So stomach 12 and stomach 13 are on either side of the clavicle, foursoon lateral to the midline. So the fine foursoon midline to acromion process is eightsoon, so we divide it in half for foursoon. And then stomach 12 is above the clavicle in the supraclavicular fossa.
I have a dot here. And then stomach 13 is right below the clavicle, foursoon lateral to the midline. So we could say right below the clavicle or in the zeroeth intercostal space.
So after that we're just counting down in rib spaces, four soon lateral to the midline. So again the way we find the intercostal spaces is we come to the center. Here's the manubrium, here's the sternum. Where they come together is the sternomanebrial angle. Take two fingers, put them on either side of the joint.
Now if I come out just a little bit, I can feel a rib between my fingers. This is the second rib. So my top finger is in the first intercostal space, my bottom finger is the second intercostal space.
So if we then come first intercostal space, four soon out gives us stomach 14. First intercostal space, second intercostal space, four soon out gives us stomach 15. And second intercostal space, third intercostal space gives us Stomach 16. So when we're feeling for intercostal spaces it's going to be easier to palpate the ribs near the midline and then come out. So don't come out for soon and try to feel for rib spaces. It's going to be hard to feel because there's so much muscle there. So palpate your intercostal spaces near the midline and then come out for soon. So then after that stomach 17 is in the fourth intercostal space which is the nipple.
So that's something we use. as a reference point but we don't needle it. And then stomach 18 is in the fifth intercostal space. The name of this point is rugen which means root of breast. So if I wanted to I could palpate down and find the fifth intercostal space but generally it's right underneath the pec muscle.
In women this is going to be right where the underwire of the bra is so that's where stomach 18 would be. Hey I just want to do this one more time just so you can see what these points look like on different body types. And I ran out of stickers, so I just drew on myself with children's markers.
So hopefully that still shows up okay. So like we said, stomach 12 and stomach 13 are above and below the clavicle, four soon lateral to the midline. After that, we're on the chest and we're just counting down rib spaces. So I find sternomaneubrial angle, take two fingers, put them on either side. Come out to find the second rib.
My top finger is in the first intercostal space, so I come out four soon for stomach 14. Come back to the midline, find the sternal manubrial angle, find the second rib. My bottom finger is in the second intercostal space, so I come out four soon to find stomach 15. Come back to the midline, find the sternal manubrial angle, second rib. And now I have to count down one rib space.
So here's first intercostal space, second intercostal space, second third, have the third intercostal space, come out four soon for stomach 16. Come back to the midline, sterno-manubrial angle, first intercostal space, second intercostal space, second third, third fourth, fourth intercostal space, four soon out is stomach 17, which is the nipple. So stomach 17 is just a reference point. We don't needle it and we don't do moxa on it.
And then even though we say that the nipple is in the fourth intercostal space, four soon lateral to the midline, we don't really use that as a reliable landmark to locate the other points because nipples can move around. After that is stomach 18 in the fifth intercostal space. So I could try to count rib spaces for it. So here's first intercostal space, second, second, third, third, fourth, fourth, fifth.
come out for soon. It's a little bit more difficult to palpate the fifth intercostal space here, but basically what we're doing is again this the name of this point is root of the breast. So it's right on the lower border of this pec muscle.
So it's in the space right where the breast meets the torso. So if you're doing this on a female patient, this is right where the underwire of the bra goes and you'd have to have them lift their bra up in order to get to stomach 18. So after that, we move to the upper abdomen and here our line moves from foursoon lateral to the midline to twosoon lateral to the midline. So stomach 18 is the last point on the chest, foursoon lateral.
Stomach 19 is the first point on the abdomen, twosoon lateral to the midline. And then here all our points are just onesoon apart. So let's go back to Tiffany and locate our points on the abdomen. So when we come down onto the abdomen we're going from four soon to two soon. So the way we find two soon is we could come up back up here and do midline to acromion as eight soon.
Half of eight is four, half of four is two, and we just have to bring that down onto the abdomen without moving it. The other thing we could do is just palpate for lateral border of rectus abdominis. This is four soon out. So come halfway for two soon. Stomach 25 is level with the umbilicus, too soon lateral to the midline.
And then our measurement for above the umbilicus is umbilicus to sternocostal angle is 8 soon. So we can palpate this. I usually put my fingers on either rib and then just walk it up until it comes together. And so this is going to be a little bit higher than you think.
Make sure you're not feeling down here on the xiphoid process. This is going to be a little bit higher than what you think it is. So sternocostal angle to umbilicus is 8 soon.
Stomach 19 is 6 soon above the umbilicus. So here's 8 soon. Half of 8 is 4. Halfway between 4 and 8 is 6. And we come 2 soon lateral to the midline for stomach 19. Then we can locate every other one. Here's 8 soon.
Half of 8 is 4. 2 soon lateral to the midline. Stomach 21. Here's 8 soon. Half of 8 is 4. Half again is 2. 2 soon lateral to the midline. Stomach 23. Now we can just fill in stomach 19. Stomach 20, stomach 21, stomach 22, stomach 23, stomach 24, and stomach 25. So when we come to the lower abdomen below the umbilicus, our measurement is upper border of the pubic symphysis to umbilicus is five soon. So the first thing we need to do is find upper border of pubic symphysis.
Now some people will ask the patient, can you show me your pubic symphysis? I usually avoid doing that just because a lot of people don't know and so it's going to be easier to just palpate for it. So the way we palpate is I take my hand that's closer to the feet and lay it flat on the lower abdomen and then just roll the back of my hand down until I run into upper border of the pubic symphysis.
So there's definitely a border of a bone here. When you're doing this on a real person don't actually push that hard because the bladder is right underneath but there's definitely a bone right there. So I take six fingers for my five soon.
So upper border of pubic symphysis to umbilicus is five soon. Six fingers gives me stomach 25, 26, 27, 28, 29, 30. I just have to come out too soon. So 25, 26. I should have thought a better way to do this. So I have five soon, six fingers, and come out for 25, 26, 27, 28, 29, 30. All right, so stomach 31 is on the upper leg, lateral to the sartorius muscle.
So if you look at the Dedman definition, the Dedman definition is you take the lower border of the pubic symphysis and where it lines up with the lateral border of the ASIS, that gives us stomach 31. So if you try palpating this on yourself, you can feel down, first feel the upper border of pubic symphysis, and then palpate further down to feel the lower border of your pubic symphysis. And if you do this on yourself, you should be able to figure out why we should never palpate that area on a patient. So instead, what we can do is the line of the stomach channel goes from the lateral superior border of the patella to ASIS. So we can just follow this up, and we're basically going to fall into this point. Right where the hip bends and so we can just follow up this up the line of the stomach channel and where we fall into That point is going to be Stomach 31 then when we come down to the knee again Our line is from lateral superior border of the patella to the ASIS that gives us our line So stomach 34 is too soon up from the lateral superior border And so for our two soon, we're really just taking the width of the patella.
and then coming up until we're on the line for stomach 34. So stomach 34 is 2 soon up. Stomach 33 is 3 soon up. So I take 2 soon, double it for 4. 3 soon is halfway between 2 and 4. Stomach 32 is 6 soon up.
So I take 2 soon. 2, 4, 6 for stomach 32 on the line from the lateral superior border of the patella to ASIS. Stomach 35 is on the knee below the inferior border of the patella.