医学英语学习贴——《医学视频听、写、翻译》 第一期

为提高大家学习英语的热情和兴趣，做一期有声英语活动。
临时设计了这种参与方式，希望大家多多参与、提出宝贵意见，旨在通过各种形式的学习，真正起到熟悉医学英语语感、提高医学英语能力的作用。本次第一期内容视频时间约5分钟，视频内容已经重新剪辑，并将文本材料做出了删减调整，请各位筒子参与。

参与方法：先看视频，然后把听到的内容写下来，然后再翻译成中文即可。

回复后可以在主楼看到正确答案。


This is a Video in Clinical Medcine from the New England Journal of Medicine.

This video will demonstrate safe and successful methods of performing lumbar puncture. Lumbar puncture is indicated for both diagnostic and therapeutic purposes. Also, the administration of spinal and epidural anesthesia involves the use essentially of the same technique. Analysis of cerebrospinal fluid may be helpful in the diagnosis of infectious processes such as meningitis, inflammatory diseases such as multiple sclerosis, cancers such as leukemia, and metabolic processes. Therapeutically, lumbar puncture allows for the intrathecal administration of chemotherapeutic agents and antibiotics. There are specific contraindications to lumbar puncture. The condition of patients with cardiorespiratory compromise may worsen as a consequence of the position they need to assume for lumbar puncture.
The condition of patients with cardiorespiratory compromise may worsen as a consequence of the position they need to assume for lumbar puncture.
The procedure should also be avoided in patients with signs of cerebral herniation,incipient herniation or increased intracranial pressure,and in those with focal neurologic signs.
In such patients,cranial CT should be performed before lumber puncture,although CT may not reveal signs of increased intracranial pressure.
Finally there is an increased risk of a spinal hematoma if a coagulopathy is present or if the patient is receiving anticoagulant therapy.
Patients who have previously undergone lumbar surgery should be referred to an interventional radiologist.
Before performing the lumbar puncture,you will need a commercially available tray containing the necessary supplies:a spinal needle with a stylet,equipment for skin preparation,drapes,collection tubes,and in some cases, amanometer.Typically,a 20-to-22gauge needle is used, with the lendth ranging from 1.5 inches.,or 3.8 cm,for infants to 2.5 inches.,or 6.3 cm and 3.5 inches.,or 8.9cm,for adults.
You will also need sterile gloves.
Before you begin you should explain the procedure, along with potential risks and benefits,to the patient and obtain informed consent from the patient or his or her parent or guardian.
After ontaining appropriate patient consent,the patient is positioned;either the lateral recumbent position or a sitting position can be used.
The lateral recumbent position is preferred,to obtain an accurate opening pressure and to reduce the risk of post-puncture headache.
Instruct the patient to assume a fetal position or to arch "like a cat,"with the back flexed.
This position widens the gap between the spinous processes.
Ideally,the lumbar spine should be perpendicular to the table if the patient is in the sitting position and parallel to the table if he or she is in the lateral recumbent position.
These position help keep the needle at the midline.
A line is visually drawn between the superior aspects of the iliac crest,and intersects the midline at the L4 spinous proceses.
Insert the needle in the interspace between L3 and L4 or L4 and L5,since this location is below the termination of the spinal cord.
Palpate the landmarks before preparing the skin and before admimisterring local anethesia,since the anesthesia may make landmarks harder to identify.Use a skin-marking pen to identify the site of needle insertion.
While wearing sterile gloves,clean a sufficiently large area of the overlying skin with a disinfecting agent such as chlorhexidine or povidone-iodine using a pattern of widening concentric circles.Drape the area with sterile drapes.Lay out the collection bottles in the order of priority for the diagnostic indictions.
Lumbar puncture is a painful and potentially anxiety-provoking procedure.
At amimimun,the use of a local anesthetic is a appropiate;sedation or systemic anesthesia may be required under some circumstances.
You can apply anesthetic cream topically before preparing the skin.
After preparing the skin ,you can inject local anesthetics subcutaneously.