Another analogy can be made to heart auscultation. According to different anatomical positions, heart sounds are divided into the first heart sound, the second heart sound, etc. Similarly, respiratory sounds can be divided into four types according to bronchi, bronchoalveolar, alveoli, and trachea.
Normal breathing sounds are like heart sounds. The sounds must have a rhythm, timbre, volume, etc. that are comfortable to listen to rather than abnormal.
If you hear abnormal breath sounds, just remember that every abnormality in clinical practice is closely related to anatomy. For example, this patient has pleural effusion, and the normal gas exchange activity of the patient in the area where the lesion is located must be restricted, which is manifested in that the alveolar breath sounds in the area where the lesion is located will be directly weakened or even disappear. It is not difficult to hear and judge this in clinical practice.
In addition to auscultation of the lungs, percussion should also be noted. At this point, the clinical difficulty of this patient is exposed. When doctors percuss the lungs, they should start from the second intercostal space, avoiding the heart and liver. For obese patients, it is difficult to feel the ribs and intercostal space.
While the students were listening to the percussion, Xin Yanjun took out the X-rays, CT scans and ultrasound scans of the patient and reviewed them again. When clinicians cannot directly see or touch abnormalities in patients, they need to use more modern medical equipment to help them see.
Unfortunately, these auxiliary equipment examinations cannot help doctors solve all clinical problems once and for all, because the instruments can make mistakes. If this mistake is made on a patient suspected of having pleural effusion, it will lead to serious consequences.
For patients with pleural effusion, the first choice is not surgery. If the cause does not require surgery, then surgery is only necessary for 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 amount of pleural effusion 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 draining ascites and give emergency treatment first.
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Thoracentesis is different from surgery in that it is a blind operation, which relies entirely on preoperative judgment rather than on-the-spot observation during surgery. Therefore, if the preoperative judgment instrument makes a mistake, the consequences will be serious.
Like many blind operations in clinical practice, in order to avoid the consequences of errors, ultrasound or CT is often introduced again for guidance during the operation.
The problem is that CT scans of pleural effusions can be wrong. For example, in the case of encapsulated pleural effusion, the CT scan showed that the doctor could extract the fluid by puncture, which seemed to be correct. However, after several extractions, the clinical effect was not good and the disease could not be cured. Finally, we had to make up our minds to perform surgical exploration, and then we determined that it was not pleural effusion but teratoma. Teratoma is not a big deal, but if it is pulmonary echinococcosis, the CT scan could not determine it, and the doctor who did not know about it extracted the fluid, which was equivalent to the spread of echinococcosis.
The above extreme cases can be referred to as rare diseases, which are rarely seen in clinical practice, and the chance of doctors seeing them is low. If they encounter them, it can be said that they have won the lottery. However, the following cases are common in clinical practice.
CT is performed in the supine position, and the patient is usually sitting when the fluid is drawn. As a result, the CT may show that there is fluid accumulation from the 8th to the 11th rib. When the patient sits up and the doctor is about to draw the fluid, the doctor suddenly finds that the fluid may have dropped to the 11th rib. CT becomes useless and causes trouble.
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