There were proposals to consider percussion and auscultation as the gold standard for diagnosing pneumonia. That is, listening and tapping out the lungs. That would be nice, but it isn't.
The gold standard for diagnosing pneumonia is chest x-ray.
If nothing is visible on the x-ray, but the doctor swears and swears that he hears pneumonia with the ear, then in about 1 in 10 patients in the next 72 hours, pneumonia will become noticeable on the x-ray of the chest organs.
So it is very possible that such a poor fellow will be taken to the hospital, and the X-ray of the lungs will be repeated in a day or two.
And vice versa. If an innocent person was forcibly photographed an X-ray of the lungs and found something similar to pneumonia, then according to modern concepts it is still necessary to get some other signs.
Well, there is a high fever or a cough with phlegm, or pain in the side, or shortness of breath. That is, an X-ray, apart from all this, in a strong person without complaints does not mean much. Is this point clear?
Why did you remember about percussion and auscultation? Because it's simple and effective.
Remember, we already discussed how pneumonia impregnates the lungs with pus? This pus gurgles with delicate small bubbles in the very depths of the lungs, and the disintegrating alveoli crunch in a peculiar way.
It sounds strange, but it happens even in a healthy person in the morning. This sound is called crepitus. While we are lying in bed with our ribcage pressed against the mattress, the lungs do not fully expand.
If you wake up a person at night and make him take a deep breath, then we will hear crepitus, with which the lungs crumpled in a dream break apart. In a couple of breaths, everything will fall apart and become as usual.
So in a patient with pneumonia, no matter how much he breathes, such a crunching will be heard and heard.
The doctor also taps his finger on the patient's back to find a dull sound there.
Air-filled, healthy lungs ring like an empty barrel at the sound of a finger.
Pus-soaked areas of the lungs in pneumonia sound dull. The experienced ear can see this.
If you add to this manual examination, even a temperature above 38 degrees, or chest pain, or pulse is higher 100 per minute, or breathing more than 20 per minute, then the doctor will immediately want to apply the gold standard of diagnosis, that is, x-ray.
Is it clear with the standard?
