 Welcome to Nursing School Explained and this video on percussion technique. Procussion is a kind of an old-school method of assessing our patients, but it can be very helpful to detect abnormalities. Now, mostly in modern Western medicine, we have other assessment techniques and methodologies now such as x-rays, ultrasound, CT scans that can easily give us a good picture of what's going on with the patient. However, if you might live in a rural area or if you're interested in medical missions and you travel to a part of the world where these modalities are not easily accessible, it is very nice to know the method of percussion to really assess your patient in greater detail. And it's a nice assessment tool and assessment technique that you can utilize to really see what's going on with your patient in addition to the other assessment techniques that we have available. And for percussion, there are basically two ways of doing it which is direct and indirect percussion. Direct percussion would be just with one hand, where you would basically use your hand as a kind of like that percussion hammer to percuss the patient and indirect would be where you put one hand there and then you use the other hand and put it on the one that's touching the patient's skin. And percussing, we usually percuss the chest and the abdomen, so let's look at the different sounds that we might hear here. So for the chest percussion, there are three different sounds that we might hear and resonance is an air filled space which is good because in the chest we want to percuss the patient's lungs. So we want those to be air filled and resonance is something that's more like a hollow and air filled space just like we would expect the lungs to be. Doleness is something that would be fluid filled and hence it's bad because in the lungs we don't want any fluids there. So that would maybe mean that there's an infection, some sort of an ammonia, maybe a pleural effusion, those kind of things. So dullness is more when there's liquid underneath the surface, it's going to sound more dull because the cavity underneath is not air filled and does not resonate as much as it would be if it was air filled. And then there's another term called hyper resonance. So that is now extra resonant or more air filled than the lungs should be. And there are certain conditions where patients can have hyper resonant lungs which would be conditions such as COPD and pizema and asthma where the alveoli get really distended and the patient retains CO2 so that now there's more air in there as we would expect so it's going to sound extra hollow and this is because the lungs are hyper inflated. And then here our patients anteriorly and posteriorly, again forgive my drawing but I think it's a good visual here, we want to percuss as many spots as we do for oscultation. So we should do at least 10 on the front and the patient's backside. Same rule as for oscultation applies, you want to stay away from the bones, so the sternum in the front and the ribs, any kind of fatty breast tissue that you might encounter and then in the back the spine and the shoulder blades because we want to percuss the lungs, that's our goal here. And then again you want to start on the very top and that triangle between the clavicle on the top of the shoulder because the lungs go all the way up here to the tips of the chest and then just like a percussion you compare right to left or left to right and you work your way down make sure that you extend to the sides so that you cover those lower lobes and also that middle of on the patient's right side because there are three lobes on that right side and we don't want to miss anything in that right middle lobe that would be more in the mid-axillary line but watch my other video on the oscultation of the lung sounds where I go into more details. So that is for chest. So we have resonance, airfield, dolness, fluid field and then hyper-resonant, hyper-inflated lungs because of some CO2 retention due to certain conditions. For the abdomen very similar but the term is different. So in the abdomen the percussion and the airfield space underneath is called timpani. So think about a drum or like your tympanic membrane that's more air filled and then again dolness we have fluid filled or in the abdomen now we have organs that are underlying here and there are no real rules in the chest we know the lungs we want them to be air and not fluid filled but in the abdomen there's a lot going on in terms of different organs so we need to know our anatomy and where these organs are located so that we know is this normal to have dolness here is there an underlying organ or am I expected to maybe have some timpani there and in the abdomen things might change because remember that you have your whole digestive tract down here and let's look at our little man here so we have the ribs then we have the liver that underlies that in that right upper quadrant underlies the ribs the stomach is kind of going towards the sides and then behind it is the spleen and then we have the large intestine ascending, transverse and descending and the small intestine all in between now it will also depend on when your patient has last evening are they maybe in PO, do they have any abdominal pathologies such as bowel obstruction so that might be some abnormal findings that you could find there and it might change, there might be air in the colon there might be gas that's been building up so timpani might be normal or there might be dolness because now maybe there's a stool mass that's about ready to be excreted and we're gonna feel that palpable mass of the stool underneath where that mass sits so really important to know the anatomy and then again with the same technique we assess the patient, we determine if it's timpani or dolness and if we find dolness let's just see what's going on here probably ask the patient a couple of questions regarding their abdominal sensations nausea, vomiting, abdominal pain when the last bowel movement was maybe when they've last urinated keep in mind the bladder sits on the very lower abdomen in that suprapubic space and if the bladder is distended or full it's going to be dull but if it's not, if it's empty it might be a little bit more timpani because now the organ is empty and there might be some intestine that overlies it that has a little bit more gas there so for the abdomen it could be either or but that's very important so that we know what's underneath so that we know is it normal or abnormal and remember to ask your patient some questions please also watch my video where I actually demonstrate the direct and indirect techniques for percussing a patient and you can hopefully hear the different sounds there and get a little bit more familiar of how to perform this important skill thanks for watching Nursing School Explained please also check my Instagram where I have certain sudden tips there are some questions that pop up there in click style and I'll see you soon right here on Nursing School Explained thanks for watching