Examination

Question 1

How do you tell the difference between carotid artery and jugular venous pulsation?

Answer 1

1. Jugular is impalpable, carotid palpable
2. Jugular varies with insipiration, carotid independent
3. Jugular varies with position of the patient, carotid independent
4. Jugular varies with abdominal pressure, carotid independent
5. Movement- jugular is inward, carotid outward
6. JVP has 2 peaks per heart beat (in SR), carotid has one

Question 2

Where should you measure the JVP from?

Answer 2

Sternal angle

Question 3

What is the normal height of the JVP when the patient is sat at 45 degrees?

Answer 3

< or = 4cm from sternal notch. NB if RA pressure is low may have to lie patient flat to see JVP, or sit upright if RA pressure is high.

Question 4

Where would you normally see the JVP?

Answer 4

Suprasternal notch or behind sternocleidomastoid (internal jugular vein runs deep to sternocleidomastoid)