Therefore, when it comes to clinical extraction, the doctor must listen to the patient's percussion again to make sure that the location of the effusion is not mistaken. If there is a bedside B-ultrasound, it is best to have another B-ultrasound for guidance at this time. However, in
Under the medical conditions of that era in China, where did bedside B-ultrasound come from? Without B-ultrasound, we could only continue to rely on doctors to listen and tap to solve problems.
Let’s go back to the patient in bed 6. He is obese. It is too difficult for the doctor to hear and feel the obesity.
Xin Yanjun looked serious as she put down the results of the imaging examination. The nurse next to her once again advised her: "Don't wait for the cardiothoracic surgery department to come over."
Xin Yanjun's eyes fell on the students.
Xie Wanying's palms were percussing on the patient.
Knocking, the sound is clear. Knocking again, oh, the sound is wrong, it is voiced.
The patient, who was sitting on the chair with his hands on the back of the chair and his back to the doctor, seemed to hear something was wrong with the sound of being photographed. He turned his head and looked at the young female doctor: I had never seen him before.
Xin Yanjun approached the student and the patient, then raised her ears and listened carefully, and then looked at the student's hands.
At first glance, Mr. Xie’s hands looked gentle and delicate, but I didn’t expect them to have divine power. They were powerful and well-controlled. When he tapped, he had just the right amount of force to penetrate the thick fat layer.
The boundary between unvoiced and voiced sounds is drawn.
It can only be said that Xie's eyes seemed to see through the patient's fat layer first, and how deep the strength could be exerted to find the perfect depth.
As she had guessed, this student could help her determine the boundary line and she would definitely be able to draw fluid.
Xin Yanjun's confidence greatly increased and she said to the nurse: "Pump!"
It seems that Teacher Xin is a very courageous doctor, gentle and kind on the outside, but very strong on the inside, which once again proves that all big doctors have great personalities.
Why wait for cardiothoracic surgery? I don’t know how long it will take to wait. The patient has difficulty breathing today, so he quickly took it out to relieve the patient’s symptoms.
Wear a surgical cap, wear gloves, and be ready.
Use the syringe to absorb the local anesthetic lidocaine to perform local skin anesthesia and inject the skin.
The thoracic puncture point is always suitable for a relatively high rather than a relatively low position. Especially in this patient, the effusion happened to be on the right side. Under the right lung is the liver. Having just come out of the hepatobiliary surgery department, Xie Wanying knew very well that the liver is buried under the lower lung.
, overlaps with the lungs. Therefore, doctors generally choose the puncture point at the ninth intercostal space at the lower angle of the scapula. Puncture below the tenth intercostal space must be very cautious, as it may easily penetrate other organs.
To determine which intercostal space there is, without B-ultrasound, you can use the human anatomy to determine. If you feel the scapula, the scapula is on the posterolateral side of the human thorax. This is why the patient sits with his back to the doctor. Thoracentesis is usually
Insert the needle from the patient's back.
According to convention, the lower end of the scapula corresponds to the seventh intercostal space. If you want to be more cautious, you can count from the patient's first rib down, and you will definitely not be wrong. After all, some patients are weird and have individual differences, which may be due to birth or other conditions.
The reason is that the lower end of the scapula does not correspond to the seventh intercostal space.
This patient is obese and it is very difficult to move the ribs down one by one. But Xin Yanjun was confident today and asked her classmate Xie to help.
Xie did not disappoint her. She quickly felt the patient’s first rib space and helped the teacher count down.
