In the video below, watch the jugular venous pulsations to know what you ought to be looking for. In my experience, most of the time, physicians at all levels cannot identify confidently and accurately the pulsations that are clearly identified in the video. Indeed, in many videos purporting to show the JVP on youtube, the pulsations are being shown in the external jugular veins, or carotid arterial pulsations are seen and are being mistaken for jugular venous pulsations.
In two other positions with this particular "jugular model" (keep OJ away from her!), the pulsations were not visible enough to make a compelling video image, emphasizing the finicky nature of the pulsations, the need to position the patient correctly to see them, and the general difficulty of confidently and accurately identifying the pulsations during a cardiac examination which is all too often cursory and unreliable in its findings.
The key feature of the JVP, to differentiate it from the carotid arterial pulsations is to watch to see if the most prominent feature of the "waves" is a rapid descent or a rapid ascent. In the former case, as in the video, it is the venous X and Y descents of the venous A and V waves which are most obviously seen. All too often, the rapid ascending waves of the carotid arterial pulses are mistaken for the JVP. Look for rapid descents - when you find them you know you have found what you're looking for.
In two other positions with this particular "jugular model" (keep OJ away from her!), the pulsations were not visible enough to make a compelling video image, emphasizing the finicky nature of the pulsations, the need to position the patient correctly to see them, and the general difficulty of confidently and accurately identifying the pulsations during a cardiac examination which is all too often cursory and unreliable in its findings.
The key feature of the JVP, to differentiate it from the carotid arterial pulsations is to watch to see if the most prominent feature of the "waves" is a rapid descent or a rapid ascent. In the former case, as in the video, it is the venous X and Y descents of the venous A and V waves which are most obviously seen. All too often, the rapid ascending waves of the carotid arterial pulses are mistaken for the JVP. Look for rapid descents - when you find them you know you have found what you're looking for.
Please, please -- for our mutual and love and understanding of Bayesian analysis -- tell me you are not looking for JVP or recommending students waste their precious and limited time learning medicine with such a parlor trick that was hardly useful last century.
ReplyDeleteI did not suggest anybody examine it - I only suggested that should they do so, they would do best to examine it properly.
ReplyDelete