Chapter 1190: 【1190】Difficulty revealed

   Chapter 1190 [1190] Difficulties revealed

   It can be compared to heart auscultation. According to different anatomical positions, heart sounds are divided into first heart sound, second heart sound, etc. Breath sounds can also be divided into four kinds of breath sounds according to bronchial, bronchoalveolar, alveolar, and trachea.

  Normal breath sounds are the same as heart sounds, and the sounds must be rhythm, timbre, volume, etc., which make people feel comfortable and not abnormal.

  If breath sounds are abnormal, just remember that every abnormality clinically is closely related to anatomy. Like the present patient, who has pleural effusion, the normal gas exchange activities of the patient in the area where the lesion is located must be limited, and the alveolar breath sounds in the area where the lesion is located 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 clinical difficulties of this patient 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.

   When the students listened to percussion, Xin Yanjun took out the imaging results of the patient's previous X-ray CT film and b-ultrasound and read it again. When it is difficult for clinicians to directly witness the abnormality of the patient, they need to use more modern medical equipment to help.

  Unfortunately, the examination of these auxiliary devices cannot help doctors solve all clinical problems once and for all. Because the instrument will make mistakes. Put it on the patient who is suspected of pleural effusion. Once this mistake occurs, it will lead to very serious consequences.

   For patients with pleural effusion, the first choice is not to undergo surgery. If the cause does not involve the need for surgery, it is just what kind of surgery should be done for the effusion.

   can be compared to a patient with lower ascites.

   The production and absorption of pleural effusion in normal people are in a dynamic balance. Like ascites, the stock is very small, with more than ten milliliters being the most. If the accumulation of fluid exceeds the upper limit of the human body's tolerance and affects the patient's vital signs such as breathing, the doctor must take measures similar to those of ascites.

   Thoracic puncture and drainage, which is different from 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 is followed by errors, the consequences will be very serious.

   Like many blindsighted operations in clinical practice, in order to avoid the consequences of mistakes, b-ultrasound or CT is often re-introduced for intraoperative guidance.

   The problem is that CT of pleural effusion can go wrong. Like encapsulated pleural effusion, the CT judgment is that the doctor can extract the fluid by puncturing, which seems to be correct. However, after a few times of pumping, the clinical effect is not good, and it can not be cured all the time. In the end, I had to make up my mind to do surgical exploration, and it was determined that it was not a pleural effusion but a teratoma. Teratoma is okay, if it is pulmonary hydatid disease, those doctors who don't know about ct can't judge it, and the doctor who doesn't know will draw fluid, which is equivalent to the spread of hydatid.

  The above extreme cases can be referred to as rare diseases, which are rare in the clinic, and the probability of doctors seeing them is low. However, the following conditions are common clinically.

  ct is a supine position examination, and the patient is generally sitting when the fluid is drawn. As a result, there may be a CT showing effusion in the patient from the 8th to the 11th rib. When the patient sat up and the doctor was about to draw fluids for him, my dear, the doctor suddenly discovered that the effusion might have descended to the eleventh rib. ct becomes useless and adds chaos.

   (end of this chapter)