hello my name is Ruda AZ I'm from stutgart in Germany we are at frish at the moment in the B Spot clinic in orthopedic clinic where we do shoulder surgery and every patient gets a regional anesthesia in this case an inter scaling block with the catheter we do this ultrasound guided and I've got a little uh probe here and this uh probe is um um quite cool because it connects um with Wi-Fi to an iPad which I use as an ultrasound Monitor and this one has another very special feature because it is a twoin one probe it has got one linear section and also a face array and depending on the preset it kind of automatically switches between the two and um in order to demonstrate this I will quickly assess the diaphragmatic function before the intercine block and I do this in an abdomen preset okay I put the Probe on the marker is directed towards the mattress and uh now the image is frozen and I can actually put on some voice controls and uh tell the machine freeze and now it will dease now I've got a standard image I could again optimize the image by voice control like um decrease depth or increase gain or like uh color mode then I get the color mode B mode and I also can start a video clip by capture video and now the video is uh started take some yes we've got a dirty curtain coming in good out so this is a normal diaphragmatic function capture video will stop the video M mode okay capture video artman and o adman yeah very nice diaphragmatic function that's all to tell us that as expected the diaphragm Works totally um in a normal way be out excellent and capture video will stop the video I do prescan the marker is directed to my own left eye in order to have the right image orientation and of course I need to optimize the image again I also can of course touch the suncreen or could use some buttons that are on the probe the um subclavian artery in the center of the image that is what I want capture video and now I go up and follow the braak the plexus into the inter scaling Groove sometimes there are some vessels the vertebral vessel are right in the center of the image right now color mode here they are B mode and uh I've got the C7 spinal nerve in the transus proces this is C6 and this is C5 and ultimately this is C4 capture video and now I follow the uh C4 nerves into what we call the cical nerves pathway and I can't really uh see them really well at the moment however I still can um block them in the cervical nerve passway just underneath the stoc muscle on deala I keep my distance between the needle and the probe of course for sterility or hygiene reasons it's SK my CL paks under the H okay capture video I insert the needle go under the probe and now I inject a little bit and split all the horizontal fascia layers then I take the probe off go subcutaneously and tunnel subcutaneously in the direction where the catheter will be inserted in a minute now we will keep on doing some preparations for the sterile field
