2023/5/17北京醫院孫鐵英1PhysicalExamination

基本檢查方法北京醫院呼吸與危重癥醫學科國家呼吸疾病臨床研究中心孫鐵英2023/5/17北京醫院孫鐵英2Whatisphysicalexamination?Itisafundamentalexaminingmethod,itisproceededbythesenseorganssuchaseyes,ears,noseandhandsorsimpletools–stethoscopeandplexor.2023/5/17北京醫院孫鐵英3Thebasicmethodsofphysicalexaminationinspection視診palpation觸診percussion叩診auscultation聽診olfactoryexamination嗅診2023/5/17北京醫院孫鐵英4Inspection

2023/5/17北京醫院孫鐵英5InspectionIncludesageneralviewofthepatient’s1.mentalstatus意識狀態

2.development發育3.nutrition營養

4.posture體位5.bodymovement姿勢6.gait步態7.facialexpression表情8.complexion面容2023/5/17北京醫院孫鐵英6無力型（瘦長型）超力型（矮胖型）正力型（勻稱型）2023/5/17北京醫院孫鐵英7pallorexophthalmusCyanosis(lips)moonfacespiderangiomabarrelchestGastrictypeAbdomenalrespiratorymovementanemiaHyperthyroidismmitralfacecushingsyndromelivercirrhosispulmonaryemphysemapylorusobstructionNormal，men，childrenInspection

2023/5/17北京醫院孫鐵英8palpation2023/5/17北京醫院孫鐵英9PalpationMainlyusedinabdominalexamination

mass:

1.location部位2.size大小

3.contour邊緣4.consistency質地/邊界

5.mobility活動度6.tenderness壓痛

7.pulsation波動感2023/5/17北京醫院孫鐵英10Palpation2023/5/17北京醫院孫鐵英11ThemethodsofpalpationLightpalpation淺部觸診法DeepPalpation深部觸診法deepslippingpalpation深部滑行觸診bimanualpalpation雙手觸診法deeppresspalpation深壓觸診法ballottement沖擊觸診法Themethodsofpalpationlightpalpation淺部觸診法

abdominalmuscletensity

abdominaltenderness

2023/5/17北京醫院孫鐵英122023/5/17北京醫院孫鐵英13DeepPalpationDeepPalpation

deepslippingpalpation---deepmassbimanualpalpation---liver,spleen,kidney3.deeppresspalpation---tendernesspoint2023/5/17北京醫院孫鐵英14bimanualpalpationliverandspleen2023/5/17北京醫院孫鐵英15DeeppresspalpationtendernesspointCholecysticpoint:Murphy’ssignAcutecholecystitistendernesspoint2023/5/17北京醫院孫鐵英16

Cholecysticpoint:Murphy’ssignAppendixpoint:McBurneypoint

acuteappendicitisReboundtenderness：acuteperitonitisBallottement：沖擊

liverenlargement,

splenomegalywithmassiveascitesDeepPalpation2023/5/17北京醫院孫鐵英17Notice:Patientinsupineposition仰臥位Askpatientflexhisthighsandknees放松、屈膝Tellpatientrelaxhisabdomenalmuscles腹部放松Doctorstandsattherightsideofpatient站右側Warmhand,useyourpalmaraspectoffinger,examininggentlyandlightly,fromsuperficialtodeep.手腦并用2023/5/17北京醫院孫鐵英18Percussionlungs---margin界heart---sizeandshape大小、形狀liver---uppermargin上界Ascites腹水---shiftingdullness移動濁音2023/5/17北京醫院孫鐵英19PercussionmethodsTherearetwomethodsthatmaybeusedforpercussion

1

Indirectpercussion

2

Directpercussion

2023/5/17北京醫院孫鐵英20Indirectpercussion2023/5/17北京醫院孫鐵英212023/5/17北京醫院孫鐵英22DirectpercussionThismethodcanbedonebystrikingchestwiththepalmaraspectofrighthandorthetipsofallofthefingersheldfirmlytogether,mainlyusedtoexaminemassivefluidinthoraciccavity.2023/5/17北京醫院孫鐵英23DirectPercussion2023/5/17北京醫院孫鐵英24

Resonance清音

Dullness濁音

Tympany鼓音

Flatness實音

Hyperresonanc過清音

PercussionSounds2023/5/17北京醫院孫鐵英25Auscultation

therearetwomethodsofauscultation:

directauscultationwiththeear;

indirectauscultationwiththestethoscope.2023/5/17北京醫院孫鐵英262023/5/17北京醫院孫鐵英27bythesetwomethodswecanlistentothesounds

producedfrom

heartlungsandabdomenorthe

bloodvesselnote2023/5/17北京醫院孫鐵英28

Twoprincipaltypeofstethoscope

thebell鐘型聽診器

ismoresuitabletolistentothelowpitchedrumblesuchasthemurmurofmitralstenosis

2023/5/17北京醫院孫鐵英29Twoprincipaltypeofstethoscopethediaphragm膜性聽診器

ismoresuitabletolistentothehighpitchedtones

themurmurofaorticregurgitation,breathsoundandbowelsond2023/5/17北京醫院孫鐵英30OlfactoryexaminationSmellingtoidentifytheunusualodorwhichproducedfrompatientsuchastheodorofsweat汗sputumpusfluid膿vomitus嘔吐物Stool便Urinebreath2023/5/17北京醫院孫鐵英31嗅診酸性汗液：風濕熱、水楊酸、阿司匹林狐臭味：腋臭患者惡臭痰液：支氣管擴張、肺膿腫（厭氧菌感染）惡臭膿液：氣性壞疽糞便嘔吐物：長期劇烈嘔吐、腸梗阻爛蘋果味嘔吐物：胃壞疽腐敗性臭味糞便：消化不良、胰腺功能不良2023/5/17北