Therefore, when it is time to extract the fluid clinically, the doctor must listen to the patient's percussion again to ensure that the location of the effusion is not mistaken. If there is a bedside B-ultrasound, it would be best to have another B-ultrasound for guidance at this time. However, under the medical conditions of that era in China, bedside B-ultrasound was nowhere to be found. Without B-ultrasound, we can only continue to rely on doctors to listen and percussion to solve the problem.
Let’s go back to the patient in bed 6. He is obese, and it is too difficult for the doctor to hear and feel it.
Xin Yanjun looked serious as she put down the results of the imaging examination. The nurse next to her suggested again: "Don't wait for the cardiothoracic surgeon to come over."
Xin Yanjun's eyes fell on the students.
Xie Wanying's palms were percussing on the patient.
Knock knock, clear sound. Knock again. Alas, the sound is wrong and dull.
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 students and patients, then raised her ears and listened carefully, and then looked at the students' hands.
At first glance, Mr. Xie’s hands looked gentle and delicate, but I didn’t expect them to be possessed of divine power, with sufficient strength and good control. When tapping, the strength was just right, and the force penetrated 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 to find the perfect depth to which the patient's strength could be exerted.
As she had guessed, this student could help her determine the boundary line, and she could definitely 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. He looks gentle and kind on the outside, but 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 how long it will take for you to wait. The patient had difficulty breathing today, and he was quickly taken out to relieve the patient's symptoms.
Wear a surgical cap, wear gloves, and be ready.
The syringe absorbs the local anesthetic lidocaine to perform local skin anesthesia and inject the skin.
The thoracentesis point is always suitable for a higher rather than a lower location. 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 was buried in the lower lungs and overlapped 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 done very carefully as it may easily penetrate other organs.
To determine which intercostal space this is, there is no B-ultrasound, and the human anatomy can be used to determine it. Feel the scapula. The scapula is on the posterolateral side of the human chest. This is why the patient should sit with his back to the doctor. Thoracentesis usually involves inserting a needle from the patient's back.
By 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 never go wrong. After all, some patients are weird. Individual differences may be due to birth or other reasons that cause the lower end of the scapula to not correspond to the seventh intercostal space.
This patient is obese, and it is extremely difficult to move his ribs down one by one. However, Xin Yanjun was confident today and asked classmate Xie around her to help.
Xie did not disappoint her. He quickly touched the patient’s first rib space and helped the teacher count down.
