Physical methods of patient research

The physical methods of research are those in which the doctor uses only his senses.

The questioning of the patient gives significant information, which often allows you to diagnose and solve the problems of treatment. In other cases, the questioning allows the doctor to make a preliminary conclusion and, when moving to objective research, to fix special attention to the assessment of the state of some organs, the defeat of which seems most likely. There are also possible situations when the patient is unconscious and the history data are practically absent. In this case, the general study can be ineffective and "help out" some or other additional research methods (for example, determining the level of sugar in the blood).

Objective research by physical methods often gives significant information that has an important diagnostic, prognostic and therapeutic significance. As already mentioned, it is possible to detect certain symptoms only when they are thought of and specifically looked for. But there are cases when only observation and examination of a patient in dynamics allow solving diagnostic and other problems, since a number of signs can manifest at a later stage of the disease. In addition, you need to consider the possibility of some symptoms associated with ongoing drug therapy.

Based on the results of a comprehensive study, one can judge the general condition of the patient, which is characterized as satisfactory, of moderate severity, or severe. At the same time, sometimes the patient's state of health remains satisfactory or even good, despite the fact that his general condition can be assessed as a moderate state due to the presence of pronounced changes, found, for example, on an electrocardiogram (signs of an acute infarction) or in a blood test (hyperkalemia) .

The physical methods of research include the following:

1. inspection;
2. feeling;
3. percussion;
4. Listening.

To indicate the position of the organs or the localization of the revealed changes in the study by these methods, it is advisable to focus on some common points and lines, as well as on natural anatomical formations. Among the latter it is necessary to note the following:

1. clavicles;
2. ribs and ribs;
3. sternum, including the handle, body, xiphoid process;
4. spinous processes of the vertebrae, the account of which is easy to start with a distinctly prominent VII cervical vertebra;
5. shoulder blades;
6. scars of iliac bones;
7. pubic connection.

The following areas should be borne in mind:

1. jugular fossa over the sternum;
2. supra- and subclavian fossa;
3. axillary fovea;
4. epigastric, or epigastric, region;
5. hypochondrium areas, or hypochondrium;
6. lumbar region;
7. inguinal area.

In addition, the following vertical lines are used for physical examination:

1. the anterior median line runs along the midline of the sternum;
2. sternal, or sternal, lines run along the edges of the sternum;
3. teat, or sredneklyuchichnye, lines;
4. peri-chest, or parasternal, the lines are held in the middle between the two previous ones;
5. the front axillary lines extend along the anterior margin of the axillary fossa;
6. middle axillary lines pass through the center of the axillary fossa;
7. the back axillary lines go through the posterior edge of the axillary fossa;
8. the scapular lines pass through the lower angle of the scapula;
9. the vertebral line passes along the spinous processes of the vertebrae;
10. near-vertebral lines.

The general examination is combined with a local examination (especially of the skin), as well as feeling, tapping, listening.

Feeling (palpation)

Palpation of various organs and systems has its own peculiarities, which are presented in the sections devoted to the study of the corresponding systems. Palpating, the doctor always uses the information obtained during the previous examination of the patient, and his knowledge of topographic anatomy. As AL Myasnikov wrote, one always needs to "summon the logical judgment to help, palpating, thinking, and thinking, palpating."

For effective palpation it is necessary first of all that the patient occupy a comfortable posture, which is determined by the purpose of palpation. The position of the doctor should also be comfortable. It is more expedient that the doctor should sit to the right of the patient's bed, facing him. The hands of the researcher must be warm, the nails are trimmed. The whole palm surface of the hand participates in the palpation, although mostly the palpable movements are made by the fingers.

When feeling the abdominal cavity, it is important to use respiratory movements.

Read also about the methods of palpation:

• The lungs.
• Hearts.
• Spleen.
• Liver and gallbladder.
• The mammary gland.

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Tapping (percussion)

The introduction of percussion into everyday medical practice was largely facilitated by J. Corvizar, the famous French physician, the physician-physician of Napoleon I. Thanks to J. Corvizar, doctors learned of the work of the Viennese doctor L. Auenbruger translated by him into French "A new way, as with the tapping of the chest human cells detect a hidden disease inside the chest, "released in 1761.

When percussion of the human body there are different sounds, the nature of which depends on the elasticity, air content and elastic tissue in the underlying organ.

There are percussion direct and indirect, including using a special plessimetre - a plate and a malleus.

Currently, percussion is a common finger on the finger when the middle finger of the left hand is used as a plemetrix. It is tightly pressed, but without pressure, to the percussion site. The tapping is performed with the middle finger of the right hand, which is slightly bent and does not touch other fingers. The impact is applied on the middle phalanx of the finger-plessimetra of the left hand, and the movement is made mainly in the wrist joint (and not in the metacarpophalangeal joint) of the right arm. The strength of the blow depends on the goals and the method of percussion. Louder percussion is indicated in the same way as deep, quiet - as superficial. When striking, the doctor listens to the sounds that come with it, compares them and evaluates them, making a conclusion about the state of the bodies subject to their borders.

Percussion can be comparative and topographical. Comparative is called percussion, in which the sounds obtained over anatomically identically located symmetrical areas of the body surface (for example, percussion of the right and left lungs) are compared.

Topographical percussion aims to distinguish different anatomical formations. Determine the boundary between the organs can be when they have differences in airborne.

There are the following options for percussion sound:

1. loud - clear pulmonary;
2. quiet - stupid;
3. tympanic.

A loud or clear percussion sound is obtained normally when the thorax is tapped over the lung area. It is defined as the airborne tissue, and the content in it of a large number of elastic elements (tissue alveoli). Quiet or dull sound is obtained normally with the percussion of airless and soft organs that do not have elasticity, such as the heart, liver, muscles. There are intermediate in strength percussion sound - blunted or muffled (shortened).

In pathology, the clear sound goes into blunted and blunt due to the decrease or disappearance of air in the percussion organ.

The tympanic sound resembles the sound from a blow to the drum (tympanon) and is characterized by a greater height. It is obtained by percussion of air-containing smooth-walled cavities and above hollow organs containing air (stomach, intestines).

Thus, normally the sound of clear pulmonary with percussion of the lungs is defined on the surface of the human body, the sound is dull quiet with percussion of the liver, heart and thick layer of muscles, and the tympanic sound over the abdominal cavity.

Read also about the methods of palpation:

• The lungs.
• Hearts.
• Liver.

Listening (auscultation)

Auscultation is listening to sounds originating in the body on their own, usually as a result of the movement of air or blood.

This method of research has been used for a long time. The basis of modern ideas about the importance of auscultation was developed by the great French physician Rene Teofil Hyacinth Laennec (1781 - 1826). He also suggested using a special stethoscope for this purpose. This idea came to R. Laennec in 1816. In the study of a very full woman, he experienced difficulties in carrying out immediate auscultation. Taking a notebook and twisting it into a tube, he put one end of this tube to the patient's heart region, put his ear to the other end. At the same time, the quality of the heard sounds has improved significantly.

Stethoscope for auscultation was first a wooden tube with extensions of various shapes at both ends. Then came more comfortable soft stethoscopes, which also amplify the sounds.

Phonendoscope - a stethoscope, the end of which is applied to the patient's body, covered with a membrane (often made of plastic). At the same time a small camera is formed, amplifying the sound.

Phonendoscopes and soft stethoscopes have slightly different designs and are made of different materials, with individual selection possible.

When listening, it is important that the room is kept quiet. The stethoscope should be applied tightly enough. It should be borne in mind the possibility of the occurrence of sounds associated with the contact of the phonendoscope with the hair on the surface of the body. With expressed hair, to reduce the additional sounds, one has to moisten the appropriate listening positions.

Auscultation is used in the study primarily of the lungs and the heart, in which there naturally arise sound vibrations associated with their functioning. Changes in the auscultatory pattern, in particular the appearance of additional sounds, can have a decisive (key) significance in the diagnosis of the disease. It is important to know the variants of the norm. In addition, significant information can be obtained with dynamic auscultation and the emergence of new phenomena.

It should be borne in mind that auscultation is used after questioning and examination of the patient, as well as palpation and percussion, which provide significant information for diagnosis and certain assumptions about the nature of the disease. Therefore, it is important that auscultation is carried out purposefully in view of these assumptions.