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¡¾1190¡¿Difficulties revealed

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    It can be compared to heart auscultation. Heart sounds are divided into first heart sound, second heart sound, etc. according to different anatomical positions. Breathing sounds can also be divided into four kinds of breath sounds according to bronchi, bronchoalveoli, alveoli, and trachea.

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

    If you hear abnormal breath sounds, just remember that every clinical abnormality is closely related to anatomy.  Like the current patient, who has pleural effusion, the patient's normal gas exchange activities in the area where the lesion is located must be limited, and the alveolar breath sounds manifested in the location of the lesion 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 patient's clinical difficulties were exposed.  When doctors perform lung percussion, they should start from the second intercostal space and avoid the heart and liver.  In obese patients, even the ribs and intercostal spaces are difficult to feel.

    While the students were listening and percussing, Xin Yanjun took out the imaging results such as X-rays, CT films and B-ultrasounds that the patient had previously examined and looked at them again.  When it is difficult for clinicians to directly witness or touch patients' abnormalities, they need to make more use of modern medical equipment to help them see.

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

    For patients with pleural effusion, the first choice is not surgery. When the cause of the disease does not involve the need for surgery, it is just about the need for surgery for effusion.

    It can be compared to a patient with ascites.

    The production and absorption of pleural effusion in normal people are in a dynamic balance. Like ascites, the amount is very small, with a maximum of more than ten milliliters.  If the fluid accumulation 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 removing ascites and first provide emergency treatment.

    Thoracic puncture and drainage is different from surgery. It is an operation performed under blind vision. Blind vision relies entirely on preoperative judgment rather than watching and performing during the operation.  Therefore, if the preoperative judgment instruments make mistakes, the consequences will be serious.

    Like many blind-sight operations in clinical practice, in order to avoid the consequences of errors, B-ultrasound or CT are often introduced again for intraoperative guidance.

    The problem is that even CT scans of pleural effusion can be wrong.  Like wrapped pleural effusion, the CT judgment is that the doctor can extract the fluid through puncture, which seems to be correct.  However, after several withdrawals, the clinical effect was poor and the treatment could not be cured.  Finally, I had to make up my mind to undergo surgical exploration, and it was determined that it was not a pleural effusion but a teratoma.  Teratoma is okay, but if it is pulmonary hydatid disease, the doctors who cannot judge it through CT and do not know it will draw fluid, which is equivalent to the spread of hydatid.

    The above-mentioned extreme situations can refer to rare diseases. They rarely appear in clinical practice and the chance of doctors seeing them is low. If you encounter them, you can say you have won the lottery.  However, the following situations are clinically common.

    CT is a supine position examination, and the patient is usually in a sitting position during fluid extraction.  As a result, some patients may have a CT scan that shows fluid effusion from the 8th to 11th rib.  When the patient sat up and the doctor was about to draw fluid from him, the doctor suddenly discovered that the fluid may have dropped to the eleventh rib.  ct becomes useless and adds to the confusion.  (Remember the website address: www.hlnovel.com
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