Lost in the Labyrinth of End Points
نویسندگان
چکیده
when teaching to our housestaff trainees thoracocentesis that does not rely on chest percussion, namely, clavicle tapping with posterior chest auscultation. Stated simply, this technique takes advantage of the sound transmission characteristics of the inflated lung and the loss of sound transmission caused by the interposition of a layer of fluid between the air-filled lung and the chest wall. A steady tapping of the clavicle anteriorly by the examiner, who is positioned posteriorly reaching over the ipsilateral shoulder, generates a repeating sound that is well-transmitted through the lung to the posterior chest wall and that is readily appreciated via a stethoscope. The stethoscope then is moved slowly inferiorly from the apex to the base with each appreciated tap to the level below which no further conducted sound can be appreciated. This place represents the level of the superior aspect of the pleural effusion. In our experience, this technique correlates well with chest wall percussion performed by experienced examiners, is readily taught and learned, and has increased the comfort of our housestaff with thoracocentesis.
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