- WIPE, blah blah 🙂
- “Take vital signs”
- Position: 45°
- Proper exposure: of the neck
- General inspection of the pt and surroundings
- Examine JVP:
- Position the pt at 45° and turn head to the left
- Stand right to the pt or at the edge of the bed
- Look for the jugular between the heads of the sternocleidomastoid, lateral to the carotids
- How to differentiate between the carotid and jugular?
|
Jugular |
Carotid |
|
Between SCM heads Non-palpable Can be obliterated Biphasic waves Changes w\ position Drop w\ inspiration Increased w\ hepatojugular reflux |
Under the medial SCM head Palpable Not obliterated One pulsation Not affected by position Not affected by inspiration Not affected by hepatojugular reflux |
- Measure JVP height:
- Place a ruler on the sternal angle to measure the top pulse of JVP
- Normally < 5cm
- To measure the right heart pressure -> add 5 cm to the JVP
- JVP waveforms:
| Abnormality | JVP waveform |
| Atrial fibrillation | Absent ‘a’ waves |
| AV dissociation (CHB) | Canon ‘a’ waves |
| TS, PS, pulmonary HTN | Large ‘a’ waves |
| Tricuspid regurgitation | Large ‘v’ waves |
| Constrictive pericarditis | Steep ‘y’ waves (Friedreich’s sign) |
| CHF, fluid overload, SVC obstruction, PE | Sustained JVD + normal waveforms |
- Kussmaul’s sign: “Venous pulsus paradoxus”
- Normally: inspiration -> drop in intrathoracic pressure -> ↑ BF -> JVP ↓
- Positive Kussmaul’s sign: paradoxical ↑ in JVP during inspiration, indicating poor compliance and filling of the RV
- Causes: constrictive pericarditis, RV infarct, RH failure, restrictive cardiomyopathy, PE
- How to differentiate constrictive pericarditis vs cardiac tamponade?
