Examination of the Neck Veins (Stanford Medicine 25)
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- เผยแพร่เมื่อ 9 ก.ย. 2024
- This Stanford Medicine 25 video was created in conjunction with Stanford's AIM lab teaching the examination of the neck veins. stanfordmedici....
The jugular venous
exam is used to measure jugular venous pressure (JVP) and normal/abnormal
waveforms in the neck. The neck exam is an important aspect of assessing a patient's
volume status, especially in patients with heart failure, liver failure and kidney failure.
Both elevation of the neck veins and the variations of the neck vein waveforms share
valuable information about a patient's diagnosis.
The Stanford Medicine 25 is a Stanford School of Medicine initiative to teach and promote the bedside physical exam. Here you will find videos teaching bedside physical exam techniques.
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C wave is caused by AV valve bulging and V wave caused by atrial filling.
it seems external jugular vein
How come that I found this channel just now? Best practical med channel
Shouldn't we identify the highest point of internal jugular pulsation not the external one?
Oh man I realize this is a 6 y old comment but I'm just gonna point to this anyway if any new viewers see your comment, whilest the Internal JV pulse height has a near perfect correlation with CVP and should be the one to assess, the EJV also a really good correlation too and can replace the IJV
*اللَّهُمَّ صَلِّ عَلَى سَيِّدِنَا مُحَمَّدٍ نُورِ الْأَنْوَارِ وَسِرِّ الْأَسْرَارِ وَسَيِّدِ الْأَبْرَارِ، وَزَيْنِ الُمرْسَلِينَ الْأَخْيَارِ وَأَكْرَمِ مَنْ أَظْلَمَ عَلَيْهِ اللَّيْلُ وَأَشْرَقَ عَلَيْهِ النَّهَارُ، وَعَدَدَ مَا نَزَلَ مِنْ أَوَّلِ الدُّنْيَا إِلَى آخِرِهَا مِنْ قَطْرِ الْأَمْطَارِ ،وَعَدَدَ مَا نَبَتَ مِنْ أَوَّلِ الدُّنْيَا إِلَى آخِرِهَا مِنَ النَّبَاتِ وَالْأَشْجَارِ صَلَاةً دَائِمَةً بِدَوَامِ مُلْكِ اللَّـهِ الْوَاحِدِ الْقَهَّارِ.**اللهم صل على سيدنا محمد وعلى اله وصحبه وسلم تسليما كثيرا عدد خلقك و رضا نفسك وزنة عرشك ومداد كلماتك و عدد ما كان وعدد ما سيكون وعدد الحركات والسكون.*
correction: the v wave is not the buging of the valves after s1, that is the c wave. v wave as i know , is due to the atrial inflow of blood during systole prior to the opening of av valves and the beginning of diastole.
A-atrial contraction
C-ventricular contraction and bulging of Tricuspid valve
V- venous return
Also he said JVP of 7cmh2o but it is actually CVP and there vast difference
Perfect demonstration!!! Sir..U made it easy...thank you for your precious contribution in my clinical medical knowledge.
There is a mistake in this video. AV valve( Tricuspid valve) bulging into RA causes "c" wave. Not "v"wave, which is caused by rise in RA pressure due to filling of blood into RA while Tricuspid valve is still closed. "v" wave is followed by "y" descent which marks the opening of tricuspid valve.
How can we achieve a reliable result with the actual measurement itself? It seems like such an estimation
Thanks for the video !! Really helps a lot.
one point though, judging by the course of the vein (more oblique and it looks more superficial), i think this is external jugular vein instead of internal jugular vein isn't it?
To avoid confusion, I think you should have clarified this. Because most books stated to use internal jugular vein to measure JVP but in fact external jugular vein can be used as well. Thanks !!
Thanks for your message Ryan. Yes you are correct, this is the external jugular (which just happened to be better viewed than the jugular in this case). Either can be used but internal is preferred minimize risk of over-estimation of JVP that can occur using external only.
the external jugular vein is not reliable for measuring the jugular pressure because of its course, we should measure the internal jugular vein.
That's the EJ, though. Agree that you can see the different waves and that this is definitely a vein but is using the EJ a valid method for estimating CVP?
why is it that some videos of JVP exam have their patient on a 30 to 45 degree angle and looking to the left while your video the patient is lying flat and facing forward? just curious
Poor quality demonstrations is my bet. MacLeod's clinical examination 14th edn states to position the patient supine, reclined to 45 degrees with their head on a pillow, head turned slightly (not excessively) to the left.
When assessing the JVP, the best position is that in which the JVP can be seen. In a healthy person (such as the one in the video) jugular pulsations are not usually visible at 30-45 degrees but will localize below the clavicle (as a normal person will not have elevated central venous pressure). Thus moving this person flat will allow the JVP to be seen nicely in the neck. In persons who are severely congested (i.e in decompensated heart failure), the JVP at 30-45 degrees may be above the jaw, and thus moving the person upright to 80-90 can bring the JVP down into the neck so that it can be assessed.
As far as the facing forward is concerned, its clinician preference. Some get the patient to look to the left, others forward. It really depends on what position you can best see pulsations. The important thing is to ensure the patient is relaxed so that the sternocleidomastoids don't obscure the venous pulsations.
@@krishnaisgod1 I somehow agree with you there because we had a tutorial today and we told him that Macleod says that we should tilt the head to the left a bit, he however said no and his reasoning was that tilting the head may actually make it harder for you to see the JVP due to SCM contractions. Instead, just put the patient to 45° then slightly elevate the chin, light your torch 🔦 and then view from the belly button.
Fantastic!
thank you for your time
Money
and thank-you for my money.. Where is the base of the jugular vein?
Sir You are using external juglar vein for jvp. is there any reference of using external juglar vein for jvp??? 2nd patient is not lying at 45 degree.. kindly first tell the proper anatomy of internal juglar vein And its proper identification for jvp..
You are totally right
You are wrong. Either veins can be used.
@@Adsd822its recommended to use internal jugular vein because it connected more directly to right atrium compared to external jugular vein. But it is easier to just use external, and its okay too
Really good video thx doc.
Thank you.
well this was brilliant illustration .keep up the good work.
Thanks for the video
Good.thank you
Isn't JVP measured in 45° inclined neck level ??
yes, I guess the Dr thought people would already know or he just forgot to mention it.
30 degrees
fantastic
the best ever to me jvp exam
thanks a ton:-)
There should have been arrows over a v cause I didn't understand av av av
Is this swelling dangerous for the patient and does he have treatment?
That doesn't look like the internal jugular. You can't use the external jugular to measure it
Mike Doe I'm confused right now
It seems EJV to me too..
It is External and you can use both
@@abdullahahmad4239 External can't be used , wrong information
So it's normal to feel ur vein more if ur laying down
Best
When we can see and feel pulsations in neck
Are they normal ?
I think you examined the external jugular instead of the internal one, and v wave represented atrial filling from venous return, the wave originating from tricuspid bulging toward the atrium is c wave. Nice video nonetheless.
rotten apple we
Was it normal or abnormal i m having this at base near clavicle External jugular pulse sometimes not always.... Like 2cm above sternum and adding correction factor of 5 that becomes 7 is it normal
should the patient lying flat or propped up position to measure jvp ??
Interesting, as this is an area of the body often examined by emergency medical personnel after car crashes where neck pain with no obvious deformity are present.
i don't think people should really ''examine'' this area, a form of a C-spine support is needed until imaging/physician clearance is the best course.
اسر
@@ttrdf I was taught quick physical exam of the neck is done while manual c-spine (jaw thrust maneuver) is held, then c-collar is placed. Probably wouldn't do this specific exam on a trauma patient but would definitely be checking for jugular vein distention prior to c-collar placement
isnt that the ext jugular tho?
But we normally we measure it from internal jugular vein
What you call V wave, isnt'it actually the C wave, as illustrated in the wave-profile image?
very good video
Adding 5 is a correcting factor for keeping the patient at 180deg? beacause usually we keep the patient at 45deg angle
You add 5 cm to it because the right atrium is about 5cm deep to the Sternal angle. It's not a correction factor.
its not a rule to keep patient in 45 but we use it as its midway between flat position in which upper level of distension will be inside the skull of patient and if we measure jvp in 90 deg position the upper limit of distension will be inside the thorax of patient if its not high enough to rise above clavicle
This video reminds me of just how smart doctors are. Especially cardiologists and neurologists. Now if only one of these doctors waa smart enough to figure out how to get affordable healthcare to everybody. All this specialized knowledge is not much help to a person who can’t even go to see a doctor.
Anything less than 3cm is normal (JVP)
Patient is not on 45 degrees so this is a wrorg procedure
Is the patient condition normal?
He is due for a flight
اخر شي ما فهمت النقطة
Hi
FEW THINGS IN REGARDS TO THIS VIDEO AND COMMENTS:
1. IT IS USED EXTERNAL JUGULAR VEIN AND ACCORDING TO FEW EVIDENCE BASED MEDICINE RESEARCH IT CAN BE USED FOR JVP ESTIMATE
2. JUGULAR VENOUS PRESSURE IS IN THIS CASE 2cm, IF IT IS ADDED 5cm THEN IT IS CALLED CENTRAL VENOUS PRESSURE !?!?
3. IF YOU UNDERSTAND THE LAW OF CONNECTED VESSELS THEN YOU CAN MESURE JVP ON THE PATIENT IN SUPINE POSITION ON THE DIFFERENT ANGLES IN REGARDS TO THE HORISONTAL SURFACE!
Ejv
The tutor/examiner has some finger clubbing! He should get himself a CT Thorax >.
Maybe its congenital
Why is this in my recommendations
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oi
Thank you Joe Biden!
so bad