1、2020/4/7,北京医院孙铁英,1,Physical Examination 基本检查方法,北京医院呼吸与危重症医学科国家呼吸疾病临床研究中心 孙铁英,2020/4/7,北京医院孙铁英,2,What is physical examination?,It is a fundamental examining method, it is proceeded by the sense organs such as eyes, ears, nose and hands or simple tools stethoscope and plexor.,2020/4/7,北京医院孙铁英,3,The ba
2、sic methods of physical examination,inspection 视诊 palpation 触诊 percussion 叩诊 auscultation 听诊 olfactory examination 嗅诊,2020/4/7,北京医院孙铁英,4,Inspection,2020/4/7,北京医院孙铁英,5,Inspection,Includes a general view of the patients 1.mental status 意识状态 2.development 发育 3.nutrition 营养 4. posture 体位 5.body movement
3、 姿势 6.gait 步态 7.facial expression 表情 plexion 面容,2020/4/7,北京医院孙铁英,6,无力型（瘦长型）,超力型（矮胖型）,正力型（匀称型）,2020/4/7,北京医院孙铁英,7,pallor exophthalmus Cyanosis (lips) moon face spider angioma barrel chest Gastric type Abdomenal respiratory movement,anemia Hyperthyroidism mitral face cushing syndrome liver cirrhosis p
4、ulmonary emphysema pylorus obstruction Normal，men，children,Inspection,2020/4/7,北京医院孙铁英,8,palpation,2020/4/7,北京医院孙铁英,9,Palpation,Mainly used in abdominal examination mass: 1. location 部位 2. size 大小 3. contour 边缘 4. consistency 质地/边界 5. mobility 活动度 6. tenderness 压痛 7. pulsation 波动感,2020/4/7,北京医院孙铁英,1
5、0,Palpation,2020/4/7,北京医院孙铁英,11,The methods of palpation,Light palpation 浅部触诊法 Deep Palpation 深部触诊法 deep slipping palpation 深部滑行触诊 bimanual palpation 双手触诊法 deep press palpation 深压触诊法 ballottement 冲击触诊法,The methods of palpation,light palpation 浅部触诊法 abdominal muscle tensity abdominal tenderness,2020/
6、4/7,北京医院孙铁英,12,2020/4/7,北京医院孙铁英,13,Deep Palpation,Deep Palpation deep slipping palpation -deep mass bimanual palpation - liver, spleen, kidney 3. deep press palpation -tenderness point,2020/4/7,北京医院孙铁英,14,bimanual palpation liver and spleen,2020/4/7,北京医院孙铁英,15,Deep press palpation tenderness point,C
7、holecystic point : Murphys sign Acute cholecystitis,tenderness point,2020/4/7,北京医院孙铁英,16,Cholecystic point : Murphys sign Appendix point: McBurney point acute appendicitis Rebound tenderness：acute peritonitis Ballottement：冲击 liver enlargement, splenomegaly with massive ascites,Deep Palpation,2020/4/
8、7,北京医院孙铁英,17,Notice:,Patient in supine position 仰卧位 Ask patient flex his thighs and knees 放松、屈膝 Tell patient relax his abdomenal muscles 腹部放松 Doctor stands at the right side of patient 站右侧 Warm hand, use your palmar aspect of finger, examining gently and lightly, from superficial to deep.手脑并用,2020/4
9、/7,北京医院孙铁英,18,Percussion,lungs -margin 界 heart -size and shape 大小、形状 liver -upper margin 上界 Ascites 腹水 -shifting dullness 移动浊音,2020/4/7,北京医院孙铁英,19,Percussion methods,There are two methods that may be used for percussion 1 Indirect percussion 2 Direct percussion,2020/4/7,北京医院孙铁英,20,Indirect percussio
10、n,2020/4/7,北京医院孙铁英,21,2020/4/7,北京医院孙铁英,22,Direct percussion,This method can be done by striking chest with the palmar aspect of right hand or the tips of all of the fingers held firmly together, mainly used to examine massive fluid in thoracic cavity.,2020/4/7,北京医院孙铁英,23,Direct Percussion,2020/4/7,北
11、京医院孙铁英,24,Resonance 清音 Dullness 浊音 Tympany 鼓音 Flatness 实音 Hyperresonanc 过清音,Percussion Sounds,2020/4/7,北京医院孙铁英,25,Auscultation there are two methods of auscultation: direct auscultation with the ear; indirect auscultation with the stethoscope.,2020/4/7,北京医院孙铁英,26,2020/4/7,北京医院孙铁英,27,by these two met
12、hods we can listen to the sounds produced from heart lungs and abdomen or the blood vessel note,2020/4/7,北京医院孙铁英,28,Two principal type of stethoscope,the bell 钟型听诊器 is more suitable to listen to the low pitched rumble such as the murmur of mitral stenosis,2020/4/7,北京医院孙铁英,29,Two principal type of st
13、ethoscope,the diaphragm 膜性听诊器 is more suitable to listen to the high pitched tones the murmur of aortic regurgitation, breath sound and bowel sond,2020/4/7,北京医院孙铁英,30,Olfactory examination Smelling,to identify the unusual odor which produced from patient such as the odor of sweat汗 sputum pus fluid 脓
14、 vomitus呕吐物 Stool便 Urine breath,2020/4/7,北京医院孙铁英,31,嗅诊,酸性汗液：风湿热、水杨酸、阿司匹林 狐臭味：腋臭患者 恶臭痰液：支气管扩张、肺脓肿（厌氧菌感染） 恶臭脓液：气性坏疽 粪便呕吐物：长期剧烈呕吐、肠梗阻 烂苹果味呕吐物：胃坏疽 腐败性臭味粪便：消化不良、胰腺功能不良,2020/4/7,北京医院孙铁英,32,腥臭味粪便：细菌性痢疾 呼吸呈刺激性蒜味：有机磷杀虫药中毒 烂苹果味呼吸：糖尿病酮症酸中毒 氨味：尿毒症 肝腥味：肝性脑病,嗅诊,2020/4/7,北京医院孙铁英,33,The basic methods of physical examination,inspection 视诊 palpation 触诊 percussion 叩诊 auscultation 听诊 olfactory examination 嗅诊,谢谢,
