General Rules percussion:
1. The attitude of the doctor and the patient: the doctor is right, face to the patient.
2. Power plaster is pressed tight to the skin.
3. Modeotochka perpendicular to the finger-plaster.
4. The right hand is located in parallel left.
5. The two detachable percussion strikes.
6. Evidence of the right hand - only in the rays of the joint.
7. The hands of the doctor must be warm.
Comparative percussion of the lungs
Purpose of comparative percussion: Comparison of sounds over symmetric lung plots.
Rules of comparative percussion:
1. The impact force is the average (penetration of 6-7 cm).
2. Percussion is carried out on intercostal.
3. When performing percussion of the lungs, you should navigate the topographic line of the pectoral surface.
Fig. 2. Topographic lines on the front, side and rear surface of the chest:
1 - front median (Linia Mediana Anterior),
2 - Breast (Linia Sternalis),
3- Okolodina (Linia Parasternalis),
4- MEDIOCLAVICULARIS (LINIA MEDIOCLAVICULARIS),
5 - front axillary (Linia Axillarias Anterior),
6 is a middle axillary (Linia Axillarias Media),
7- rear axillary (Linia Axillaries Posterior),
8- Rear Middle (Linia Mediana Posterior),
9-vertebral (Linia Vertebralis),
10-okolthebralis (LiniaParavertebralis), 11-shutter (Linia Scapullaris).
Normally, percussion tone over the entire surface of the lungs are clear pulmonary.
In healthy people, a minor shortening (dull) of the percussion tone can be observed:
above the right top, since the right upper armor in short, the left and right top is somewhat lowered, as well as as a result of the best development of the muscles of the right shoulder belt;
in the appropriate areas (especially right) - for the same reason;
in the second and third intercostals on the left because of the close position of the heart;
above the lower lobes in comparison with the upper as a result of various thickness of the lung fabric;
in the right axillary region compared to the left as a result of the close location of the liver;
there is a difference in the percussion tone and due to the presence of the on the left of the space of the traube, which gives a tympanic tint.
Changes in a percussion tone with a comparative percussion, indicating the presence of the presence of the pathological process, as a rule, as follows:
reducing air content in lung tissue (pneumonia, atelectasis, pneumosclerosis, tuberculosis). This causes the appearance of the percussion tone;
filling a pleural cavity with liquid (transudate, exudate, blood). At the same time, the so-called "liver" or "femoral" stupidity is determined on the side of the damage;
increasing the airiness of the pulmonary fabric in the emphysema of the lungs causes the appearance of a "boxed" percussion tone;
increased airiness of light as a result of the formation of a smooth-alone cavity (abscess, tuberculous cavity) causes a tympanic performer sound.
The interpretation of the data obtained by the subconscission is presented in Table 3.
Table 3.
Interpretation of the results of a comparative percussion
|
Percussive sound |
Pathological clusters and syndromes |
|
Bottled (shortened) or stupid |
1. Massive seal cluster 2. Focal compaction cluster 3. Cluster (syndrome) of obtultational atelectase 4. Hydrotrax syndrome (femoral stupidity) |
|
Bottled (shortened) with a tympanic tint - is defined locally |
1. The initial stages of inflammation of the pulmonary fabric (inflammatory edema of the alveolar wall + conservation of the air and airiness of the alveoli + reduction of their elasticity) 2. Compression atelectasis syndrome |
|
Tympanic determined on one side |
syndrome pneumothorax |
|
Tympanic determined locally on a limited area |
cavity syndrome in lung cluster options: calve cluster in lightweight, drainaged bronchi (diameter\u003e 5 cm) cluster dry mild cyst ("thin-walled" cavity in light) cluster BlebS. |
|
Boxed is determined throughout the breathing surface. |
Light emphysema syndrome cluster options: cluster obstructive emphysema cluster of idiopathic emphysema cluster invalus emphysema |
|
Boxed is defined locally on a limited area |
local cluster (peripocal, scar) emphysema intermediate emphysema cluster (in terms of cases) vicar emphysema cluster |
Table 4.
Integral assessment and interpretation of the results of a comparative percussion of light and voice jitter
|
Palpatorno |
Percussian |
Testifies ... |
|
Percussive sound |
Syndrome (cluster) |
|
|
Weakened |
1. Hydrothorax syndrome 2. Obstrument Atelectase Syndrome 3. Mountains or Fibrotorax |
|
|
Gain |
Cluster of massive sealing of lung fabric (brunt pneumonia). |
|
|
Gain |
Dull with a tympanic tint |
1. Cluster of massive sealing of lung fabric. It is observed in the initial stage (in the first hours) of inflammation, testifies to the stage of the tide in the bruboral pneumonia. 2. Compression atelectasis syndrome |
|
Weakened |
Shortened (dull) |
Cluster of massive sealing of lung fabric. It is observed in the height of the disease, testifies to the step of compelling with a bruboral pneumonia. |
|
Weakening |
Tympanic |
Syndrome pneumothorax |
|
Boxes |
Light emphysema syndrome |
Topographic percussion of the lungs
Topographic percussion targets:
1. Determination of the height of standing tops of light on the right and left.
In healthy, they protrude in front of the clavicle on 3-4 cm. On the rear surface, the standing height of the tops corresponds to the level of an accelerated process of the VII cervical vertebra.
2. Determination of the width of the crennics fields (or the width of the lungs) is carried out at the front edge M. Trapezius and averages from 3 to 8 cm.
3. Determination of the lower borders on all topographic lines. 4. Determination of the mobility of the lower pulmonary edge (Table 5).
Topographic percussion rules:
1. The impact force is quiet (2 - 3 cm penetration).
2. Percussion for ribs and intercostal.
3. The direction of percussion from the pulmonary dull sound. 4. Light border mark - along the edge of the finger facing the lung sound (the only exception - when determining the respiratory excursion of the lower edge of the lung on exhalation).
The width of the fields of the clining, the height of the standing of the lungs, the boundaries of the lungs and the mobility of their lower edges may vary with many pathological conditions. The interpretation of the data obtained by the priest percussion is presented in Table 5.
Table 5 Interpretation of the results of the topographic percussion of the lungs
Comparative percussion
Comparative percussion is carried out in a specific sequence. First compare the percussion sound over the tops of the lungs in front. The polesimeter in this case is parallel to the clavicle. Then the shoes are applied with a hammer on the clavicle, which replaces the plastermeter. With percussion of the lungs below the clavicle, the polesimeter is placed in the intercostal gaps in parallel to the ribs and strictly in the symmetric areas of the right and left half of the chest. By mid-hearted lines and medially, their percussion sound is compared only to the level of the IV rib, below the left is the heart changing the percussion sound. To carry out a comparative percussion in the axillary regions of the patient should raise his hands up and lay palm behind the head.
Comparative percussion of the lungs rear begin with the supere-to-peel, the finger-platmeter is installed horizontally. With percussion of inter-pumping areas, a finger-platmeter put vertically. The patient at that moment crosses his hands on the chest and thereby takes the blade of the duck from the spine. Below the corner of the blades, the polesimeter is again applied to the body horizontally, in the intercostal, parallel to the ribs.
With a comparative percussion of the lungs, the percussion sound and in symmetric points may not be exactly the same force, duration and height.
Changing a percussion sound in a healthy person due to both a mass or thickness of the pulmonary layer and the influence of the percussion sound of neighboring organs. The percussion sound is slightly quieter and shorter is defined in the following places: 1) above the right top, as it is located somewhat lower than the left top at the expense of a shorter right top bronchum, on the one hand, and as a result of the larger development of the muscles of the right shoulder belt, on the other; 2) in the second and third intercostals to the left at the expense of the closer arrangement of the heart; 3) above the upper pieces of the lungs compared with the lower shares as a result of various thickness of air-containing lung tissue; 4) in the right axillary region compared to the left due to the proximity of the liver location. The difference in the percussion sound here is also due to the fact that the stomach is left to the diaphragm and light, the bottom of which is filled with air and with percussion gives a loud tympanic sound (the so-called partial space of the traube). Therefore, the percussion sound in the left axillary region due to the resonance from the "air bubble" of the stomach becomes loud and high, with a tympanic tint.
Changing the percussion sound in pathological processes It may be due to a decrease in the content or a complete absence of air in part of the lung, filling the pleural cavity of the liquid (transudate, exudate, blood), an increase in the airiness of the pulmonary fabric, the presence of air in the pleural cavity (pneumothorax).
In pathological processes, the change in the air content in the lungs causes changes in the percussion sound. Inflammatory processes lead to the seal of lung fabric. Over such sites, the percussion sound will be blunt or dull (close to blunt sound). The percussion sound will be stupid and above the liquid in the pleural cavity in pleuritic or hydrotrax. With emphysema of the lungs, percussion sound above them can resemble the sound occurring when the box (box sound). When the smooth-alone cavity is formed in light (abscess, cavity), when the air is accumulated in the pleural cavity, the percussion sound as a result of the resonance will be tympanic. Above very large (6-8 cm diameter) and a smooth-alone cavity in a light percussion sound will also be tympanic, but low, reminding sound when the metal vessel is impaired (metallic sound). If such a cavity is superficially and communicated with the bronchus with a narrow hole, with P. there is a peculiar quiet and rattling sound - the noise of the cracked pot; With percussion of a patient with an open mouth, a tympanic sound above the cavity will be higher and shorter, and with closed below and longer (the phenomenon of Wovery). With P. Patient, during the breath, the tympanic sound above the cavity becomes higher and shorter, and during the exhalation below and longer (the phenomenon of freeroid). With the cavity of the egg-shaped form containing air and liquid, P. patient with a change of body position can give a tympanic sound of different heights (Gerhardt phenomenon). With a reduction in lightness of the lungs and lowering the elastic voltage, the alveoli percussion sound becomes dull or takes a tympanic tint (timbre) - a blunt-tympanic sound.
16. Comparative percussion of the lungs. Changing the percussion sound in pathological processes from the lungs and pleura.
Question 16 See Question 15.
17. Various types of performer sounds and their diagnostic value. Determination of the excursion of the lower edges of the lungs during breathing.
Types of performer sounds
When tapping on the body site, fluctuations of subjectable media arise. Some of these oscillations have a frequency and amplitude sufficient for auditory perception of sound.
At percussion, there are 3 main performer sounds and 2 intermediates.
Basic percussion sounds:
1. Clear pulmonary sound makes up a chest over an unchanged alveolar cloth. This sound is low (a frequency of 60-90 Hz), loud, long.
2. Dumb (femoral) percussion sound. Such a sound is published by organs and fabrics that do not contain air, dense: muscles, bones, heart, liver, etc. This sound is relatively high (300-500 Hz), quiet, short.
3. Tympanic percussion sound. Such a sound is published by organs and fabrics containing air cavities: abscess, tuberculous cavity, air cysts, air in the pleural cavity (pneumothorax), etc. Tympanic sound depending on the size, cavity form, the nature of its walls can be low (40-60 Hz) and high (120-300 Hz). This percussion sound has clear overtones and closest reminds the musical sound of the drum.
Intermediate percussion sound 2: dulling (intermediate between blunt and pulmonary) and box percussion sound (intermediate between clear pulmonary and tympanic sound).
1. The dull sound is formed when a dense formation is covered or surrounded by air alveolar lung tissue (the relative boundaries of the heart, limited seals of the lung tissue - pneumonic infiltrate, tumor, etc.).
2. Boxing percussion sound occurs when the lung tissue is swollen, the development of lung emphysema. It resembles the sound published by the pillow.
Percussion sounds have adopted designations.
The loud and long sound, the most close musical tone and sound similar to the sound when hitting the drum, is called tympanic, or tympanite. It occurs at percussion over the filled gas (or air) by cavities with stressful walls, for example. Above the intestines in the meteorism, a portion of the air accumulation at a tension pneumothorax, normally over the space of Traube3.
Short quiet and high sound arising over airless fabrics are called stupid, or percussion stupidity; The extreme expression of these properties has the sound arising from the percussion of the muscle mass of the thigh, the femoral stupidity.
Other percussion sounds reflect the interimity of airiness and the density of the medium between the tympanite and femoral dullness: the box sound is determined above the lungs in emphysema; Loud clear - over the free air (or gas) in the cavities; Clear performer sound - above the lungs with normal airiness; dull sound - above sections of low airiness of the tissue (for example, a focus of pneumosclerosis), over a dense formation or organ surrounded by air cloth; stupid percussion sound - over dense airless organs or pathological formations, in particular, liquid accumulations during massive hydrotorax, pleurite, ascite
Definition of excursion:
The mobility of the lower edge of the lungs is determined as follows: first find the lower boundary of the lungs in normal physiological respiration and noted by its dermograph. Then they ask the patient to make the maximum breath and at the height of it to delay the breath. The finger-plastermeter before inhale must be located on the detected line of the lower boundary of the lung. Following the deep breath, he continues to percussion, gradually moving a finger-plaster station down 1-1.5 cm before the appearance of absolutely blunt sound, where the dermograph on the top edge of the finger makes the second mark. Then the patient is asked to make the maximum exhalation and at the height of it to delay the breath. Following the exhalation, they make percussion upwards until the appearance of a clear pulmonary sound and on the border with the relative dullness of the sound of the dermatograph make the third mark. Then the distance between the second and third marker is measured, which corresponds to the maximum mobility of the lower edge of the lungs.
With a serious condition of the patient, when he cannot hold his breath, use another way to determine the mobility of the lower edge of the lungs: after the first mark, indicating the lower limit of the lung at calm breath, they ask for a patient to take a deep breath and exhale, during which continuous perfoor strikes are produced gradually Moving the finger-plaster down. First, the percussion sound during the inhalation is loud and low, and during the exhalation - quiet and higher. Finally reach such a point over which the percussion sound becomes the same strength and height both during the inhalation and exhalation. This point is considered to be the bottom boundary at the maximum breath.
Then, in the same sequence, the lower limit of the lung on the maximum exhalation is determined.
In the study of the respiratory system, percussion is used to identify pathological changes in lung tissue and pleural cavities (comparative percussion), as well as to determine the pulmonary boundaries (topographic percussion). It is possible to be carried out at the vertical position of the patient. When percussion on the front surface of the chest patient stands (sits) with lowered hands, on the side surfaces of the chest - raises his hands behind the head, and on the back of the chest - slightly leans forward, lowering his head, and crosses the hands of nodudi, putting the palms on the shoulders . The breath of the patient during the study should be even and shallow. The doctor holds, percussion standing or sitting, depending on the position and growth of the patient. With percussion on the front and side surfaces of the chest, the doctor is in front of the patient, on the back surface of the chest - behind it.
G.Comparative percussion of the lungsit is carried out sequentially on the front, side and rear surfaces of the chest. At the same time, alternately percussion on symmetric sections of both halves of the chest. Determine the nature of the sound at each point of percussion and compare it with a performer sound on the opposite side, as well as with sound in the adjacent parts of the lungs. The accuracy of the results of a comparative percussion largely depends on the identity of the conditions for its holding on symmetric areas. In particular, the position of the finger-plaster on the chest wall includes the position of the fingertipsimeter, the pressure exerted by it on the perfumed surface, and the strength of the percussion strikes. Usually, the percussion blows of the middle force are used first, however, in the necessary cases, percussion blows of different power can be alternately. In particular, to detect pathological sites lying in the depths of the pulmonary fabric, strong pencil strikes should be used, while the foci lying superficially and having small sizes are detected by quiet percussion. When changing the nature of the peculiar sound in any section, as well as in doubtful cases, it is advisable to repeat the percussion, while changing the order of applying percussion strikes on symmetric areas.
Initially, the doctor rises in front of the patient and he picks alternately in both pressed pits. For this, the finger-plaster is directly above the clavicle and parallel to it. Then he picks his finger-hammer in the clavicle using them as a plaster meter. Next, he picks up in the first and second intercostalities on the mid-cosmic lines, having a finger-plastermeter in the course of intercostal gaps (Fig. 5, a). In the underlying fields of the front surface of the chest, the comparative percussion is not carried out, since the left of the second intercostal is the heart dullness, and on the right, the character of the percussion sound was determined before the study of the right border of the heart (see the topic "Cardiovascular system").
On the side surfaces of the chest, the comparative percussion is consistently carried out along the front, middle and rear axillary lines. The doctor asks for a patient to raise his hands behind his head and hesitates alternately on both sides first in the axillary pits, and then in the fourth and fifth intercourse, having a polesimeter in the course of intercostal intervals (Fig. 5, b). In the underlying intercostals on the axillary lines, the comparative percussion is usually not carried out due to the fact that the region of the tympanic sound of the space of the traube is closely located, and the field is the area of \u200b\u200bhepatic stupidity.
To carry out a comparative percussion on the back surface of the chest (Fig. 5, c), the doctor gets behind the patient and asks him to slightly bended forward, lowering his head, and cross hands on the chest, putting his palms on the shoulders. At the same time, the blades are diverted to the sides, expanding the inter-opacker space. Initially, he picks up in the appropriate areas. To this end, a finger-plaster sets up above the uks of the blade and parallel to it. Then it consistently punches on the symmetric sections of the upper, middle and lower departures of the inter-opumen space, the plane-plaster is alternately on the right and to the left of the spine and parallel to it (percussion should not be carried out). After that, he picks up on both sides in the sublock areas, in particular in the seventh, eighth and ninth intercostal, at the beginning of the spaded lines. At the same time, the film-plaster sets in the transverse direction along the intercostal intervals.
Fig. 5. Scheme of comparative percussion of the lungs on the front (A), side (b) and rear (c) surfaces of the chest
Normally, with a comparative percussion above the entire surface of both lungs, it is detected clear pulmonary soundmostly the same on symmetric sections of the chest. At the same time, it is necessary to keep in mind that over the left top, the percussion sound can be somewhat more "clear" than above the right, which is due to the main muscle thick of the shoulder belt on the right (the patient "left-handers" can be detected over the right top).
In case of detection of the site over which when percussion instead of a clear pulmonary sound, a change in the percussion sound is noted, the coordinates of this site should be specified, and also approximately determine which lobes it is located. As you know, both lungs have the upper and lower lobes, and the right light, in addition, is still a secondary share. On both sides, the upper and lower fractions are projected on both sides to the back surface of the chest, the boundary between which runs along the line connecting the point of the intersection of the IV rib with the rear axillary line and the faint process III of the breast vertebra. On the lateral and front surfaces of the left half of the chest, the boundary between the upper and lower lobes of the left lung passes along the line connecting the specified point with the place of attachment VI rib to the sternum. A similar line on the lateral and front surfaces of the right half of the chest corresponds to the boundary between the middle and the lower lobes of the right lung, while the border between its upper and middle lobes passes horizontally along the course of the IV ribs from the rear axle line to the right edge of the sternum.
R Lokal dumping percussion soundhe indicates a sealing and decrease in the airiness of a piece of pulmonary fabric in the percussion zone (pneumonia, tuberculosis, tumor, atelectasis, light infarction). The dullness of the percussion sound in the inter-opumen space at the level of IV-VI of breast vertebrae may be caused by the expansion of the mediastinum, for example, due to the increase in lymphatic nodes. Unlike a clear pulmonary sound, a dull sound is quieter, higher by a tonality and less long, but the indicated pathological processes do not reach the nature of the blunt sound obtained by percussion over dense airless organs. At the same time, when the fluid is accumulated in the pleural cavities (exudative pleurisy, hydrotorax, hemotorax) percussion over traffic reveals a stupid sound, resembling the sound obtained by percussion over the thigh muscles ("femoral stupidity"). Typically, in this case, a stupid percussion sound is determined above the lower depth of the pleural cavity where the liquid accumulates. However, with a disturbed pleurite zone of stupid sound can be located atypically.
B patients with emphysemic lungs above all departments of the chest at percussion is determined boxesdue to the increase in the airiness of the pulmonary fabric. With scarring of wrinkling or resection of one light, the vicarial (replacement) emphysema of a healthy lung, over which percusser will be determined in the tympanic sound. The accumulation of air in the pleural cavity (pneumothorax) also leads to the appearance of a boxed sound above the entire surface of the corresponding half of the chest. The detection of boxed sound on a limited area usually indicates the presence of in a lightly superficial, large, filled air, smooth-alone cavity, such as an abscess or tuberculous cavity. In this case, it can be noted an increase in the tonality of sound if the patient opens the mouth (the phenomenon of the Wovery) or takes a deep breath (fremyel phenomenon). If the cavity is communicated with the bronchus through a narrow sliding hole, then with percussion over it, there is a peculiar intermittent rattling tympanic sound, as when the closed empty vessel with a cracked wall ("noise of a caught pot") occurs. This sound can be reproduced if you hit the knee to the brushes by folding them in the "lock", but not pressing the palms tightly to each other.
II.Topographic percussion of the lungsincludes the sequential definition of their lower boundary, the mobility of the lower pulmonary edge, the height of the standing and the width of the tops. The definition of each specified parameter is performed at the beginning on the one hand, and then on the other. The finger-plastermeter in all cases is located parallel to the lung boundary, and the average phalanx of the finger should lie on the line, along which perpetus is carried out in the direction perpendicular to it. Using quiet performer strikes, perfect from the area of \u200b\u200ba clear pulmonary sound to the location of it in a stupid (or dull), which corresponds to the lung boundary. Fixed a finger-plaster found border and determine its coordinates. At the same time, abroad is taken by the edge of the fingertipsimeter, addressed to the area of \u200b\u200bclear pulmonary sound. In cases where it is necessary to make measurements, it is convenient to use in advance known length or width of the phalange of their fingers.
Lower lung borderdetermined by vertical identification lines. The definition of the front axillary lines begin, because on the right mid-crook the lower lung boundary was already found earlier before the percussion of the right border of the heart (see the topic "Cardiovascular system"), and a heart arrives in the left to the front breast wall. The doctor rises in front of the sick, asks him to raise his hands behind his head and consistently hesitates along the front, middle and rear axillary lines. A polesimeter's finger is in the armpit parallel to ribs and peers along the ribs and intercheses in the direction from top to bottom until the boundary of the transition of clear pulmonary sound is detected (Fig. 6, a). After that, the doctor gets up behind the patient, asks him to lower his hands and in the same way, he spends his percussion on the blade line, ranging from the lower corner of the blade (Fig.6, b), and then hesitates from the oil-color line from the next level. It should be borne in mind that the definition of the lower boundary of the left lung on the anterior axillary line can be difficult due to the close location of the area of \u200b\u200bthe tympanic sound in the spacespace.
Fig. 6. The initial position of the finger-plaster and the direction of its movement during the percussion definition of the lower boundary of the right light on the front axillary (A) and the blade (b) lines
To designate the localization of the found lower lung borders, ribs (intercostal) are used, whose account lead from the clavicle (in men - from the nipple lying on the V edge), from the lower corner of the blade (seventh intercreic) or from the lowest free-lying XII edge. In practice, it is possible to determine the localization of the lower boundary of the lung on the front axillary line, mark it with a dermograph and use this mark as a guide to determine the coordinates of the lower boundary of this light on other lines. The localization of the lower boundary of the lungs by the octolar lines is made to be denoted by respectable vertebrae processes, since the muscles of the back disturb the ribs here. With the score of the spinning processes, the vertebrae is focused on the fact that the line connecting the lower corners of the blades (with the hands lowered), crosses the VII of the chest vertebra (table).
Comparative percussion of the lungs
1. The study should be carried out in orthostatic position 2. Move only hands. 3. Begin to percussion from a healthy side 4. Picking strikes should be the same by strength and duration. 5. For comparison, first use a loud percussion. Over the front departments of the lungs.1st point - above the clavicle. 2nd point - under the clavicle, 3rd point- II intercole 4th point - III intercole 5th point - MORENHEMOVSKY YAM Over the side departments of the lungs. They ask the patient to put hands on the head and take elbows. 1 point - the height of the axillary fifth; 2nd point - V inter estreon Above the posterior lung departments. 1 point - above the blades; 2nd point between blades; 3rd point - under the blades; 4th point - on the shovel; Changes in a percussion in the direction of dull1. Seal (exudate, destruction, tumor, fibrosis, collapse, compression) 2. Extraction of the lung from the chest wall (by the accumulation of exudate, tumor of pleura) 3. Changes in the chest wall (inflammatory process in the edge, in soft tissues, tissue swelling). Changes in the performer towards tympanic1) from increasing their airiness (emphysema, cavities in the lungs) 2) Pneumothorax (distance light from the chest gas); 3) the emergence of gas (with injuries of the chest). Complex changes in the percussion sound over the lungsBottured tympanite is determined For the following states of the lungs: 1. The initial stage of the lung infiltration. 2. incomplete lung atelectasis. 3. With the lung gangrene. 4. The cavity in the lung, surrounded by perifocal inflammatory infiltrate. 5. Valve pneumothorax. Metal percussion sound There is no less than 6 cm having smooth walls, and at pneumothorax. "Cracked pot noise." This sound occurs over the cavities located close to the surface of the chest and communicating with the bronchus through a narrow slot.
Topographic percussion of the lungs
The topographic percussion is carried out and to determine the localization of the pathological focus in the lung or pleural cavity. Determination of the height of the topthe lungs are in front of the PLESSMETER-PLESSMETR parallel to the clavicle. Light percussion strikes, measure the height of this point over the clavicle. Under normal conditions, it is 3-4cm. Rear the upper limit of the lung is determined from the middle of the hollow spike direction towards the point located on 2-4 cm lateral from the VII cervical vertebra. Under normal conditions, behind the top may be below the level of the VII cervical vertebra, 1-2 cm. Fields of Carniga - The zone of the pulmonary percussion sound above the tops. Polesimeter pose across the trapezoid muscles of her front edge in the center. Having perfectly, the plaster movement moves the duck, then knutut to a stupid sound. The distance between the points is the width of the crennics fields (5-6 cm.) Low Lung Border. Percussion spend on all lines from top to bottom. A finger-plastermeter put in parallel to ribs. Borders: Lines in both lungs (front axillary - VII edge, medium - VIII edge, rear - IX edge, shovel edge, near vertebrate - XI breast vertebra). At the right lung there are two more lines (okology - V inter estreon, the middle-clearable - Vi edge). The mobility of the lower edge of the lungsFirst method In the study of patients who can perform respiratory maneuvers, and apply in the clinly-standard, and orthostatic position of the patient: determine the lower border of the lung in the middle Ak-Sallar line and mark the point, then the same with a deep breath and deep exhale. Get three points. Second methodpatients who cannot perform respiratory maneuvers, the 1st moment: in the patient's position lying the right hand it is slightly removed, the lower boundary of the lungs in the middle axillary line is performed. The 2nd point: a finger-plastermeter is installed by about 2-3 cm below the found border and cause rhythmic light blows. Percussion sound here is stupid.
3rd moment: asked the patient to breathe so deeply as it can without a breath delay, and at the same time continue to chop in the intended point. If, when inhaling the lower edge of the lungs reaches the level of the finger-plaster, then the percussion sound is clarified, becomes pulmonary. Make a mark on the outer edge of the finger-plastermeter. Consequently, the mobility of the lung is quite satisfactory.
Changes of lung boundaries in pathologyIncreasing the lower borders of the lungs is possible with a high stand dome of the diaphragm of various genesis: pregnancy, obesity, flatulence, ascites, liver, damage the muscle of the diaphragm, wrinkling the process in the lungs. Reducing The mobility of the lungs is noted in the emphysema of the lungs, stagnant in the lungs, painful syndrome, pleural sobbles.
Among the methods of primary diagnosis of diseases of the respiratory organs is isolated by percussion of the lungs. This method consists in closing certain parts of the body. With such a climbing, certain sounds arise, according to the features of which the sizes and borders of the organs are installed and existing pathologies are detected.
The volume and height of the sounds depends on what density is inherent in tissues.
Despite the development of many new diagnostic methods, the percussion of the lungs is still widely applied in practice. An experienced specialist is often able to put an accurate diagnosis without the use of technological means, thanks to which the treatment can be started significantly earlier. However, percussion may have doubts about the alleged diagnosis, and then other diagnostic agents are used.
Percussion of the chest can be different. For example:
- Direct (straight). It is carried out using fingers directly by the patient's body.
- Indirect. Performed by the hammer. In this case, you need to strike in this case via the plane applied to the body, which is called a plaster.
- Finger-finger. With this method, the percussion of the lungs in the role of a plaster is the finger of one hand, and the blows are made with a finger of another hand.
The choice of technology depends on the preferences of the doctor and the peculiarities of the patient.
Features of execution
When percussion, the doctor must analyze the heard sounds. It is according to them that the borders of the respiratory organs can be determined and set the properties of internal tissues.
The following types of sounds detected during percussion are distinguished:
- Dumb sound. It may occur when the compacted area is detected in the lungs.
- Boxing sound. This type of sound appears in the case of excessive airiness of the body under study. The name arose due to the similarity with how the empty cardboard box sounds with a slight impact on it.
- Tympanic sound. It is characteristic of performing lung sites with smooth-beams.
According to the features of sounds, the main properties of internal fabrics are identified, thereby determining pathology (if any). In addition, during such a survey, the borders of the organs are established. When deviations are detected, you can assume a diagnosis characteristic of the patient.
Most often, at percussion, the finger-finger technique is used.
It is performed according to the following rules:
To make this method of diagnostics, the doctor must comply with the execution technique. It is impossible without special knowledge. In addition, experience is needed, since in absence it will be very difficult to make the right conclusions.
Features of comparative and topographical percussion
One species of this diagnostic procedure is the comparative perception of the lungs. It is aimed at determining the nature of sounds arising when performing in the area of \u200b\u200blight. It is carried out on symmetric areas, while the blows must have the same force. During its execution, the procedure for actions and the correct position of the fingers is very important.
Such percussion can be deep (if the presence of pathological sites is deeply inside), superficial (when pathological foci is close) and ordinary. Exploration is carried out on the front, rear and side surfaces of the chest.
The topographic percussion of the lungs is designed to determine the upper and lower borders of the organ. The results obtained are compared with the norm (a special table has been developed for this). According to the existing deviations, the doctor may assume one or another diagnosis.
This type of percussion of respiratory organs is performed only by a superficial way. The boundaries are determined by the tonality of sounds. The doctor must necessarily comply with the procedure fulfillment and be careful not to miss important surveillance details.
Normal indicators
This method of studying respiratory authorities makes it possible to detect pathological phenomena without the use of more complex diagnostic procedures. Most often, x-ray or MRI is used to identify similar features, but their use is not always appropriate (due to irradiation of UV rays or greater cost). Thanks to the percussion, the doctor can detect the displacement or deformation of the organs in the inspection.
Most of the conclusions are based on the boundaries of the patient. There is a certain norm on which specialists are oriented. It should be said that the normal indicator of the lung boundaries in children and adults is almost no different. The exception can be indicators of a child of preschool age, but only with respect to the tip of the body. Therefore, in preschool children, this boundary is not determined.
Measurements of the upper boundary of the lungs are performed and in front of the chest, and behind it. On both sides there are guidelines that are based on doctors. The leader on the front of the body is the clavicle. In the normal state, the upper boundary of the lungs runs 3-4 cm above the clavicle.
Determination of the upper borders of the lungs
From the back, this boundary is determined by the seventh cervical vertebra (it is slightly different from the other with a small spiny process). The top of the lungs is approximately at the same level as this vertebra. I look for this boundary with clouding from the clavicle or from the blade in the direction upwards until the stupid sound appears.
To identify the lower limit of the lungs, you need to take into account the layout of topographic lines of the chest. Scripture is performed on these lines from top to bottom. For each of these lines, a different result will be obtained, since the lungs have a cone-shaped form.
In the normal state of the patient, this border will run on a plot from 5 intercostal (when moving along an ocolatified topographic line) to 11 breast vertebra (by the oil-color line). Between the lower boundaries of the right and left lungs will be discrepancies due to the heart located next to one of them.
It is also important to take into account the fact that the location of the lower borders affect patients's physique features. With a thin bodytone, the lungs have a more elongated form, due to which the lower boundary turns out to be slightly lower. If a patient is inherent in a hypersthenic physique, then this border may be somewhat higher than the norm.
Another important indicator to pay attention to this survey is the mobility of the lower borders. Their position may vary depending on the phase of the respiratory process.
When inhaling, the lungs are filled with air, which is why the bottom edges are shifted down, when they are exhaled, they are returned to the usual state. A normal indicator of mobility with respect to the midcurbicular and the blade lines is 4-6 cm, relative to the average axillary - 6-8 cm.
What do deviations mean?
The essence of this diagnostic procedure is to assume the disease on the deviations from the norm. Deviations are most often associated with the displacement of the borders of the organ up or down.
If the upper parts of the lungs in the patient are shifted above, which should be, this suggests that pulmonary fabrics have excessive air industry.
Most often, this is observed in emphysema, when the alveoli loses elasticity. Below the normal level of the tip of the lungs are located if the patient develops diseases such as pneumonia, pulmonary tuberculosis, etc.
When the lower bound is shifted, this is a sign of the patrimony of the chest or abdominal cavity. If the lower limit is located below normal level, it may mean the development of emphysema or the omission of internal organs.
When offset down only one lung, you can assume the development of pneumothorax. The location of these boundaries above the above level is observed in pneumosclerosis, obstruction of bronchi, etc.
It is also necessary to pay attention to the mobility of the lungs. Sometimes she may differ from normal, which indicates a problem. You can detect such changes inherent for both lungs or for one - this also needs to be considered.
If the patient is characterized by a bilateral decrease in this value, you can assume development:
- emphysema;
- bronchi obstruction;
- formation of fibrous changes in tissues.
A similar change characteristic only for one of the lungs may indicate that liquid accumulates in pleural sinus, or on the formation of pleurrodiaphragmal adhesions.
The doctor must analyze all the features discovered to make the right conclusions. If it fails, you need to apply additional diagnostic methods to avoid errors.
