Therefore, when it comes to the time of drawing blood, the doctor must listen to the patient's percussion again to confirm the location of the effusion. If there is a bedside B-ultrasound, it would be best to use it for guidance. However, under the medical conditions in China at that time, there was no bedside B-ultrasound. Without B-ultrasound, the doctor could only rely on listening to the percussion to solve the problem.
Let’s go back to the patient in bed 6. He is obese, and it is very difficult for the doctor to hear and tap his pulse.
Xin Yanjun put down the imaging test results with a serious look on her face. The nurse next to her suggested again: "Why don't you wait for the cardiothoracic surgery department to come over?"
Xin Yanjun's gaze fell on the students.
Xie Wanying was percussing the patient with the palm of her hand.
Knock, knock, clear sound. Knock again, oops, this sound is wrong, it's voiced.
The patient, who was sitting on the chair with his hands on the back and his back to the doctor, seemed to hear something wrong with the sound of him being tapped. He turned around and looked at the young female doctor: I have never seen this before.
Xin Yanjun approached the student and the patient, then pricked up her ears to listen carefully and looked at the student's hand.
At first glance, Xie's hands looked quiet and delicate, but they were actually as powerful as gods. They were strong and well-controlled. When they knocked down, the force was just right, penetrating the thick fat layer and knocking out the boundary line between clear sounds and voiced sounds.
...
...
All I can say is that Xie's eyes seemed to have seen through how thick the patient's fat layer was and how deep the force could be exerted.
This student was able to help her determine the boundary line just as she had guessed, and she was sure that the fluid could be drawn.
Xin Yanjun gained confidence and said to the nurse, "Draw it!"
It seems that Teacher Xin is a very courageous doctor. He looks gentle and kind on the outside, but he is actually very strong on the inside. This once again proves that all big doctors have great personalities.
What are you waiting for? I don't know when I will end up waiting. The patient has difficulty breathing today. We need to extract the medicine immediately to relieve his symptoms.
Wear surgical cap and gloves and get ready.
Use a syringe to draw up the local anesthetic lidocaine to perform local skin anesthesia and inject a dermatophyte.
The puncture point of the thorax is always better at a higher position rather than a lower one. Especially for this patient, the effusion is just on the right side. The liver is under the right lung. Xie Wanying, who just graduated from the Department of Hepatobiliary Surgery, knows very well that the liver is buried in the lower lung and has an overlapping area with the lung. Therefore, doctors generally choose the puncture point at the ninth intercostal space below the scapular angle line. Punctures below the tenth intercostal space should be performed with great caution, as it is easy to puncture other organs.
To determine the intercostal space, if there is no ultrasound, the human anatomy can be used to determine the intercostal space. The shoulder blade is located on the posterior and lateral side of the thorax, which is why the patient has to sit with his back to the doctor. Thoracentesis is usually performed by inserting the needle from the patient's back.
According to convention, the lower end of the shoulder blade corresponds to the seventh intercostal space. If you want to be more cautious, you can count from the patient's first rib, and you will never go wrong. After all, some patients are strange, individual differences may be congenital or other reasons cause the lower end of the shoulder blade and the seventh intercostal space not to correspond.
This patient is obese, so it is very difficult to count his ribs one by one. But Xin Yanjun is confident today, so she asks her classmate Xie to help.
Student Xie did not disappoint her. He quickly felt the first intercostal space of the patient and helped the teacher count downwards.
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