The scratch test. The resource poor mans ultrasound.

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Palpation of the belly for pathology is a fine art.

One tool for outlining the solid organs of the belly or detecting large amounts of blood vs air is the scratch test.

It works because sound transmits differently through solid vs hollow objects.

Equipment:

a stethoscope, The better the quality the better the “resolution” especially if you have post deployment hearing…….

a pen, I prefer a sharpie but a ball point works fine most days

a  fingernail.

Try this at home on your self or a family member in 3 easy steps.

1) Take the scope and place it just below the right rib cage on the mid clavicular line for starters. This is right over the liver…. on a good day.

2) Next begin using that high tech fingernail to scratch the skin surrounding the stethoscope. Listen for the initial change in sound volume.

3) Mark with the pen where the sound volume changes.

Hey! it is shaped like the liver! A dense blood filled object.

A normal adult liver should be about 7cm tall at the mid clavicular line.

You will hear the bone if you place it over the rib, this is not helpful.

This test can also detect an enlarged spleen. Normal is not detectable below the left costal margin.

A large hemoperitineum can be detected as well as a large stool.

The test is not needed to detect common autologus cranio rectal transplantation as that malady is self evident when the patient speaks.

Good luck and hope this test works as well for you as well as it has for me in austere settings.

Further references:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3598244/

http://depts.washington.edu/physdx/liver/tech.html

 

8 responses to “The scratch test. The resource poor mans ultrasound.

  1. Pingback: Hogwarts: The Scratch Test – Improvised ‘Ultrasound’ | Western Rifle Shooters Association·

  2. A lot of old school diagnostic art is being lost because of technology. (technology is almost always better) but it is a valuable tool. Thanks! I am really interested in this and any other physical exam tricks you can post or links to resources. (oh by the way thank you for including sources in your posts)

    Liked by 1 person

  3. Was an anesthetist for 3+ decades, always noticed that generally, the foreign med grads who came to the states appeared much more adept at clinical diagnosis w/o the use of the higher tech available. They would say something to the effect of ” it looks like this is…..”, and later it was confirmed by the Science Fiction Theater model 3000ZZ+ Image Processor, all because they didn’t have that stuff back in their country of Oz, as their education was more down to earth. I mean think about it. Back in the 1700’s, as an example, Auenbrugger discovered chest percussion to ascertain the existence and extent of pleural effusion (fluid on the lungs) . He used his hands, placed on the patients back, hitting his knuckle with the finger of the other hand, and listen to the sound it produced. LOL, original rapper. He made the connection from his father, an innkeeper, who would rap the casks of wine or beer to discover the level of the fluid contents, or so the story goes. There are many similar anecdotal references in medicine. Like all things in life, keen observation is of paramount importance.

    Liked by 1 person

    • I tend to agree. There was an emphasis on physical exam in medical school, but once you hit the reality of the wards in America, it all fell away because the advanced techniques were more accurate. Obviously that doesn’t apply in a grid-down situation (although I do hope to find a grid-down method of powering an ultrasound!) and physical exam becomes paramount.

      Like

    • Thread drift———
      Would be interested to hear your feedback on anesthesia.

      Lidocaine / marcaine while supplies last for local or regional blocks. Wish I could find powder for shelf life stability.

      I use scopalamine for RSI in the field due to shelf and temp stable and low cost.
      Used to be able to get powdered succ.

      I use Ketamine for procedures for the same reasons and safety profile as well. I also use it with narcotics for complex extractions and rough evac as well in very injured patients.

      I also have old Ether drawover for inhaled anesthetic.
      di-ethyl Ether can be purchased easily or made from ETOH and sulfuric acid. Only to be used in a well ventilated OR and exaust vented outside.

      last ditch I have everclear or Vodka that can be run IV or PO for sedation in hemodynamicly stable patients.

      Like

      • @pa4ortho,
        I have been looking for an EMO drawover anesthesia vaporizer for sometime. Uses ether or halothane if available. They are still used in third world countries out in the boonies. May I ask what type of vaporizer you have and where you procured it? As to my feedback on your items, looks fairly comprehensive. I think ketamine is a particularly useful drug either as an anesthetic or for analgesia. Developed for use in the army as a battlefield anesthetic. Good, as it maintains the airway, is IV route so easily administered. Some downside as increases BP and HR, not so good for folks with hypertension. Also increases intracranial pressure which isn’t good in certain circumstances. Lidocaine and marcaine are wonderful to have.
        Great for regional anesthesia if the drugs are known to be sterile, and you know how to administer a block. I will post a link later about making your own lido. Not sure why you had succinylcholine, in the wrong hands w/o experience, disaster can easily result once the breathing stops and you have marginal or no airway management skills. And of course
        good old ETOH, I prefer mine shaken not stirred. As to other things, might consider laryngeal mask airways in variety of sizes, ambu bag with assorted mask sizes, oral and nasopharyngeal airways, and if you know how laryngoscope, blades and endotracheal tubes. Whew! Enough for now. TTYL.

        Liked by 1 person

  4. A reference for making Lidocaine.

    Original article from the website, ” ModernSurvivalOnline ” created by
    John Rourke. I am giving him full credit for this information, and the original autjhor, RalphP. I am in the process of contacting him for permission. If he declines, I will inform Doc Grouch and Ivy Mike to remove the information. I cannot attest to the information I linked to, and of course deny any responsibility for anything at all concerning it. The link is provided for your complete review, and the reader assumes all responsibility for any use of said information and what they decide to do with said information.

    http://modernsurvivalonline.com/how-to-make-injectable-lidocaine-hcl/

    When in doubt, consult your physician, or a higher authority.

    Liked by 1 person

    • You have my permission if it matters, although I do believe ModernSurvivalOnline owns the copyright on it now.

      I’d appreciate reading any thoughts anyone has on it, and particularly from professionals in the medical or pharmaceutical professions.

      And for pa4ortho, Lidocaine HCL (USP) in powder/crystalline form is available here if you can’t find it cheaper somewhere else: http://www.sciencelab.com/page/S/PVAR/10419/SLL1060

      Like

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