Chapter 1190 【1190】Difficulties Revealed

It can be compared to heart auscultation. Heart sounds are divided into first heart sound and second heart sound according to different anatomical locations. Breath sounds can also be divided into four types according to bronchi, bronchoalveoli, alveoli, and trachea.

The normal breathing sound is the same as the heart sound, and the sound must be rhythmic, timbre, volume, etc., which are comfortable to listen to rather than abnormal.

If breath sounds sound abnormal, just remember that every clinical abnormality is closely related to anatomy. Like the current patient with pleural effusion, the normal gas exchange activities of the patient in the lesion area must be limited, and the alveolar breath sounds in the lesion area 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 patient's clinical difficulties were exposed. The doctor's lung percussion starts from the second intercostal space, avoiding the heart and liver. In obese patients, it is difficult to feel even the ribs and intercostal spaces.

While the students were listening and percussing, Xin Yanjun took out the X-ray, CT and B-ultrasound imaging results of the patient and read them again. When it is difficult for clinicians to directly witness and touch patients' abnormalities, they need to use more modern medical equipment to help them see.

It is a pity that the examination of these auxiliary devices cannot help doctors solve all clinical problems once and for all. Because instruments make mistakes. Putting it on the patient in front of him who is suspected of having pleural effusion, once this mistake occurs, it will lead to serious consequences.

For patients with pleural effusion, the first choice is not surgery. If the cause does not involve surgery, it is just the effusion.

It can be compared to a patient with ascites.

The production and absorption of pleural effusion in normal people is in a dynamic balance. Like ascites, the stock is very small, with a maximum of more than ten milliliters. If the effusion exceeds the upper limit of the human body's tolerance and affects the patient's breathing and other important vital signs, the doctor must take measures similar to ascites pumping, first rescue.

Thoracentesis, unlike surgery, is an operation under blind vision. Blind vision depends entirely on preoperative judgment rather than doing it while watching during surgery. Therefore, if the preoperative judgment equipment makes mistakes, the consequences will be very serious.

Like many blind operations in clinical practice, in order to avoid the consequences of mistakes, B-ultrasound or CT will be introduced again to guide the operation.

The problem is that CT of pleural effusion can be wrong. Like encapsulated pleural effusion, the CT judgment is that the doctor can draw out the fluid through puncture, which seems to be correct. However, after several times of smoking, it shows that the clinical effect is not good, and it cannot be cured all the time. In the end, we had to make up our minds to do surgical exploration, only to judge that it was not pleural effusion but teratoma. The teratoma is fine, but if it is pulmonary echinococcosis, doctors who can’t judge it on CT and don’t know it will draw fluid, which is equivalent to the spread of echinococcosis.

The above-mentioned extreme situations can refer to rare diseases, which rarely appear in clinical practice, and the probability of doctors seeing them is low. If you encounter them, you can say that you have won the lottery. However, the following situations are clinically common.

CT is a supine position examination, and the patient is generally sitting when the fluid is drawn. As a result, patients may have effusions shown by ct from the 8th to the 11th ribs. When the patient sat up and the doctor was about to draw fluid for him, good guy, the doctor suddenly discovered that the effusion might have descended to the eleventh rib. ct becomes useless and messy.