Health Assessment, part 31: Percussion Findings

Hi. I'm Meris, and in this video, I'm going to be talking to you about different findings associated with indirect percussion over the chest, the abdomen, and other structures. I'm going to be following along using our health assessment flashcards. These are available on our website, leveluprn.com, if you want to grab a set for yourself. Or if you prefer digital products, I would invite you to check out Flashables, which are the digital version of all of our flashcards. All right. Let's go ahead and get started.

So first up, let's talk about what percussion even is. So when I'm talking about percussion in this video, I'm talking about indirect percussion, which is where I'm going to take my finger or fingers and place it over the structure where I'm percussing. And I am going to then hit my own fingers with my other fingers. And that will transmit some vibrations into the underlying structures, which in turn will cause there to be a noise of some variety. Then I can listen to that noise, and I can make some inferences about what the underlying structures may be and what the status of those structures is based on the noise that I hear.

Now, before we move on, I do want you to know that this is not something that I do routinely as part of my job as an ER trauma nurse. This is mostly done by advanced practice nurses, such as nurse practitioners, when they are doing a thorough assessment and coming up with a diagnosis or when this is done by providers, such as physician associates or physicians. That being said, you still need to be familiar with these concepts and be able to perform this assessment technique. But I want to draw your attention to this card that we have on percussion findings because we have a very nice table here for you that goes over the different sounds, the sound quality, and what the possible cause is. But I'm going to go through this with you now.

So the first one that I want you to be aware of is something called resonance. And resonance is a low-pitched, hollow sound that is associated with percussing over normal, healthy lung fields. Now, keep in mind, when you are assessing over lung fields, it's super important to make sure that you are percussing in the intercostal space. If I percuss over a rib, I'm going to get a very different sound than if I percuss over the actual intercostal space. If I percuss over a rib, I'm percussing the rib. If I percuss over the intercostal space, then I'm percussing what is beneath it, which is, hopefully, the lung.

Moving on, we have something called hyper-resonance. And remember hyper meaning high or more than expected. So this is more resonance than expected. And this is, just like resonance, a low-pitched but booming sound. And this is associated with areas of air trapping. So hyperinflation of the lungs, such as in COPD, or if there were to be air in the pleural space, such as with a pneumothorax. With a pneumothorax, I have air where the lung should be. I have air outside of the lung that is pushing the lung in. And that is nothing but air versus air inside of a nice healthy lung. So when I percuss over that, I'm going to get this booming but low-pitched sound called hyper-resonance. Hyper-resonance should say to you, "There is a lot of air under this area that I am percussing." Very commonly related to COPD, but there could be other causes as well, such as pneumothorax.

But moving on down the list, we have dullness. And dullness is a quiet, high-pitched thudding sound. And dullness is most commonly associated with percussing over a solid organ, such as the liver. However, I want you to know that you can hear dullness as well when you are percussing over lung fields if those lungs have fluid or consolidation in them. So resonance comes from percussing over air, but dullness comes from percussing over something solid, like a dense solid organ, like the liver, or something that is fluid-filled because that fluid is not going to transmit the vibrations in the same way as the air. So if I were percussing over the area of pneumonia that a patient has, I would expect to hear dullness. So if you look at this X-ray and see the area of pneumonia in the left lower lobe, which I know it's on the right side of the image, but that is the left lung, the left lower lobe, I would expect to hear dullness when I percuss there versus resonance over the healthier areas that do not have consolidation in them.

Moving along the list, we have flatness. And flatness is a shorter or quieter sort of a thud than in dullness. It's flat. It falls flat. I don't know how to describe it other than there's really not much sound there. And this is expected when we are percussing over muscles and bone. So if I were to percuss for some reason over my patient's tibia, then I would expect to hear flatness. I like showing you these X-ray images because I think if you can visualize kind of the structure underneath that we would be percussing, you can see why this would change the sound that's being transmitted. So again, muscle or bone, they are not going to transmit that sound, that vibration very well at all. So that sound is going to fall flat. It is going to be a very short, quiet thud.

And lastly, there is tympany. And just like the tympanic membrane, tympany has to do with a drum. So anytime you hear something tympany or tympanic, that refers to a drum-like quality, which is very much helpful if you know what a timpani drum is. Spelled slightly different. In medical terms, timpani is with a Y, but the drum is with I's. However, it's that same idea. And I want you to think about a timpani drum when you think about tympany, the noise. Now, this noise is going to be a high-pitched drum-like sound, and this is expected when we are percussing over hollow organs, such as the stomach or the bowels. So I just want you to think of this now. Alone, yes, it's a hollow organ, but it has all of these different pockets, right? It has all these alveoli, has all of these different structures that are keeping it from being just purely hollow. But when we talk about the stomach, for instance, that's just a big holding sack, right? That's just an empty organ that is meant to expand to hold food. So if I percuss over the stomach, I expect to hear this high-pitched booming sound like a drum, like I go beating on a timpani drum.

All right. That is it for our review of percussion findings associated with the chest, the abdomen, and other structures. But now I'm going to give you some quiz questions to test your knowledge of key facts I provided in this video. The nurse anticipates hearing tympany when percussing over what structure or organ? Over hollow organs, such as the stomach or bowels. What is the expected finding when percussing over healthy lungs? Resonance. When percussing over the chest of a patient with a pneumothorax, what does the nurse expect to hear over the affected area? Hyper-resonance. Flatness is the expected finding when percussing over which structure or organ? Over muscles and bone.

All right. That is it for this video. I hope you found this review useful. I'll see you in the next one. Thanks so much, and happy studying.