I would have to agree with Jules NGIRIMANA and disagree with Mike Fleete. The point of doing SHIFTING DULLNESS is that you SHIFT the FLUID so that the DULLNESS SHIFT! In this video, the reason that I say its wrong is because the doctor asked the patient to turns towards her after marking down the point of dullness which the fluid is not shifted to anywhere but remained at the same location she noted the dullness. No matter where we percussed and found the dullness, we should always imagine that there is a fluid there and asked patient to turn or roll whether left or right in a direction that the fluid is able to flow to the other side of the abdomen, so that when you percuss the same place you marked down just now, you detected tympany lets say if the fluid shifted, but if you percuss dullness again at the place you marked, it simply suggest no ascites.
I've learned it like this: Stand on the right side of the patient, percuss laterally (away from you, towards the left side of the patient) untill you hear dullness, mark that spot. Then let the patient turn AWAY from you (so that you face the patients back) and start percussing from the bellybutton downwards to the place where you hear dullness and compare with previous spot. Also...the way of percussion in this video is strange. the movement of the percussing finger should come from the wrist
According to Bate's Physical Exam she performed it properly: patient laid on his right lateral side, she is on the left side of the bench because she is right handed, and she percussed.
I wish I could like your comment so many times. You're correct. This video is correct. There is more than 1 way to do this technique! And they're both right...duhhhh
Be a little hesitant whenever someone tells you there is no ____ (physical exam finding) and this means there is no _____. The negative LR is 0.4 and + is 2.4, which means it is marginally good at ruling in or out, but certainly not definitive. You can perform it the way she did or rolling to opposite, depends on who you read. Cattau required turning to both sides. Read Steven MacGee, the one and only, if you want to learn how to interpret the exam.
This video is wrong.You percuss towards left side of the patient and after detecting a dull note you mark it and the patient turn to his/her right side,then you continu percussing towards his/her left side to detect any change of the position of the dull note.If there is ascites that note shift towards the left side of the patient.
This is wrong!?? Thats not how u check shifting dullness. When on the right side of the bed, ure supposed to percuss laterally to the LEFT flank until u hear a dull note, turn the pt toward you, wait 30 sec - 1 minute, then percuss at the same point. If there is fluid in abdomen (ascities), then gravity would have allowed it to sink towards the right side -> causing a resonant tone, ie shifting dullness. Please research before posting videos. Thanks
I would have to agree with Jules NGIRIMANA and disagree with Mike Fleete. The point of doing SHIFTING DULLNESS is that you SHIFT the FLUID so that the DULLNESS SHIFT! In this video, the reason that I say its wrong is because the doctor asked the patient to turns towards her after marking down the point of dullness which the fluid is not shifted to anywhere but remained at the same location she noted the dullness. No matter where we percussed and found the dullness, we should always imagine that there is a fluid there and asked patient to turn or roll whether left or right in a direction that the fluid is able to flow to the other side of the abdomen, so that when you percuss the same place you marked down just now, you detected tympany lets say if the fluid shifted, but if you percuss dullness again at the place you marked, it simply suggest no ascites.
@mdforall pls reupload a corrected video as the technique is wrong. thanks
percussion must be parallel to the area of percussion
pt turn to the opposite side the dull area become resonant
on whichever Side you test for dullness must be facing UPWARDS when the patient is turned
I've learned it like this:
Stand on the right side of the patient, percuss laterally (away from you, towards the left side of the patient) untill you hear dullness, mark that spot. Then let the patient turn AWAY from you (so that you face the patients back) and start percussing from the bellybutton downwards to the place where you hear dullness and compare with previous spot. Also...the way of percussion in this video is strange. the movement of the percussing finger should come from the wrist
The video is WRONG, the patient should turn on opposite side from the doctor
I agree with you, there is a wrong in the exam. and there is multiple wrong tricks in her way of exam.
According to Bate's Physical Exam she performed it properly: patient laid on his right lateral side, she is on the left side of the bench because she is right handed, and she percussed.
Thanks for saving me. I was about to do it like this in my test tomorrow lol.
markmorgangenius True. And it makes alot of sense. The fluid, if present, should move to the opposite side, rendering the area tympanic on percussion.
+markmorgangenius should we all alert the uploader? if no this video gonna bring disaster to alot of students who thinking of doing the same in exam
I wish I could like your comment so many times. You're correct. This video is correct. There is more than 1 way to do this technique! And they're both right...duhhhh
turn the pt to the opposite side.
Be a little hesitant whenever someone tells you there is no ____ (physical exam finding) and this means there is no _____. The negative LR is 0.4 and + is 2.4, which means it is marginally good at ruling in or out, but certainly not definitive. You can perform it the way she did or rolling to opposite, depends on who you read. Cattau required turning to both sides. Read Steven MacGee, the one and only, if you want to learn how to interpret the exam.
@doubleu3dot I Agree with you thanks for your comment.
Agree!
amen i agree also. i was shocked to see this. one thing though, irs nit resinance but tympany that you will produce.
wrong!
This video is wrong.You percuss towards left side of the patient and after detecting a dull note you mark it and the patient turn to his/her right side,then you continu percussing towards his/her left side to detect any change of the position of the dull note.If there is ascites that note shift towards the left side of the patient.
Thank you for uploading the video, but this is incorrect, feel free to message me for details on how this is properly done.
Incorrect
thanks_))
very helpful_))
Did someone already mentioned this is so wrong?
wrong
this is totally wrong...the position shud hv been left lateral position!!!
She's doing it wrong.
Why she teach us wrong thing fam?
This is wrong!?? Thats not how u check shifting dullness. When on the right side of the bed, ure supposed to percuss laterally to the LEFT flank until u hear a dull note, turn the pt toward you, wait 30 sec - 1 minute, then percuss at the same point. If there is fluid in abdomen (ascities), then gravity would have allowed it to sink towards the right side -> causing a resonant tone, ie shifting dullness. Please research before posting videos. Thanks
Incorrect!!!
Wow... So wrong ..
why she learn us wrong , fyfan