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   Back to the 6-bed patient again, he was obese, and it was too difficult for the doctor to hear it out.

   Xin Yanjun, who put down the imaging examination results, looked serious. The nurse next to her advised her again: "Don\'t wait for the cardiothoracic surgeon to come."

   Xin Yanjun\'s eyes fell on the students.

   Xie Wanying\'s palm is percussion on the patient.

   knock knock, unvoiced. Knock again, hey, this sound is wrong, it\'s dull.

   Sitting on the chair, with both hands on the back of the chair, the patients with their backs to the doctor seemed to have heard that the sound of being shot was wrong, and turned to look at the young female doctor: I had never seen it before.

   Xin Yanjun approached the students and patients, and then raised his ears and listened carefully, and then looked at the students\' hands.

Classmate Xie\'s hands seemed to be quiet and delicate at first glance. I didn\'t expect that if they had supernatural power, sufficient strength, and good control, when they knocked down, they had just the right amount of strength and penetrated the thick layer of fat. The boundary line between unvoiced and voiced real sounds is drawn.

   All I can say is that Xie’s eyes seemed to see through the thickness of the patient’s fat layer first, and the depth to which the strength could be exerted was just right.

   This student is the same as she guessed, she can help her determine the boundary line, and she can definitely draw fluids.

   Xin Yanjun\'s confidence increased greatly, and she said to the nurse, "Pick!"

   It seems that Mr. Xin is a very courageous doctor. He is gentle and honest on the outside, but he is actually tough on the inside, which once again confirms that the big doctor is a good character.

  What are you waiting for, I don\'t know which year of the monkey and horse month to wait. The patient had difficulty breathing today, and was quickly taken out to relieve the patient\'s symptoms.

   Wear surgical cap, gloves, and be ready.

   Syringe **** the local anesthetic lidocaine, to do local skin anesthesia, hit Pichu.

   The thoracentesis point is always the appropriate higher rather than lower location. Especially in this patient, the effusion is just on the right side. Under the right lung is the liver. Just after she came out of the hepatobiliary surgery, Xie Wanying knew very well that the liver was buried in the lower lung and overlapped with the lung. Therefore, doctors generally choose the puncture point to perform the puncture in the ninth intercostal space on the subscapular angle line, and the puncture below the tenth intercostal space should be very careful, as it will easily penetrate to other organs.

   To determine the number of intercostal spaces, there is no b-ultrasound, which can be judged by using the human anatomy. Feeling the scapula, the scapula is on the posterolateral side of the thorax, which is why the patient sits with his back to the doctor. Thoracentesis is generally done by inserting the needle from the patient\'s back.

   By convention, the lower end of the scapula corresponds to the seventh intercostal space. If you want to be more cautious, you can count down from the first rib of the patient, and you can\'t go wrong. After all, some patients are strange, individual differences, may be born or other reasons cause the lower end of the scapula and the seventh intercostal space does not correspond.

   This patient is obese, and it is extremely difficult to count down the ribs one by one. However, Xin Yanjun was confident today and asked Xie classmates around him to help.

  Xie did not disappoint her, she quickly felt the patient\'s first rib space and helped the teacher count down.

   (end of this chapter)