How to treat JVD as emt-B

[LOPLII]

hi, i heard from my classmate. he said position the patient can relieve JVD. i am curious about the treatment for JVD as emt-B.

THANKS

 

[VFlutter]

Why would you "treat" JVD? Do you understand what JVD is? And what it indicates?

Not trying to be rude but you should do a little reading and get a better understanding of what you are asking about.


Yes JVD changes with positioning. How are the Jugular veins going to look with the HOB at 45 degrees? What about with the HOB flat? trendelenburg?

 

[shiroun]

Why would you "treat" JVD? Do you understand what JVD is? And what it indicates?

x2. You can't treat JVD as a basic. It's a sign of heart disease/problems

 

[EpiEMS]

ALS intercept and diesel.

 

[VFlutter]

ALS intercept and diesel.

Why? You would call for an ALS intercept based on the presence of JVD alone?

 

[EpiEMS]

Why? You would call for an ALS intercept based on the presence of JVD alone?

I should've been clearer -- when I think JVD, the first thing that comes to mind is cardiac tamponade (via Beck's triad, with JVD being one of the signs). Tension pneumothorax and CHF come to mind quite quickly, too.

Since medics can decompress a tension pneumo, if they're not already with me, I'll be calling them for an intercept on the way to the ED. Tamponade, while not treatable in the field by ALS providers (at least, where I am, I'm not in a system with medics that can perform pericardiocentesis), can decompensate into things that I can't do much about. Same goes for CHF that's decompensating. I can transport people with CHF, sure, but I'd rather have ALS folks along with me, people who can actually start CPAP and such.

JVD alone, no, but I'd certainly be giving thought to ALS if I see JVD.

 

[JPINFV]

If a patient is decompensating, the presence of absence of JVD shouldn't play a part in if a patient needs paramedics. If a patient is not decompensating, then the presence or absence of JVD shouldn't play a part in if a patient needs paramedics. It's a clue to what's going on (increased systemic venous pressure), but it isn't really a sign of immediate severity.

 

[VFlutter]

Thank you for clarifying and good info about the various causes. I was trying to lead on that JVD in and of itself is not a problem that requires treatment, it is a sign of something else going on.

 

[NYMedic828]

EMT classes usually teach JVD for the sole purpose of it being a sign of cardiac tamponade (Beck's Triad)

The presence of JVD alone does not indicate anything. When a patient is lying down, they often have JVD due to increased blood pooling/return to the heart via the EJ.

If a patient is sitting/semi-fowlers and has JVD you may have something to search for but if no other signs/symptoms are presenting it is probably their norm.

Anything that reduces return of or backup of blood to the right atrium can cause JVD. (such as CHF/pulmonary edema)

JVD itself is not a treatable condition, it is merely a potential clue to the underlying cause is.

 

[Aidey]

How JVD is measured is also dependent on what angle the pt is sitting at. JVD in someone sitting at 50 degrees is going to look different than JVD in someone sitting at 90 degrees.

 

[JPINFV]

How JVD is measured is also dependent on what angle the pt is sitting at. JVD in someone sitting at 50 degrees is going to look different than JVD in someone sitting at 90 degrees.

Technically speaking, it doesn't matter what the head of the bed is. Elevated JVP is when the JVP is 3 cm above the sternal angle regardless of the tilt of the bed (lower tilt means it has to go further to reach 3 cm elevation). Just having a JVD visible doesn't mean it's elevated.

 

[Aidey]

I misunderstood it when I read that section of Bates. After spending more time than is reasonable trying to find that section in Bates (PDF file on a tablet) I can clarify what I meant.

If the patient is lying too supine or too upright it may obscure the anatomical markers needed to truly measure if there is elevated jugular venous pressure or not. Therefore if your pt is at 20 degrees or 90 degrees they may have elevated jugular venous pressure but you might not see it.

Better?

 

[JPINFV]

Yes... because 3 cm above the angle covers more vein at 20 degrees. The quality of pulsations and troughs (I'm not too familiar with them past they exist and can be used) can also be used, which can be seen at lesser angles, but still not be elevated JVD.

 

[Aidey]

I'm an idiot. I have a copy on my old computer. Complete with search function.

To estimate the level of the JVP, you will learn to find the highest point of
oscillation in the internal jugular vein or, if necessary, the point above which
the external jugular vein appears collapsed. The JVP is usually measured in
vertical distance above the sternal angle, the bony ridge adjacent to the
second rib where the manubrium joins the body of the sternum.
Study the illustrations below very carefully. Note that regardless of the patient’s position, the sternal angle remains roughly 5 cm above the right atrium.
In this patient, however, the pressure in the internal jugular vein is somewhat
elevated.

In Position A, the head of the bed is raised to the usual level, about 30°,
but the JVP cannot be measured because the meniscus, or level of oscillation,
is above the jaw and therefore not visible.

In Position B, the head of the bed is raised to 60°. The “top” of the internal
jugular vein is now easily visible, so the vertical distance from the
sternal angle or right atrium can now be measured.

In Position C, the patient is upright and the veins are barely discernible
above the clavicle, making measurement untenable.

 

[AnthonyTheEmt]

If the patient is lying too supine or too upright
Better?

Please explain what too supine looks like??

Like this: :rofl:

 

[Shishkabob]

JVD is a sign and not a disease, there is no "treating" it.


There's finding out if it's related to a disease pathology and working it in to your diagnosis.

 

[Bullets]

In my EMT class they only taught JVD as a sign of tension pneumo/hemo thorax. No mention of cardiac tamponade

 

[usalsfyre]

In my EMT class they only taught JVD as a sign of tension pneumo/hemo thorax. No mention of cardiac tamponade

1. There's no such thing as a tension hemothorax...there's not not enough blood in your body.

2. Anything that causes decreased atrial clearance/venous backup will lead to JVD. Tension pneumo, cardiac tampanode, CHF and cardiogenic shock all have the potential to do so.