It can be compared to heart auscultation. Heart sounds are divided into first heart sound, second heart sound, etc. according to different anatomical positions. Breathing sounds can also be divided into four kinds of breath sounds according to bronchi, bronchoalveoli, alveoli, and trachea.
Normal breath sounds are the same as heart sounds. The sounds must be rhythmic, timbre, volume, etc., which makes people feel comfortable and not abnormal.
If you hear abnormal breath sounds, just remember that every clinical abnormality is closely related to anatomy. Like this patient now, there is pleural effusion, and the patient's normal gas exchange activities in the area where the lesion is located must be limited, as shown in
The alveolar breath sounds at the location of the lesion will directly weaken or even disappear. It is not difficult to hear and judge this clinically.
In addition to auscultation of the lungs, attention should be paid to percussion. At this time, the clinical difficulty of this patient is exposed. When percussing the lungs, the doctor should start from the second intercostal space and avoid the heart and liver. Obese patients, including the ribs and
It is difficult to feel the intercostal space.
While the students were listening and percussing, Xin Yanjun took out the X-ray, CT, and B-ultrasound imaging results that the patient had previously examined and looked at them again. When it is difficult for clinicians to directly witness and touch the patient's abnormalities, more use is needed.
Modern medical equipment comes to help.
Unfortunately, the examination of these auxiliary equipment cannot help doctors solve all clinical problems once and for all. Because the instruments will make mistakes. When it comes to the patient who is suspected of having pleural effusion, once this error occurs, it will lead to serious consequences.
For patients with pleural effusion, the first choice is not surgery. When the cause of the disease does not involve the need for surgery, it is just the effusion that requires surgery.
It can be compared to a patient with ascites.
The production and absorption of pleural effusion in normal people are in a dynamic balance. Like ascites, the amount is very small, with a maximum of more than ten milliliters. If the effusion exceeds the upper limit of tolerance that the human body can tolerate, affecting the patient's breathing and other important vital signs, the doctor
Measures similar to those used to remove ascites must be taken, and emergency treatment must be given first.
Thoracic puncture and drainage, unlike surgery, is an operation performed under blind vision. Blind vision relies entirely on preoperative judgment rather than watching and performing during the operation. Therefore, if the preoperative judgment instrument makes mistakes, the consequences will be serious.
Like many clinical blind-sight operations, in order to avoid the consequences of errors, B-ultrasound or CT are often introduced again for guidance during the operation.
The problem is that CT scans of pleural effusions can be wrong. For example, with wrapped pleural effusion, the CT judgment is that the doctor can extract the fluid through puncture, which seems to be correct. However, after several extractions, the clinical effect is poor, and it can never be cured.
Okay. Finally, I had to make up my mind to do surgical exploration, and then I judged that it was not a pleural effusion but a teratoma. Teratoma is okay, but if it is pulmonary hydatid disease, doctors who can't tell with CT and don't know have to draw the fluid.
, which is equivalent to the spread of hydatid.
The above-mentioned extreme situations can refer to rare diseases, which rarely appear in clinical practice and the chance of doctors seeing them is low. If you encounter them, you can say that you have won the lottery. However, the following situations are common in clinical practice.
CT is a supine position examination, and the patient is usually in a sitting position when drawing fluid. As a result, some patients may have a CT scan that shows fluid effusion from the 8th to 11th rib. When the patient sits up and the doctor is about to draw fluid from him, good guy,
The doctor suddenly discovered that the fluid may have descended to the eleventh rib. The CT scan became useless and added to the confusion.