what are you mainly looking for when inspecting the neck?
-JVD (jugular venous distension)
-JVP (jugular venous pulsations)
-skin abnormalities
*sometimes carotid pulse/upstroke
(better determined w/ palpation)
what type of abnormalities do you look for when inspecting the neck?
trauma
skin abnormalities: lacs, rash, moles, lesions
muscular atrophy/hypertrophy
masses
when palpating for the carotid artery, what are you looking for?
carotid pulse
-only palpate unilaterally
»> both at same time you can cause pt to pass out
when auscultating the carotid pulse, what are you looking for and what does it sound like?
carotid bruit
- turbulent blood flow through the vessel
at what position is JVD best evaluated and what can it indicate?
lying at 30 degrees recumbence
-right sided heart failure (veins empty in vena cava and go to R atrium)
how do you measure the sternal angle for JVD & what is a normal measurement in healthy patients?
< 4cm
- pt lying down at 45 degrees
- use one ruler on top of sternum vertically & another ruler horizontally to determine the distance from sternum to jugular vein
what is considered a normal carotid pulse upstroke?
brisk upstroke of carotid pulse
what does delayed upstroke of the carotid pulse suggest?
aortic stenosis
- prevents pulse from getting there
- does not correlate with S1
what does bounding upstroke of the carotid pulse suggest?
aortic insufficiency
-increased amount of volume
what does decreased/faint upstroke of the carotid pulse suggest?
decreased stroke volume
- local atherosclerotic issues bruit/buildup
- severe anemia
what does weak/thready upstroke of the carotid pulse suggest?
cardiogenic shock
why is the bell better in auscultation of the carotid pulse?
higher frequency -> better tones & contact w/ skin
what are some conditions associated with turbulent blood flow through carotid?
◦ Atherosclerotic issues
◦ Tortuous artery
◦ Hyper-vascularity with hyperthyroidism
◦ External compression from thoracic outlet syndrome
if you can detect a carotid bruit after turning the pt 90 degrees, what does this indicate? what should you do?
tortuous artery: abnormal twisting of arteries -send pt for carotid doppler -pt may be at risk for: aneurysm formation dissection ischemic events
True or False:
Bruits do not correlate with clinically significant underlying disease.
True
- bruits can be congenital/normal
- loudness/intensity doesn’t correlate to a problem
why are carotid dopplers problematic when trying to detect \ asymptomatic carotid disease?
Low sensitivity and specificity
-false positives occur if pt does not have any carotid pulse abnormalities
when is the use of carotid dopplers indicated?
high risk populations
- older age
- artherosclerotic disease
*can cause 10% of ischemic strokes
how do you measure for JVP?
– Raise the head of the bed or examining table to 30 - 45°
– Turn the patient’s head to the left (as blood comes out of a valve, it goes to right jug vein first, preferred place to look)
– Place a centimeter ruler upright on the sternal angle, perpendicular to the floor.
– Identify the topmost point of the flickering venous pulsations
– Place a card or tongue blade horizontally from the top of the JVP to the ruler, making a right angle
– Measure the distance above the sternal angle in centimeters: a 3- to 4-centimeter elevation is normal (anything above is abnormal)
what do jugular veins reflect & if an elevation is present, what can it indicate?
right atrial pressure
-right ventricular failure/right heart failure
what can decreased JVP indicate?
◦ Hypovolemic state
◦ Sepsis
if the JVP is elevated > 3cm above the sternal angle, what associated conditions can this indicate?
◦ Heart failure ◦ Tricuspid stenosis ◦ Chronic pulmonary hypertension ◦ Superior vena cava obstruction ◦ Cardiac tamponade ◦ Constrictive pericarditis
