# What am I looking at? JVD?



## micsaver (Jan 30, 2009)

I have read a bit about JVD and know I'm suppose to look for it when doing an assessment, but I haven't come across any good learning videos or images that really show me what I'm looking for. You can see the neck veins on most guys I know when they are standing around having conversation. Which vein is that? Is there a way to really tell the difference between JVD and the usual veins you find on the neck?


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## medic417 (Jan 30, 2009)

http://www.youtube.com/watch?v=Ekp7F8uz7YQ


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## micsaver (Jan 30, 2009)

OK I watched that, bummer it's a bit blurry. I also watched this one
http://www.youtube.com/watch?v=gJmwiu06Z9c

So are you really just looking for a visual pulsating vein on the neck when they are lying down?

Still wondering what vein it is that is visible on the necks of many people.


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## Noctis Lucis Caelum (Jan 30, 2009)

Try this
http://www.youtube.com/watch?v=PPlqmLikb1Y&feature=related


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## micsaver (Jan 30, 2009)

here is my confusion:
  my book states, "JVD is present when you can see the patient's neck veins bulging. the neck veins are usually not visible when the pt is sitting up. If they are bulging when the patient is upright it means the blood is backing up because the heart is not pumping properly."

So why can we often see muscular (some not so muscular) guys neck veins when they are standing? Is that the Jugular vein or a different vein?

Then the book says "flat neck veins in a FLAT patient (a person lying down) is a sign of blood loss." Is this a correct assumption?


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## jochi1543 (Jan 30, 2009)

micsaver said:


> here is my confusion:
> my book states, "JVD is present when you can see the patient's neck veins bulging. the neck veins are usually not visible when the pt is sitting up. If they are bulging when the patient is upright it means the blood is backing up because the heart is not pumping properly."
> 
> So why can we often see muscular (some not so muscular) guys neck veins when they are standing? Is that the Jugular vein or a different vein?
> ...



Wow, that kid's neck was insane.


I think that blood loss assumption makes sense, although I don't know if this is a fact. The external jugular should be visible when the head is turned to the side. If it's not visible (and there aren't 5 chins blocking the view), it would suggest that perfusion to the area is not that great, and if there isn't enough blood going to your head, something definitely isn't right.


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## rhan101277 (Jan 30, 2009)

JVD usually indicates that there is a backup of blood somewhere.  Take a water hose for example and kink it, thats kind of the idea.  I think for body builders that maybe their muscles being so big and them working them out maybe cause a small amount of constriction on it somewhere from the musculature.


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## Ridryder911 (Jan 31, 2009)

First ask yourself, what is normal jugular venous distention? Most Paramedics do not even know the answer. One cannot know if they are distended if they do not know the normal.

I will post more later, when I see the answers. 

R/r 911


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## Aidey (Jan 31, 2009)

I've found that the best place to see a variety of people with JVD, edema, and crappy lung sounds is a dialysis clinic.


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## EMT007 (Jan 31, 2009)

Ridryder911 said:


> First ask yourself, what is normal jugular venous distention? Most Paramedics do not even know the answer. One cannot know if they are distended if they do not know the normal.
> 
> I will post more later, when I see the answers.
> 
> R/r 911



Normal depends on the position the patient is in.

With the patient's torso at a 45 degree angle, the veins should only be distended up to the point of the angle of louis (where the manubrium meets the sternum). Anything above that point and you can assume high veinous pressure.

If a person is upright, there should be no distension - if there is, venous pressure is at least 10 mmHg.


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## rhan101277 (Feb 1, 2009)

EMT007 said:


> Normal depends on the position the patient is in.
> 
> With the patient's torso at a 45 degree angle, the veins should only be distended up to the point of the angle of louis (where the manubrium meets the sternum). Anything above that point and you can assume high veinous pressure.
> 
> If a person is upright, there should be no distension - if there is, venous pressure is at least 10 mmHg.



Yeah if you have pressure on it, its coming from a blockage or blood buildup somewhere.  Also you should see JVD in CHF pts.


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## EMT007 (Feb 1, 2009)

rhan101277 said:


> Yeah if you have pressure on it, its coming from a blockage or blood buildup somewhere.



huh?  (+chars)


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## EMT007 (Feb 1, 2009)

Btw, I found this picture, and this is basically what I was talking about in my earlier post...







(although that green line looks a little higher than I would like it)

So, RR, did I pass the knowledge test?


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## Ridryder911 (Feb 1, 2009)

EMT007 said:


> Btw, I found this picture, and this is basically what I was talking about in my earlier post...
> 
> 
> 
> ...



Yep. One would have to take the measurement of the jugular venous of the green horizontal bar and the measurement of the vertical green bar would be ruler. Usually, anything > 5cm @ 45 degrees midclavicular is considered to JVD. 

To accurately chart JVD, one should document the degree the patient was at (i.e. 45 degrees) the height from the Angle of Louis as measured and where it measurement was from.i.e. midclavicular line. For example JVD is noted 7cm MCL, @45 degree angle. 

I always found it ironic when inexperienced or uneducated medics describe trauma patients has "has JVD' when they are in a supine position. Most patients with adequate perfusion have JVD in that position. So be careful upon making such statements alone describing a potential injury. 

R/r 911


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## medic417 (Feb 1, 2009)

Ridryder911 said:


> I always found it ironic when inexperienced or uneducated medics describe trauma patients has "has JVD' when they are in a supine position.
> R/r 911



:huh:  No way.  I was taught this many years ago as a basic and your saying Paramedics do not no it.  I am ashamed of my fellow medics.  :blush:


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## rhan101277 (Feb 1, 2009)

EMT007 said:


> huh?  (+chars)



I meant venous pressure sorry.


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