情消退。

And with this pandemic have come difficulties in terms of diagnostics. How do you image the lung and how do you deal with the contamination issues when you’re taking somebody from one room to another. You know, one of the modalities of imaging that we had to use quite a bit of this last week in the hospital was the CAT scanner. It’s a very integral part of the system that we use.

大流行带来了诊断方面的困难。如何成像肺部？当你将某人从一个房间带到另一个房间时，如何处理污染问题？你知道，我们上周在医院中使用一个成像方式是使用CAT扫描仪。这是我们使用的系统的一个非常重要的部分。

The problem, however, is that anybody that comes into the emergency room that has a cough, or a fever, or even less than that, is going to be considered as a person of interest in terms of being infected. The term that we use is a PUI or a person or patient under investigation.

然而，问题在于，进入急诊室的任何人如果咳嗽、发烧，将被认为是感染者。我们使用的术语是PUI（被调查的个人或患者）。

The problem with that is that when you send that patient to the CAT scanner, they do the CAT scan, but then they have to spend the next hour or so wiping down that CAT scanner because if it turns out that the first patient is positive, and the next person that comes in is not, then you could spread that virus to that patient. So the number of CAT scans that you can do on a regular basis is really reduced and that can impede your ability to do appropriate work up in the emergency room.

这样做的问题是，当你将该患者送到CAT扫描仪上进行扫描，但随后他们必须花下一个小时左右的时间来擦拭该CAT扫描仪，因为如果发现第一个患者是阳性，而下一个进来的人不是，那么就会把病毒传播给另一个患者。因此，你可以定期进行的CAT扫描数量确实减少了，这会降低检查效率。

Something that’s much quicker, much easier to wipe down, and something that’s portable, that  you could even put a transparent plastic cover over it and go from room to room simply changing the plastic cover is an ultrasound. Well, as you know, as they say “necessity is the mother of invention.” And in this case, the inventions have already been made. It’s just that we’re getting more creative. And even more so a portable ultrasound machine that can be hooked up to a small device or iPad is even more convenient and can be wiped down very quickly.

我们需要更快，更容易擦拭的设备，以及便携式的设备，甚至可以在上面放一个透明的塑料套，然后从一个房间到另一个房间时换个塑料套就可以。就像你知道的那样，正如他们所说的，“必要性是发明之母”。现在发明出来了，只是我们想改进一下。甚至更方便的是，可以连接到小型设备或iPad的便携式超声仪更加方便并且可以很快擦除。

Now, I want you to understand what’s going on with ultrasound in Covid-19. And the best person to do that is the one who taught me ultrasound. Dr. Joshua Jacquet is the Emergency Ultrasound Director at the Cleveland Clinic Akron General in Akron, Ohio. You can read more about Dr. Jacquet on our website, but let’s get a better understanding of what’s going on with ultrasound in Covid-19.

现在，我想让你们看一下超声波在Covid-19中的使用。而做到这一点的最佳人选就是教我超声的人。约书亚·雅克特（Joshua Jacquet）医生是俄亥俄州阿克伦市克利夫兰诊所阿克伦医院的急诊超声总监。你们可以在我们的网站上阅读有关Jacquet医生的更多信息，现在让我们好好了解一下超声在Covid-19中的使用。

Well, thank you Roger. I just want to take a second to appreciate you in the MedCram team for all that you’ve done to release these amazing Covid-19 update videos. As I’ve been following along with you, I’ve wanted to discuss lung ultrasound. Before the pandemic, I utilized lung ultrasound in the care of my Emergency Department patients routinely, mostly the diagnose of respiratory illnesses, and that’s because it’s more accurate than a chest x-ray which we routinely use and more accurate than our stethoscope. And it rivals the accuracy of CT Imaging. So it’s not surprising to me that in the Covid-19 pandemic people are starting to utilize lung ultrasound more because of its advantages.

好，谢​​谢Roger。我只想花一点时间在MedCram团队中感谢你为发布这些令人惊叹的Covid-19更新视频所做的一切。我一直在与你一起关注，我想讨论一下肺部超声检查。在大流行之前，我通常在急诊室患者中使用肺部超声检查，主要是诊断呼吸系统疾病，这是因为它比我们常规使用的胸部X光、听诊器更精确，并且可以与CT成像的准确性相媲美，因此在Covid-19大流行中，由于其优势，人们开始更多地使用肺部超声，这不足为奇。

You can see in this article Ultrasound useful for detecting Covid-19 pneumonia emergency medicine providers say and this is a group of Italian Imaging experts and they’re using the word here urging for ultrasound as one possible alternative.

大家在这篇论文中看到“超声波对于检测Covid-19肺炎急诊医疗人员很有用”，这是一组意大利影像专家，他们在这里强烈推荐超声波作为一种可能的替代选择。

So why would these Imaging experts urge us to be utilizing lung ultrasound？ Roger, you already did a video that describe the advantages of CT in the accuracy early in the Covid-19 illness. But CT has some major disadvantages. And here’s a paper “Findings of lung ultrasonography of novel coronavirus pneumonia.” This was published in intensive care medicine. And the primary purpose of this study was to compare the CT findings with the lung ultrasound findings. So if CT is accurate and we can compare the findings, then we can suspect that lung ultrasound is accurate.

那么为什么这些影像专家会敦促我们使用肺部超声波成像技术呢？罗杰（Roger），你已经制作了一段视频，描述了在Covid-19病早期，CT在准确性方面的优势。但是CT有一些主要的缺点。这是一篇论文“新型冠状病毒性肺炎的肺部超声检查结果”，发表在重症监护医学上。这项研究的主要目的是将CT检查结果与肺部超声检查结果进行比较。因此，如果CT准确，并且我们可以比较两方面的结果，那么我们猜想肺部超声是准确的。

So the reason I bring out this article here is because they considered in their experience lung ultrasound to have major utility in the management of these patients due to some advantages, they point out it’s safe. There’s no radiation. Radiation increases your cancer risk over time and chest x-ray and CT both use radiation. It’s repeatable, meaning you can do the exam as many times as you clinically need to and repeat it quickly. It’s low cost compared to other imaging.

因此，我在这里提出这篇文章的原因是，由于他们的某些优势，他们认为肺超声在这些患者的治疗中具有重要作用，因此指出这是安全的，没有辐射。随着时间的流逝，放射线会增加你患癌症的风险，并且胸部X光和CT都会使用放射线。而超声是可以重复的，这意味着你可以根据临床需要进行多次、快速重复检查。与其它成像相比，它的成本较低。

You can use it at point of care, meaning right at the bedside I can get information that will help me manage my patient. You can do a rapid assessment of the patient at presentation. You can track the evolution of the disease. So in real time, if there’s a change, it’ll show up on lung ultrasound. And then they point out many other decisions that the doctors have to make, especially in the Intensive Care Unit. Those decisions, many times, are complicated, and ultrasound can be used as a piece of the puzzle to help make those decisions.

你可以在护理时使用它，这意味着在床边，我可以获得帮助我管理患者的信息。你可以对患者进行快速评估。你可以跟踪疾病的演变。因此，如果有变化，它将实时显示在肺部超声检查中。然后他们指出医生必须做出的许多其它决定，尤其是在重症监护室。这些决定很多时候都很复杂，超声可以作为一个解决方法来帮助做出这些决定。

So here’s another article. This is a correspondence published in the Lancet by several Italian doctors encouraging us. In this Covid-19 outbreak, use less stethoscope and more ultrasound. “Is lung ultrasound the stethoscope of the new millennium? Definitely yes.” And so they’re showing the advantages of using a portable ultrasound system. We see a picture of it here where you could have a tablet and a ultrasound probe attached by Bluetooth or Wi-Fi.

这还有另一篇文章。这是《柳叶刀》上几位意大利医生发表的一封信，鼓励我们，在这次Covid-19爆发中，少用听诊器，多用超声波。“肺超声是新千年的听诊器吗？肯定是的。”他们介绍了使用便携式超声系统的优势。我们在这看到一张图片，你可以在其中通过蓝牙或Wi-Fi连接平板电脑和超声波探头。

And you can cover these with sterile covers, so as not to transmit the infection to another patient after you’re done. And so they point out here in their opinion the use of ultrasound is now essential in the safe management of Covid-19 outbreaks, since it can allow can common execution of clinical examination and lung imaging at the bedside by the same doctor, meaning the doctor can come in, talk to you, do the exam and get lung imaging with ultrasound right there instead of having to send you to chest x-ray or CAT scan.

你可以把设备套上无菌套，以免在完成后将病毒传播给另一位患者。他们在这里指出，在安全管理Covid-19疫情中，超声波的使用现在必不可少，因为它可以允许同一位医生在床边共同执行临床检查和肺部成像，这意味着医生可以进来，与你交谈，进行检查并在那里进行超声肺成像，而不必将你送拍胸部X光或做CAT扫描。

And here’s another video showing the advantage of having a portable device. You can cleanse and disinfect it and cover the entire thing in a sterile cover. So if you go into the hospital or in a triage setting and you need to get an ultrasound, this is just a little bit of what that might look like. So the probe just touches your body, there’s gel between the ultrasound probe and you, and then the machine shows a picture of what your lungs look like on the inside.

这是另一个视频，展示了拥有便携式设备的优势。你可以对其进行清洗和消毒，然后将整个物品套上无菌套。如果你去医院或分诊，并需要进行超声检查，这只是看起来的一小部分。探头只是触碰到你的身体，超声波探头和你的身体之间有凝胶，然后机器上就显示你肺部的图像。

So this is one of the first articles that describes the lung ultrasound findings in Covid-19. They looked at 20 patients in China and compared their CT images with their ultrasound images. And just to give you an idea, on CAT scan this white patchy area‘s where Covid-19 is affecting the lung, and on ultrasound that may appear like these vertical white lines, which we call B lines coming down from the lining of the lung. On another patient, this white patchy area here and here are both areas where Covid-19 is affecting the lungs, and on lung ultrasound you see this irregularity of the lining of the lung and this kind of white out shadow area that it produces.

这是描述Covid-19中肺部超声检查结果的第一批论文中的其中一篇。他们研究了中国的20名患者，并将他们的CT图像与超声图像进行了比较。大家看一下，在CAT上扫描Covid-19影响肺部的白色斑片区域，然后在超声上出现像这些垂直白线一样的现象，我们称其为B线从肺内层下来。在另一位患者上，这里和这里的白色斑块区域都是Covid-19影响肺部的区域，在肺部超声检查中，你会看到肺部衬层的这种不规则性以及产生的这种白色阴影区域。

So on this patient, you see more this white rounded consolidated area in Cat Scan with these black lines, which is air still trying to get into that area of the lung, and on lung ultrasound that shows up as this kind of dark blob here with these white dots inside which are air on ultrasound.

在该患者身上，你会在Cat扫描中看到更多带有黑线的白色圆形实心区域，这是空气仍在试图进入肺部区域；在肺部超声检查中，这种带这些白色点的黑斑里是空气。

So how might you see health care providers using lung ultrasound in Covid-19. Well, as discussed, they may use it in triage when they’re seeing a bunch of patients instead of chest x-ray or CAT scan and that may help us know how severe the illness already is and who is at risk for it getting worse. We may be able to also utilize it while we’re waiting for that PCR test to know if that’s positive or negative.

你如何看待医疗保健提供者在Covid-19中使用肺部超声检查。正如所讨论的，他们可以使用它对很多患者进行分诊，而不使用胸部X光或CAT扫描，这可能有助于我们了解疾病的严重程度以及谁有病情恶化的危险。我们在等待PCR测试阳性还是阴性时也可以使用它。

And here’s an article showing an example of this. Under pressure one Italian doctor triage is by ultrasound. Other area is “can ultrasound help us predict who is going to get worse before they do?” Most believe that it’s very advantageous to follow the progression of the disease and as we talked about before, it can help make some of the tough decisions that we need to make in these Covid-19 patients.

这篇文章介绍了一个实例。在压力下，一名意大利医生进行了超声分诊。“超声可以帮助我们预测谁会变得更糟吗？”大多数人认为，它对跟踪疾病的进展非常有利，正如我们之前所说的那样，它可以帮助我们做出一些需要对这些Covid-19患者做出的艰难决定。

And remember it’s not just patients that are being affected by this pandemic, but healthcare providers are as well. Here’s an example of Dr. Yale Chen, who contracted Covid-19. He’s an emergency physician in Spain and he shares a diary on Twitter daily of his symptoms and his lung ultrasound findings. So as we’re following the progression of his symptoms while he’s at home, we’re also able to follow the progression of his lung ultrasound findings and learn from him both how he’s feeling in the progression of disease as well as the progression of his lung ultrasound findings.

请记住，不仅是对受大流行影响的患者有用，而且医疗保健提供者也是如此。感染Covid-19的Yale Chen医生是西班牙的一名急诊医师，他每天在Twitter上分享自己的症状和肺部超声检查结果的日记。因此，当我们跟踪他在家中的症状进展时，我们也能够跟踪他的肺部超声检查结果的进展，并向他了解他的感觉及肺部超声检查结果的进展。

So for all the reasons we discussed today, you’re going to see lung ultrasound utilized in Covid-19 more and more. Now, if you’re a health care professional and you need to learn more about lung ultrasound, there are many resources. So at MedCram, we’ve released lung ultrasound and Covid-19 educational videos. We’ve added them to our lung ultrasound explained clearly course and we’ll also release them separately on YouTube. These will be free and open access to any provider who’d like to educate themselves on how to utilize lung ultrasound in Covid-19.

你将越来越多地看到在Covid-19中使用肺超声。如果你是卫生保健专业人员，并且需要了解有关肺部超声的更多信息，那么这里有很多资源。因此，在MedCram，我们发布了肺部超声检查和Covid-19教育视频。我们已将它们添加到我们清晰讲解的肺部超声课程中，我们还将在YouTube上单独发布它们。这些服务将免费提供给任何想对其如何在Covid-19中使用肺超声进行自我教育的提供者。

So we are praying that this virus is eradicated and this pandemic ceases, but in the meantime healthcare professionals are utilizing every resource at their fingertips to take the best care of their patients.

让我们为这种病毒的根除和大流行的停止而祈祷，但与此同时，医疗保健专业人员正尽其所能利用各种资源来为患者提供最佳护理。