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Lung percussion sounds2/22/2024 ![]() When over normally dull sound, the percussion blow is not audible at all. Therefore physician strikes the pleximeter so lightly the normally resonant sound is barely audible. The lighter the percussion blow is the lower the sound intensity. This special technique is based on the principle that resonant percussion sound has higher intensity that dull one. Moreover, its usefulness lacks scientific support. One of the example is scratch test of the liver. The technique itself varies greatly in different authors. Physician places stethoscope over the body wall and percuss it, listening to the changes of the sound through the stethoscope. This less known technique combines percussion and auscultation with stethoscope. Although traditionally taught, studies have shown there is high interobserver variability in the absolute findings, questioning its validity.Īuscultatory Percussion. It’s useful for outlining the borders of the organs like liver or spleen. From the definition, it is impossible to detect symmetrical bilateral process. It’s usefulness lies in detecting asymmetrical finding indicating underlying pathologic process rather than the sound or note itself. ![]() In this method physician is comparing percussion sounds at identical places on both sides of the chest. Repeat steps 2 and 3 with the same force and same technique to elicit valid percussion sound.īased on clinical use there are three types of percussion – comparative, topographic and auscultatory.Ĭomparative Percussion.After the blow, quickly withdraw the plexor finger or let it rest lightly on the pleximeter.Use quick, hard but relaxed motion of the wrist, not the finger itself. With the tip of the right middle finger (plexor) strike the left middle phalanx bone.Other fingers should be spread apart and not touching the body as it dampens the vibrations and changes percussion note. Make sure it’s pressed firmly as light touch changes sound intensity. Place hyperextended left middle finger (pleximeter) on the body wall.In early days, wooden or ivory plates or coins were used. Nowadays physicians use their left middle finger. In this method percussion blows are conveyed to body wall indirectly through pleximeter which is placed firmly on the body wall. It replaced direct method partly because percussion blows were so hard it caused patients great pain and put them at risk of trauma. This method was developed by Piorry and Škoda. In early days, percussion hammers were used. ![]() Most of the time physicians use their right middle finger. In this method physician is striking the body wall directly with the plexor. It’s the original method of Auenbrugger and Laennec. There are two main methods for percussion – direct and indirect.ĭirect Method. This may be due to inconsistent technique. Based on observational studies percussion has relatively low kappa coefficient (κ) which means there is high interobserver disagreement. Percussion is relatively simple examination skill, yet to be mastered it needs to be practiced properly. ![]() Had he been examined properly, asymmetrical apical tympanic and basal dull note would had been appreciated. Chest x-ray detected iatrogenic pneumohemothorax. During the procedure, electrode was misplaced as a rare complication outside of the pericardium. Subclavian vein was used as a way to insert electrodes. ![]() Clinical Vignetteģ0-year old male was admitted to the cardiology department after an episode of ventricular fibrillation, necessitating ICD implantation. Until the discovery of x-ray in 1895, percussion and auscultation were the only chest investigation methods. Many physicians started to investigate its role in diagnosing diseases even more, most notably René Laennec, the student of Corvisart and the inventor of stethoscope, Josef Škoda, the first physician to apply principles of physics in percussion, and Adolph Piorry, the inventor of pleximeter and indirect percussion technique known today. It gained on popularity only because Napoleon’s court physician Jean-Nicolas Corvisart translated it to French in 1808. In 1761, after a decade of post-mortem experiments Auenbrugger published the first monography about percussion. He observed the technique from his father who by percussing wine barrels was measuring their fluid level. However, it was Leopold Auenbrugger, an Austrian physician, who first described its role in lung diseases. Percussion was known to physicians in ancient times, including Hippocrates. ![]()
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