We’re ensuring the size of the cuff is appropriate for his arm. Wrong sized cuffs can affect the blood pressure. We explain it a little more in the video “understanding blood pressure” ua-cam.com/video/rLEbOjWgmvE/v-deo.html 😊
I took and failed/passed anatomy classes for a degree I have never used in my life (shows you how much i hate that degree) now i am back in school for something i have passion for but we had to learn how draw anatomy which i hissed on 😂 anyway I agree with you though. ASMR is better than learning anatomy in science classes.
@@DrJamesGill I don't know why but whenever I am reading your comments or replies I always imagine you doing the Basil Rathbone voice from Sherlock Holmes movies. Your voice has so much similarity, just if you add the sharp sophistication which Rathbone did.
Dr Gill, since the birth of my children I’ve not slept well only averaging around 4 hours per night and taking forever to finally fall asleep. I now play your videos every night and the soothing tones of your voice coupled with the interesting subject matter get me off to sleep within 30 mins. I don’t mean that in a bad way, your not boring me just relaxing my mind and putting me at ease. I can’t thank you enough.
Pressing on your stomach is a way to find out if the size of your internal organs is normal, to check if anything hurts, and to feel if anything unusual is going on. Looking, listening, and feeling are all part of a physical exam.👍
I used to think I was weird as a kid cos I loved when the nit nurse used to come to school and check our hair for lice . The sensation is now known as ASMR and everyone loves it. Happy days . Great vid
This reminded me of the type i had a tumor in my ovary for over a year. STORY: I went to my dr to get checked since I was gaining weight fast, wasn't pooping, and looked pregnant. (I was in 8th grade). They did blood work, I took a pregnancy test, and my dr did an abdominal check. She felt something so she sent me to a small local hospital. There they did xrays, an ultrasound, and another pregnancy test. They ended up telling me that I had poop stuck in there and so they gave me medication to help me. Months passed and the pain got worse. It was so bad I couldn't get out of bed and 3 500mg pain killers did nothing. I went to me dr again and she did an abdominal check again. She told she didn't think it was poop and that i needed to go to bigger hospital ASAP. I was scared so I waited a month. In that month I couldn't even get out of bed. On the day I finally went, the hospital run xrays, an ultrasound, pregnancy test, and did some more blood work. Within 4 to 5 hours a dr came in and said, "yeah, your going to need emergency surgery. We don't know what it is. And whatever it is, it has taken over your entire ovary. So yeah your getting surgery tomorrow at 7am." When I got out of surgery he told me things were a bit complicated so he had to basically do a c section. He said that I had a tumor the size of a melon in my ovary and that my ovary was literally about to rip. He couldn't save my ovary but the good thing is that he took it out when he did since he said it could of caused cancer if it erupted. What was funny about his visit is that he brought in the tumor in a container that had some liquid. IT WEIGHTED 5 POUNDS! I was as fascinated as he was when I saw it. His eyes lit up like Christmas lights when he saw it. 😂 For years I didnt know what caused it but finally, fast forward to today, 26 years old now. I just found out that I have PCOS... which *drumroll* causes tumors to grow in your ovary. Point of the story, GET YOUR ABDOMIN CHECKED!
@@DrJamesGill That implies that enough of the herd will take the vaccine. Not sure how it is for you guys in England, but here in the US half the population is INSANE.
@@DrJamesGill OMG A LEGEND HAS ANSWERED ME!!! Wish I were but although I have been learning from your videos I mostly use them to relax because ASMR haha You’re awesome! Both as an instructor and as a asmrtist Saludos!
We’re checking the size of the cuff, against the size of the arm. If the cuff is too small, then it will mean the blood pressure is artificially elevated
Excellent video. It really helped me in my OSCE. Couple of things that were needed in my station and not here were: 1- Inspection & palpation of the testicles for testicular atrophy (Cirrhosis) 2- Per Rectal Examination Thank you very much for the video Doctor
They are mentioned at the end of the video as things which are often required to “complete” the exam. However more often than not for osce purposws they are considered separate exams - certainly in the two Med schools around here
Actually, Dr. Gill videos are for educational purposes. For Warwick students, and others with diverse interests in health. Of course there we are, the asmr fans. This man deserves all the good things in life. 🤍
Have to hand it to you; you are the only channel that I can watch and not fall asleep because I am too immersed in watching the examinations and explanations despite not being a medical student. I never would have thought that I enjoy watching an examination, but dislike being in one. The more you know 😅
Any1 else get proper buzzing when dr gill uploads a vid? I instantly know I’m going to drift into a deep sleep tonight. Also. I’m pretty sure I’ve become a qualified doctor as a sideline of asmr.
Great video, I’ve been watching this as a registered nurse to review some of my assessment skills I haven’t used in a while. One thing I noticed that was different from what I’ve been taught though is the order you assessed in. We were always taught to inspect, auscultate, percuss, and then palpate on an abdomen inspection since palpating May cause the bowels to produce some slight sounds that wouldn’t be there otherwise. Just wanted to throw that out there to highlight some of the difference in technique! Thank you for the videos they’re much appreciated!
I'm not sure why some countries approach it differently. I've tried to address that fact in the Abdo exam explanation ua-cam.com/video/pEKWIMBpKRs/v-deo.html
I would love to have Dr. Gill as my physician. He’d make me feel so comfortable I’m already nervous doing physical exams and so shy. I love his accent too!
Listening for changes on resonance. So for example a obstruction would sound dull. We discuss it in the abdo deep dive video 😊 ua-cam.com/video/pEKWIMBpKRs/v-deo.html
Just a heads up, at the end there's a list of possible abnormal findings, which isn't legible due to a suggested playlist. This might be something you'd want to solve, or not.
We’re ensuring it is the right size of the patient so as not to cause an incorrect BP reading You can see more about it in our understanding the BP video ua-cam.com/video/rLEbOjWgmvE/v-deo.html
Hey Dr. Gill. It seems that in UK-based videos, the auscultation is done after the palpation and percussion, but in American-based videos, the auscultation is specifically done prior to the palpation and percussion, typically citing that it must be done in that order as the palpation and/or percussion could artificially alter the bowel sounds. I'm curious why this big difference seems to exist.
I’m honestly not sure. But given it’s my main academic subject, I did try to look at the literature, and as mentioned in the video auscultation is quite a weak sign in terms of assisting with the diagnosis. So doesn’t really matter I thin
As mentioned, it appears to be a conserved flaw in methodology. There is I) not evidence it has to be last ii) evidence is a really poor clinical skill - 50% of consultant reviews for obstruction based on BS were not borne out on scan
@@DrJamesGill thank you!! It’s interesting to follow up on the evidence behind these practices. Thank you for explaining, your channel has been invaluable!! 🙏
Imagine Dr. Gill doing the Glengarry Glen Ross speech. "ABC. Always. Be. Checking for lumps and bumps." "If you'd be so kind to put that coffee down? Splendid. "
Hi, Dr. Gill! I've been watching your content for years, but I've always been meaning to ask this. Why do so many of your videos start with a hand examination, irrespective of the primary area of the body being examined?
Why does he always check their hands at the beginning of so many of these examinations? I’m especially curious about putting the fingers together thing
There are a lot of things seen in the hands that can suggest underlying pathology We explain it in the abdo video ua-cam.com/video/pEKWIMBpKRs/v-deo.html
Dr. Gill, may I ask why you both palpated and percussed his abdomen before auscultating? For the abdomen you should always listen first so as not to alter bowel sounds with physical manipulation. I’m surprised that your video shows the incorrect order, there will be those that will learn this way from your video and it may be detrimental to their education.
I’m sorry, but you are incorrect there The order for medical examination is “Inspection, palpation, percussion, auscultation” The reason being that the auscultation is the weakest of the four areas I’ve heard previously that people incorrectly argue that auscultation should be done earlier as there was a thought auscultation could be affected by the other parts of the examination. The evidence, and the waiting of auscultations actually so weak that it’s the other way round, that information earlier can incorrectly sway a differential. For example only 25% of obstruction has the classically discussed “tinkling bowel sounds” Similarly, even the duration that an examiner listens for bowel sounds is now debated, with some research suggested lack of bowel sounds can be normal even as long as four minutes As Elizabeth mentioned, even in clinical skills the science evolves. Such as - during an English spoken exam - the change from having the patient say “ninety nine” to a correct diphthong. I don’t have the references to hand currently, but will come back later with a few papers showing the low quality of auscultation as a sign generally - which is why it is placed last 😊
I respectfully disagree but look forward to the References you intend to provide to support your claim. No one in the medical field would disagree that the order for physical examination is “Inspect, Palpate, Percuss, Auscultate” EXCEPT in the case of the abdominal exam. To assert that simply because auscultation is not as diagnostically beneficial as palpation that is a reason to ignore that physical manipulation of the abdomen can alter the bowel contents and disrupt potential findings seems to me, quite absurd. With that attitude why Auscultate at all? You are completing each in quick succession, palpating first allows no extra benefit while potentially hindering the effectiveness of auscultation.
Ok. Bowel sounds, As mentioned, may be absent for up to 4 mins in normal people, many textbooks, advocate for leashing for “at least 1 min” There is little evidence it support that the presence of normal bowel sounds ruled out an obstruction - First is a book refer - evidence based physical diagnosis - elsevier 2007 One study has only 24% of people with confirmed bowel obstruction having absent bowel sounds Another has little correlation between auscultation and clinical condition. Abnormal bowels sounds only being correctly identified 26% of the time, and the paper stresses clinical decisions should NOT be made on basis of auscultation Here is one you can read online www.ncbi.nlm.nih.gov/pmc/articles/PMC4566372/ Use of bowel sounds in diagnostic is very poor, if you look at the studies - Felder et al shows a sensitivity of only 22% for SBO pubmed.ncbi.nlm.nih.gov/24776861/ Bowel sounds only have a benefit it they are heard in that they may exclude pathology - which as we’ve seen is weak, the ppv of abnormal bowel sounds is 12.1% a strongly pushing the sign aside in terms of diagnostic relevance If we look at the causes of altered bowel sounds - Mechanical obstruction - so hernia, cancer, adhesions, volvulus - we get sounds due to the lack of normal oscillatory movement of the bowel contents - smooth muscle will itself begin to shut down with prolonged obstruction stopping peristalsis. - keeping auscultation last - as indicated in MacLeods clinical examination - will not affect this absence Infection Essentially inflammation of the smooth muscle stopping peristalsis - again no effect Ileus - post operatively We don’t KNOW why the bowel shuts down here, but again we think it is due to smooth muscle inflammation after manipulation. We can get an ileus with hypOkalaemia, reducing muscle activity due to hyperpolarisation of muscle cells - which again is not affected by palpation first - more than my own opinion. MacLeods clinical examination - one of the core textbooks for the U.K. and most of the medical world, maintains the standard - inspection, percussion, palpation and auscultation. The fact that that text book is held in such high regard, is currently on it’s 8th edition, and is edited by clinicians I can only ever dream of being at the same level of is enough for me to keep the current practice as taught in the U.K.
“...one of the core textbooks for the U.K. and most of the medical world, maintains the standard - inspection, percussion, palpation and auscultation.” Then why did you palpate before percussing in this video?
I’ve noticed in many of your videos, which I’ve re-watched many a time, that when you check the blood flow in the fingernails, you choose the ring finger. Any particular reason why?
Dr. Gill, I had always understood that auscultation of the abdomen should be done before palpation because palpation may change what you hear. Is that not correct?
We’ve discussed in the clinical deep dive on the abdo, but there is no research evidence to support auscultation first, and there is also plenty of evidence to suggest auscultation is a very weak clinical sign anyway
Percussion is looking for changes in tone. For example, dullness might indicate constipation or a tumour (there would be other info to help you guide from one to the other, that’s just a crude example )
We gather information from lots of areas about a single system. So very simply low blood pressure after an accident and blow to the abdomen may indicate internal bleeding.
The first pass around is checking for pain. The second is a deeper palpating to see if you can detect any masses, so you literally have to push with more force
Dr Gill, I was wondering why do you ask the patient to do that with their fingers at 1:18. I've seen many videos where doctors do this and I'm curious.
Hi Dr Gill, I'm currently a second year medical student approaching her ISCEs and I was wondering whether I was able to check something. On palpating the liver borders, we have been taught to both palpate both the upper and lower border, to assess if there is a case of hepatomegaly or whether the liver is being displaced (therefore the upper border would/may become palpable on inspiration). Thank you!
I’ll double check, but I’m not sure how easy it is to PALPATE for the upper border Certainly you’ll PERCUSS for the change in tone, to delineate the upper and lower border however I’m very clear that I use MacLeods as a reference text - but for ease this discussion, here is a link to University of Washington, where they are also palpating the lower border, but percussing for both depts.washington.edu/physdx/liver/tech.html
@@DrJamesGill That's great, thank you so much!! Your videos have been a lifesaver seeing as my entire med school experience thus far has been online and zoom haha!
Nice approach doctor , but do you think u must auscultate before you palpate ned percuss the patient's abdomen ? It may be sound wired to jump right away to auscultation , but I guess u know why?
Ik u probably have a video about this but could you explain that first minute of the video where ur asking him to do things with his hands I don't get how its relevant
@@DrJamesGill probably shouldn't have said anything! Really though, i probably only spotted them as I edit for work. But hopefully helps moving forward, always easy to miss the single frames. Keep up the good work though, the edits are great.
In the same way that “ninety nine” was previously taught for vocal resonance, I feel that the direction to auscultate first is similarly outdated. We address the point in the abdominal deep dive video and touch on the lack of evidence to support auscultation being first ua-cam.com/video/pEKWIMBpKRs/v-deo.html
Quick question; why did you start with palpation before auscultating and percussion? I have always been taught auscultation first, then percussion, and then palpation... in order to avoid potential changes you will make in hearing bowel sounds and tympani; from the applied pressure of palpation to the abdominal organs.
I find myself quite curious. Perhaps this has been explained and I'm just a bit dull, but what does the tapping on the abdomen signify? I've seen multiple exam videos that do this, and I'm not sure why.
percussion allows us to assess for dull areas - masses/faeces. loud, or resonant areas allow us to look for blockages, and gas buildup as two simple examples. we’ll go through this more with the Deep Dive abdo explanation video
There isn’t evidence to support that. I specific address the point in the Understanding the Examination video The link is here 😊 ua-cam.com/video/pEKWIMBpKRs/v-deo.html
What is the reason for checking the hands during an abdominal exam? What abnormalities would you be looking for, and what would those abnormalities indicate?
Thanks. Yes that is correct. We discuss that point in the video about understanding the blood pressure assessment ua-cam.com/video/rLEbOjWgmvE/v-deo.html
Not according to Macleod Clinical Examination textbook. A few people have raised the point, but the literature searches I have done not support an alternative approach. I wonder if these is USA / Europe divide. In the same way we perform prostate checks with the patient lying down, but I believe it is different in the USA
My tummy growls a lot and very constantly, I even feel the growls rumbling inside my tummy, that is, I feel the movements of my intestines in my tummy sometimes, what should it be?? It is normal??
With not being able to check the teeth and tongue; now that we've got Lateral Flow tests would you be able to do a video that explains that, and then repeat this video (with negative tests) to show the mouth part of the examination?
Hi dr Gill. At 1:42 you are checking something... but what? Looks like you are checking if the blue matches his skin tone?
We’re ensuring the size of the cuff is appropriate for his arm.
Wrong sized cuffs can affect the blood pressure. We explain it a little more in the video “understanding blood pressure”
ua-cam.com/video/rLEbOjWgmvE/v-deo.html
😊
For patients who are Smurfs, you often need to opt for a differently colored cuff.
🤣🤣🤣
@@meltee01 Or if they’re cosplaying as someone from the X-Men! 😂
He's so kind to answer it. Loved it
This man has fully accepted his role in the asmr community without even batting an eye. We love a multifaceted king
ASMR has taught me more about medicine and anatomy than 7 years of science classes in school ever did
The internet can be quite surprising
I took and failed/passed anatomy classes for a degree I have never used in my life (shows you how much i hate that degree) now i am back in school for something i have passion for but we had to learn how draw anatomy which i hissed on 😂 anyway I agree with you though. ASMR is better than learning anatomy in science classes.
What are yous studying now?
@@DrJamesGill I don't know why but whenever I am reading your comments or replies I always imagine you doing the Basil Rathbone voice from Sherlock Holmes movies. Your voice has so much similarity, just if you add the sharp sophistication which Rathbone did.
@@jassinghchaney6141 it’s pretty cool how he interacts with the fans. One of the few ‘celebrities’ on UA-cam that actually do. Much respect!
One day I think we should get a full head to toe cranial nerve assessment
agree💫💫💫
Not sure if brilliant joke or mild confusion
Head to toe cranial nerve haha. Cranial nerves are the one directly connected to the brain in the head. Head to toe would just be a physical exam
Oh baby yes
Please signed me up!
Dr Gill, since the birth of my children I’ve not slept well only averaging around 4 hours per night and taking forever to finally fall asleep. I now play your videos every night and the soothing tones of your voice coupled with the interesting subject matter get me off to sleep within 30 mins. I don’t mean that in a bad way, your not boring me just relaxing my mind and putting me at ease. I can’t thank you enough.
Omg. You are just like me. I have been listening to him to relax and eventually sleep.
@@alizay3026you recently had a kid too?
@@iloveyouskii no dear. 🙂
“Hello there I’m Dr Gill, open the cash register and give me all your money”
Nope. Doesn’t work 😔
“Let me putapitapaper” would allow the register to be opened
**cashier hands over bag of money** "That's lovely thank you." ;)
🤣🤣🤣
@@89horizon Any double vision!
Pressing on your stomach is a way to find out if the size of your internal organs is normal, to check if anything hurts, and to feel if anything unusual is going on. Looking, listening, and feeling are all part of a physical exam.👍
Why so deep though 😟
Yeah well these virtual appointments cannot tell most of that.
@@preppy_robloxlifeBecause everyone likes it deep.
I used to think I was weird as a kid cos I loved when the nit nurse used to come to school and check our hair for lice . The sensation is now known as ASMR and everyone loves it. Happy days . Great vid
Ha! Not just me then 😀
Yes!
The doctor always asks how the patient is doing. But I want to know how the doctor is doing. So.
How are you Dr. Gill?
Considering all things. Could be worse! Thanks for asking 😊
Hope you’re still doing good Doc. We care about your well being
Thanks guys. We’re ticking along. Trying to keep smiling 😊
Dr James Gill How is kitty doing??
"Going to check your liver"
Me: "During Quarantine? uhh......... uuuuuuuuuuuhhh....... how bout next year?"
Hahaaaa I relate to this 😆
Same here👍👍🤣
😂
😂😂😂😂😂
ok
1:09 “Can you please do the Macarena”
Well with the mask the patient don't have to worry about sandwich breath
these r my fave comments
Someone please do a "in and out" 1hour loop....it really make me relax 😂
I’ll take that with an “any double vision” loop
OMFG I definitely would "second" that! :D
And putapitofpaper
Yes pleaseeeee
I don’t know if this works for you guys, but know UA-cam lets you to repeat indefinitely the video ❤️
I like the patient's body and he's very laidback
This patient obviously works hard. The Palms of his hands tell the tale.
He a climber
@@LekiCurbsYou oh right. Thanks mate. 👍
@@LekiCurbsYou How'd you know? Do you have his Instagram?
@@spencerschmidt75 I'd quite like to know too. Who is the patient in the video
@@benjaminn8534 Yup. It's been months but haven't found it yet
This reminded me of the type i had a tumor in my ovary for over a year.
STORY: I went to my dr to get checked since I was gaining weight fast, wasn't pooping, and looked pregnant. (I was in 8th grade). They did blood work, I took a pregnancy test, and my dr did an abdominal check. She felt something so she sent me to a small local hospital. There they did xrays, an ultrasound, and another pregnancy test. They ended up telling me that I had poop stuck in there and so they gave me medication to help me. Months passed and the pain got worse. It was so bad I couldn't get out of bed and 3 500mg pain killers did nothing. I went to me dr again and she did an abdominal check again. She told she didn't think it was poop and that i needed to go to bigger hospital ASAP. I was scared so I waited a month. In that month I couldn't even get out of bed. On the day I finally went, the hospital run xrays, an ultrasound, pregnancy test, and did some more blood work. Within 4 to 5 hours a dr came in and said, "yeah, your going to need emergency surgery. We don't know what it is. And whatever it is, it has taken over your entire ovary. So yeah your getting surgery tomorrow at 7am." When I got out of surgery he told me things were a bit complicated so he had to basically do a c section. He said that I had a tumor the size of a melon in my ovary and that my ovary was literally about to rip. He couldn't save my ovary but the good thing is that he took it out when he did since he said it could of caused cancer if it erupted. What was funny about his visit is that he brought in the tumor in a container that had some liquid. IT WEIGHTED 5 POUNDS! I was as fascinated as he was when I saw it. His eyes lit up like Christmas lights when he saw it. 😂
For years I didnt know what caused it but finally, fast forward to today, 26 years old now. I just found out that I have PCOS... which *drumroll* causes tumors to grow in your ovary.
Point of the story, GET YOUR ABDOMIN CHECKED!
You poor thing.
It’s shocking how they miss so many womens issues
Imagine in 20 years someone will find out this video and will think: Why those ppl are wearing masks?
Wouldn’t it be lovely in 20yrs if we’re that far past it!
Imagine they are saying: "Damn they already wore them 20 years ago"
Who says we won't still be wearing masks in 20 years?
I think it’s unlikely. Partially due to cultural reasons.
I think once the covid 19 vaccines are being widely administered I think use will reduce
@@DrJamesGill That implies that enough of the herd will take the vaccine. Not sure how it is for you guys in England, but here in the US half the population is INSANE.
"Hello MyNamesDr Gill"
Me: well hello sleep :d!
Are you SURE you are not one of my students?? 😂😂
@@DrJamesGill haha we all wish we were
@@DrJamesGill OMG A LEGEND HAS ANSWERED ME!!! Wish I were but although I have been learning from your videos I mostly use them to relax because ASMR haha You’re awesome! Both as an instructor and as a asmrtist Saludos!
@@emmanuelk.4520 aint that the truth 😊
Much love for that thorough and aggressive hand sanitizer use !
1:42 "Ah yes. He is not blue. Perfect."
Anyone knows why he did that?
We’re checking the size of the cuff, against the size of the arm.
If the cuff is too small, then it will mean the blood pressure is artificially elevated
Excellent video. It really helped me in my OSCE.
Couple of things that were needed in my station and not here were:
1- Inspection & palpation of the testicles for testicular atrophy (Cirrhosis)
2- Per Rectal Examination
Thank you very much for the video Doctor
Reference: Clinical Examination by Nicholas And Simon
They are mentioned at the end of the video as things which are often required to “complete” the exam.
However more often than not for osce purposws they are considered separate exams - certainly in the two Med schools around here
Cannot wait until this video goes viral so glad thar Dr gill is bringing another Asmr video for us
Actually, Dr. Gill videos are for educational purposes. For Warwick students, and others with diverse interests in health. Of course there we are, the asmr fans.
This man deserves all the good things in life. 🤍
ive had enough "going viral" this year
@@La_sagne valid Point
The asmr is what YOU take away from this
It isn't his intent
Have to hand it to you; you are the only channel that I can watch and not fall asleep because I am too immersed in watching the examinations and explanations despite not being a medical student.
I never would have thought that I enjoy watching an examination, but dislike being in one. The more you know 😅
Any1 else get proper buzzing when dr gill uploads a vid? I instantly know I’m going to drift into a deep sleep tonight. Also. I’m pretty sure I’ve become a qualified doctor as a sideline of asmr.
Always been curious about the tapping technique. What kind of reaction does it cause and what is James feeling for?
Listening for dullness - obstructions of some form, and hyper resonance which might also be associated,
นำ ำทยีา
Dr Gill:
Patient: But are you gonna putapitapaper?
Not in an abdo exam
@@DrJamesGill When the man himself responds. I am humbled sir.
Great video, I’ve been watching this as a registered nurse to review some of my assessment skills I haven’t used in a while. One thing I noticed that was different from what I’ve been taught though is the order you assessed in. We were always taught to inspect, auscultate, percuss, and then palpate on an abdomen inspection since palpating May cause the bowels to produce some slight sounds that wouldn’t be there otherwise. Just wanted to throw that out there to highlight some of the difference in technique! Thank you for the videos they’re much appreciated!
I'm not sure why some countries approach it differently. I've tried to address that fact in the Abdo exam explanation
ua-cam.com/video/pEKWIMBpKRs/v-deo.html
Nice! The mask didnt hurt the audio quality at all
Awesome video Doc :)
👍
I would love to have Dr. Gill as my physician. He’d make me feel so comfortable I’m already nervous doing physical exams and so shy. I love his accent too!
OMG my favourite exam. And I’m Not even a doctor. Just love it!
Could you imagine Dr. Gill and Hollie doing a video together... the medical ASMR world would implode
That would be my dream come true...💥
Okay stupid question, but what is the point of the tapping on the fingers across the tummy?
Listening for changes on resonance. So for example a obstruction would sound dull.
We discuss it in the abdo deep dive video 😊
ua-cam.com/video/pEKWIMBpKRs/v-deo.html
@@DrJamesGill thank you! ☺️
Just a heads up, at the end there's a list of possible abnormal findings, which isn't legible due to a suggested playlist.
This might be something you'd want to solve, or not.
Thanks I’ll tweak that shortly 😊
3:27 doc be wearin his watch everyday holy fahk the hair is gone and the tan line strong 🤣🤭
i had an examination today and i was so stressed before but after watching this i was all good!
the video- *a detailed professional examination by a doctor for informational purposes*
the people who watch it- *unintentional asmr and memes*
If people are learning, I’m happy 😊
I've been watching your videos for like 3 years now and I've just realized, how do you get all these different camera angles?
We re film MANY times. I think the abdo film took us about 3 hours
@@DrJamesGill you re-film each time??? You don’t just have multiple cameras???
The lord of the ASMR kingdom is back! Thanks for another great video Dr.!
More to come!
I just love these relaxing videos and the sound of his voice
Musn't the deep palpation of the liver and spleen be continuous instead of lifting the hand?
Not really no, you lift off to move forwards
Did I go to medical school
No. Have I watched all of these a thousand times
Yes
I really want to know how you check the organs when you tap your finger on them. What kind of sound you want to hear and what should alarm you?
What is it that you are looking for when you hold the end of the cuff against the patients arm at 1:43?
We’re ensuring it is the right size of the patient so as not to cause an incorrect BP reading
You can see more about it in our understanding the BP video
ua-cam.com/video/rLEbOjWgmvE/v-deo.html
Hey Dr. Gill. It seems that in UK-based videos, the auscultation is done after the palpation and percussion, but in American-based videos, the auscultation is specifically done prior to the palpation and percussion, typically citing that it must be done in that order as the palpation and/or percussion could artificially alter the bowel sounds. I'm curious why this big difference seems to exist.
I’m honestly not sure. But given it’s my main academic subject, I did try to look at the literature, and as mentioned in the video auscultation is quite a weak sign in terms of assisting with the diagnosis. So doesn’t really matter I thin
Same here in Australia. I’m a nurse educator and auscultating last is a no-no here.
As mentioned, it appears to be a conserved flaw in methodology. There is I) not evidence it has to be last ii) evidence is a really poor clinical skill - 50% of consultant reviews for obstruction based on BS were not borne out on scan
@@DrJamesGill thank you!! It’s interesting to follow up on the evidence behind these practices. Thank you for explaining, your channel has been invaluable!! 🙏
Glad it’s been useful 😊
1:18 what are you checking for when you ask the patient to put their fingernails together??
clubbing, take a look here 😊
studio.ua-cam.com/users/videopEKWIMBpKRs
Wish I had a doctor this good, really bad waistline pain while sat at desk. Have to undo trousers.. just flares up for weeks at time
It would definitely be worth while talking to your doctor. There are a couple of things, which you could easily be helped with 😊
Imagine Dr. Gill doing the Glengarry Glen Ross speech.
"ABC. Always. Be. Checking for lumps and bumps."
"If you'd be so kind to put that coffee down? Splendid. "
No...
ABC is Airway, Breathing, Circulation,
Plus you can extend it:
ABC...DEFG - Don’t Ever Forget Glucose
@@DrJamesGill thank you
👍
I love these blogs! My fave is the woman with the pink sweater and the first man Aiden.
Μου αρεσουν πολλυ τα βιντεοσας ειστε πολλυ καλος σας θαυμαζω σαν ανθρωπο και σαν επιστημονα και την ευγνειασας
I feel sorry for anybody working a job constantly putting sanitizer on their hands. I think that stuff is bad for your skin
It can dry your hands, but as long as you use a moisturiser too, it’s not a problem
@@DrJamesGill any recommendations for a good moisturizer?
@@DrJamesGill too inconvenient
One practice I know has the moisturiser next to the sanitiser.
I’d recommend Dermol is it is antiMICROBIAL, so won’t undo the sanitiser
I felt like the Hand sanitizer bit was a bit too sexual... Like the Alan Partridge demo 😳
How do you select the students that go into these videos?
Just ask who wants to help
@@DrJamesGill I want to help
Hi, Dr. Gill! I've been watching your content for years, but I've always been meaning to ask this. Why do so many of your videos start with a hand examination, irrespective of the primary area of the body being examined?
That hands can demonstrate a cornucopia of signs which can relate to other systems i the body
Why does he always check their hands at the beginning of so many of these examinations? I’m especially curious about putting the fingers together thing
There are a lot of things seen in the hands that can suggest underlying pathology
We explain it in the abdo video
ua-cam.com/video/pEKWIMBpKRs/v-deo.html
Dr. Gill, may I ask why you both palpated and percussed his abdomen before auscultating? For the abdomen you should always listen first so as not to alter bowel sounds with physical manipulation. I’m surprised that your video shows the incorrect order, there will be those that will learn this way from your video and it may be detrimental to their education.
I was thinking the same, but maybe... is there something that we are mising? 🤔 Maybe there is new evidence...?
I’m sorry, but you are incorrect there
The order for medical examination is “Inspection, palpation, percussion, auscultation”
The reason being that the auscultation is the weakest of the four areas
I’ve heard previously that people incorrectly argue that auscultation should be done earlier as there was a thought auscultation could be affected by the other parts of the examination.
The evidence, and the waiting of auscultations actually so weak that it’s the other way round, that information earlier can incorrectly sway a differential. For example only 25% of obstruction has the classically discussed “tinkling bowel sounds”
Similarly, even the duration that an examiner listens for bowel sounds is now debated, with some research suggested lack of bowel sounds can be normal even as long as four minutes
As Elizabeth mentioned, even in clinical skills the science evolves. Such as - during an English spoken exam - the change from having the patient say “ninety nine” to a correct diphthong.
I don’t have the references to hand currently, but will come back later with a few papers showing the low quality of auscultation as a sign generally - which is why it is placed last
😊
I respectfully disagree but look forward to the References you intend to provide to support your claim. No one in the medical field would disagree that the order for physical examination is “Inspect, Palpate, Percuss, Auscultate” EXCEPT in the case of the abdominal exam. To assert that simply because auscultation is not as diagnostically beneficial as palpation that is a reason to ignore that physical manipulation of the abdomen can alter the bowel contents and disrupt potential findings seems to me, quite absurd. With that attitude why Auscultate at all? You are completing each in quick succession, palpating first allows no extra benefit while potentially hindering the effectiveness of auscultation.
Ok. Bowel sounds,
As mentioned, may be absent for up to 4 mins in normal people, many textbooks, advocate for leashing for “at least 1 min”
There is little evidence it support that the presence of normal bowel sounds ruled out an obstruction -
First is a book refer - evidence based physical diagnosis - elsevier 2007
One study has only 24% of people with confirmed bowel obstruction having absent bowel sounds
Another has little correlation between auscultation and clinical condition. Abnormal bowels sounds only being correctly identified 26% of the time, and the paper stresses clinical decisions should NOT be made on basis of auscultation
Here is one you can read online
www.ncbi.nlm.nih.gov/pmc/articles/PMC4566372/
Use of bowel sounds in diagnostic is very poor, if you look at the studies - Felder et al shows a sensitivity of only 22% for SBO
pubmed.ncbi.nlm.nih.gov/24776861/
Bowel sounds only have a benefit it they are heard in that they may exclude pathology - which as we’ve seen is weak, the ppv of abnormal bowel sounds is 12.1% a strongly pushing the sign aside in terms of diagnostic relevance
If we look at the causes of altered bowel sounds -
Mechanical obstruction - so hernia, cancer, adhesions, volvulus - we get sounds due to the lack of normal oscillatory movement of the bowel contents - smooth muscle will itself begin to shut down with prolonged obstruction stopping peristalsis.
- keeping auscultation last - as indicated in MacLeods clinical examination - will not affect this absence
Infection
Essentially inflammation of the smooth muscle stopping peristalsis - again no effect
Ileus - post operatively
We don’t KNOW why the bowel shuts down here, but again we think it is due to smooth muscle inflammation after manipulation.
We can get an ileus with hypOkalaemia, reducing muscle activity due to hyperpolarisation of muscle cells - which again is not affected by palpation first
- more than my own opinion. MacLeods clinical examination - one of the core textbooks for the U.K. and most of the medical world, maintains the standard - inspection, percussion, palpation and auscultation. The fact that that text book is held in such high regard, is currently on it’s 8th edition, and is edited by clinicians I can only ever dream of being at the same level of is enough for me to keep the current practice as taught in the U.K.
“...one of the core textbooks for the U.K. and most of the medical world, maintains the standard - inspection, percussion, palpation and auscultation.” Then why did you palpate before percussing in this video?
New episodes of Dr Gill? Yaasssssss keep this up and I just may be a qualified medical professional
well I think a couple of people have said they're considering medical school...
I listen to this Drs voice to fall asleep. It tickles my brain.
I’ve noticed in many of your videos, which I’ve re-watched many a time, that when you check the blood flow in the fingernails, you choose the ring finger. Any particular reason why?
No reason at all. Any finger will do. Likely just a habit of my internal examination protocol 😊
Dr. Gill, I had always understood that auscultation of the abdomen should be done before palpation because palpation may change what you hear. Is that not correct?
We’ve discussed in the clinical deep dive on the abdo, but there is no research evidence to support auscultation first, and there is also plenty of evidence to suggest auscultation is a very weak clinical sign anyway
This may seem like a stupid question but what does the tapping on the stomach do? Why do you do it and what does it check for?
He’s knocking to see if anyone is in there.
Percussion is looking for changes in tone. For example, dullness might indicate constipation or a tumour (there would be other info to help you guide from one to the other, that’s just a crude example )
Dr. Gill does it again!
👍
Just curious but what do the arms have to do with the abdomen?
We gather information from lots of areas about a single system. So very simply low blood pressure after an accident and blow to the abdomen may indicate internal bleeding.
I've always seen press on the stomach with two hands when they go deeper. Is there a reason for that?
The first pass around is checking for pain. The second is a deeper palpating to see if you can detect any masses, so you literally have to push with more force
Dr Gill, I was wondering why do you ask the patient to do that with their fingers at 1:18. I've seen many videos where doctors do this and I'm curious.
Hi Dr Gill, I'm currently a second year medical student approaching her ISCEs and I was wondering whether I was able to check something. On palpating the liver borders, we have been taught to both palpate both the upper and lower border, to assess if there is a case of hepatomegaly or whether the liver is being displaced (therefore the upper border would/may become palpable on inspiration).
Thank you!
I’ll double check, but I’m not sure how easy it is to PALPATE for the upper border
Certainly you’ll PERCUSS for the change in tone, to delineate the upper and lower border however
I’m very clear that I use MacLeods as a reference text - but for ease this discussion, here is a link to University of Washington, where they are also palpating the lower border, but percussing for both
depts.washington.edu/physdx/liver/tech.html
Hope that helps, if you find anything otherwise I’d be really interested to learn
@@DrJamesGill That's great, thank you so much!! Your videos have been a lifesaver seeing as my entire med school experience thus far has been online and zoom haha!
What does the tapping exactly do I’ve always asked myself 🤔
For one example, it allows you to tap out the borders of the organs - liver, spleen, bladder
Oh ok make sense now thank you love your videos!
1:18
"Love you Dr. Gill!"
Based on his hands and feet, this man is hardworking
An hour long compilation of all these examinations and Ill never wake up
3:36 “If you’d be kind enough to take your shirt off and then I will lie you back on the bed.”
🤨
I noticed a change in pitch when percussing the lower left abdomen, am I imagining this ?
I heard it as well...wonder what is wrong there
Nice approach doctor , but do you think u must auscultate before you palpate ned percuss the patient's abdomen ? It may be sound wired to jump right away to auscultation , but I guess u know why?
Ik u probably have a video about this but could you explain that first minute of the video where ur asking him to do things with his hands I don't get how its relevant
Here you go. This is the deep dive for the abdo exam
ua-cam.com/video/pEKWIMBpKRs/v-deo.html
Hi James,
Great video, just a heads up, but you've got a few flash frames/loose frames:
02:29
03:16
03:32
06:57
thanks, they are really short, annoyed I missed them the first time around! But unfortunately cant do anything about it now
@@DrJamesGill probably shouldn't have said anything! Really though, i probably only spotted them as I edit for work. But hopefully helps moving forward, always easy to miss the single frames. Keep up the good work though, the edits are great.
Thanks Harry. There are lots of people on here who have helped me to get better with time
Question Doctor. Wouldn’t the JVP also be examined during the Abdominal Examination?
I was taught to auscultate the abdomen before palpation and percussion because this could influence bowel sounds
In the same way that “ninety nine” was previously taught for vocal resonance, I feel that the direction to auscultate first is similarly outdated.
We address the point in the abdominal deep dive video and touch on the lack of evidence to support auscultation being first
ua-cam.com/video/pEKWIMBpKRs/v-deo.html
Dr. Gill has nice hands.
Hey Dr. Gill! How are the fingers related to the abdomen? I'm referring to 1:17
You can see anaemia, liver disease, protein issues, tremors, all relating to abdo pathology
I thought we were supposed to do auscultation before the palpation. ?
For all the dislikers , there is special room in hell for specially those who dislike Dr gill's videos.
glad to see you're still posting videos Dr. Gill, and staying safe!
Thanks? You too! We’re trying 😊
But is their a littlebitofpeiceofpaper
Good video Dr Gill
Quick question; why did you start with palpation before auscultating and percussion? I have always been taught auscultation first, then percussion, and then palpation... in order to avoid potential changes you will make in hearing bowel sounds and tympani; from the applied pressure of palpation to the abdominal organs.
love dr Gill!!! THE KNOWLEDGEYOU LEARNED AND ASMR YOU EXPERIENCED!!! LOVE FROM NYC WASHINGTON HEIGHTS!!🔥🔥💯💯
Thanks 😊
I find myself quite curious. Perhaps this has been explained and I'm just a bit dull, but what does the tapping on the abdomen signify? I've seen multiple exam videos that do this, and I'm not sure why.
percussion allows us to assess for dull areas - masses/faeces. loud, or resonant areas allow us to look for blockages, and gas buildup as two simple examples.
we’ll go through this more with the Deep Dive abdo explanation video
Good morning doctor. Palpation before auscultation: wouldn't it affect the bowel sounds after doctor?
There isn’t evidence to support that. I specific address the point in the Understanding the Examination video
The link is here 😊
ua-cam.com/video/pEKWIMBpKRs/v-deo.html
Shouldn't you auscultate before palpating the abdomen?
This seems to be a USA / Europe difference. Our text books have auscultation. Plus it’s also a very weak sign
What is the reason for checking the hands during an abdominal exam? What abnormalities would you be looking for, and what would those abnormalities indicate?
There are SO many features in the hands that can highlight abdominal issues
🔥🔥💪💪🙏🙏💯💯!! DR GILL THW GOAT OF ASMR AND DOCTOR SUBJECTS!!💪💪💯💯
What’s 1:43 for? When he places the strap on his arm for a second?
He is checking the size of the blood pressure cuff to ensure it isn't too loose or tight, as this could give an incorrect reading.
@@modestwriggles thank you
Thanks.
Yes that is correct. We discuss that point in the video about understanding the blood pressure assessment
ua-cam.com/video/rLEbOjWgmvE/v-deo.html
The best. The only one I would trust to be examines by
Hi thank you so much dr. Gill! One question tho, auscultation should come first before palpation shouldn’t it?
Not according to Macleod Clinical Examination textbook. A few people have raised the point, but the literature searches I have done not support an alternative approach.
I wonder if these is USA / Europe divide. In the same way we perform prostate checks with the patient lying down, but I believe it is different in the USA
You have the voice of an ASMRtist 😌 Stay Safe Doctor Gill! 😷
My tummy growls a lot and very constantly, I even feel the growls rumbling inside my tummy, that is, I feel the movements of my intestines in my tummy sometimes, what should it be?? It is normal??
No word of a lie, when the Doc started washing his hands, all I could smell for the next 5 minutes was sanitiser.. ghost smells on another level ! Lol
Now that’s an interesting hallucination
Meanwhile I was thinking, "oh, name brand. Fancy."
@@XSemperIdem5 😂
Dr Gill, when percuss what actually are you doing/learning?
So what is the benefit of running the blood pressure twice with and without the stethoscope?
With not being able to check the teeth and tongue; now that we've got Lateral Flow tests would you be able to do a video that explains that, and then repeat this video (with negative tests) to show the mouth part of the examination?
Great informative video Dr. Gill as always!
Thanks 😊
Excellent abdominal exam given the constraints of covid
👍