体格检查体格检查12ForewordForeword前言前言DonDon’’ttouchthepatientttouchthepatientstatefirstwhatyoustatefirstwhatyousee;see;cultivateyourpowerscultivateyourpowersofofobservation.observation.SIRWILLIAMOSLERSIRWILLIAMOSLER1849-19191849-19193TakehomemessageThemedicalhistoryandphysicalThemedicalhistoryandphysicalexaminationisthemostvaluablepartofexaminationisthemostvaluablepartoftheclinicalexaminationinreachingatheclinicalexaminationinreachingadiagnosis.diagnosis.4PayAttentiontothePayAttentiontotheFollowingsFollowings体格检查注意事项体格检查注意事项IntroductionIntroductionYourYourbehaviorbehaviorSurroundingsSurroundingsPrivacyPrivacyPositionPositionSequenceSequence介绍介绍行为举止恰当行为举止恰当环境合适环境合适注意病人的隐私权注意病人的隐私权体检时病人的体位体检时病人的体位体检的顺序体检的顺序查体顺序卧位患者:一般情况和生命体征→头颈部→前、侧卧位患者:一般情况和生命体征→头颈部→前、侧胸部(心、肺)患者取坐位后背部(包括肺、脊柱、胸部(心、肺)患者取坐位后背部(包括肺、脊柱、肾区、骶部)卧位腹部→上、下肢→肛门直肠→外肾区、骶部)卧位腹部→上、下肢→肛门直肠→外生殖器→神经系统(最后站立位)。生殖器→神经系统(最后站立位)。坐位患者:一般情况和生命体征→上肢→头颈部→坐位患者:一般情况和生命体征→上肢→头颈部→后背部(包括肺、脊柱、肾区、骶部)患者取卧位后背部(包括肺、脊柱、肾区、骶部)患者取卧位前、侧胸部(心、肺)→腹部→下肢→肛门直肠→前、侧胸部(心、肺)→腹部→下肢→肛门直肠→外生殖器→神经系统(最后站立位)。外生殖器→神经系统(最后站立位)。56第一章基本检查方法第一章基本检查方法BasicExaminationTechniquesBasicExaminationTechniques视诊视诊inspectioninspection触诊触诊palpationpalpation叩诊叩诊percussionpercussion听诊听诊auscultationauscultation嗅诊嗅诊olfactoryexaminationolfactoryexamination7ToolsofthePhysicalExamStethoscopeBPcuffOtoscopeOphthalmoscopeCanyouthinkofanyothertools?第一章基本检查方法8InspectionInspection视诊视诊::thefirstthefirststepinphysicalstepinphysicalexaminationexaminationTheareastobeinspectedshouldbeTheareastobeinspectedshouldbevisiblevisible充分暴露所视部位充分暴露所视部位GoodlightingisimportantGoodlightingisimportant光照良好光照良好TheangleofthelightcanbeusedtoTheangleofthelightcanbeusedtoadvantageadvantage角度合适角度合适InspectionandthinkingwithknowledgeInspectionandthinkingwithknowledge边视诊边思考边视诊边思考第一章基本检查方法9PalpationPalpation触诊触诊LightpalpationLightpalpation浅部触诊法浅部触诊法DeeppalpationDeeppalpation深部触诊法深部触诊法DeepslippingpalpationDeepslippingpalpation滑行触诊滑行触诊法法BimanualpalpationBimanualpalpation双手触诊法双手触诊法DeeppresspalpationDeeppresspalpation深压触诊法深压触诊法BallottementBallottement冲击触诊法冲击触诊法第一章基本检查方法10LightPalpationLightPalpation浅部触诊手法浅部触诊手法第一章基本检查方法11DeepPalpationDeepPalpation深部触诊手法深部触诊手法第一章基本检查方法12BimanualPalpationBimanualPalpation双手触诊手法双手触诊手法第一章基本检查方法触诊注意事项1.1.手法轻柔手法轻柔2.2.从无病部位到有病部位从无病部位到有病部位3.3.观察病人表情观察病人表情4.4.边检查边思考边检查边思考13第一章基本检查方法14PercussionPercussion叩诊叩诊directpercussionindirectdirectpercussionindirectpercussionpercussion直接叩诊间接叩诊直接叩诊间接叩诊第一章基本检查方法15IndirectPercussionIndirectPercussion间接叩诊间接叩诊TappingtheinterphalangealTappingthei...