Jugular Vein Distention

​Some of the most notable causes of JVD in the pre-hospital setting are right sided heart failure, cardiac tamponade (think Beck's ️), tension pneumothorax, right ventricular infarction, obstructive shock.

To properly evaluate JVD the patient should be placed upright at a 45 degree angle. It's normal for patients to have some level of distention when lying supine...

Did you know that by evaluating the jugular veins we are also getting an idea of the central venous pressure (CVP)? Yep, we are, whether we know it or not. Normal CVP is around 10 cmH2O - this results in some JVD to about the level of the clavicles. For every 1cm of distention above the clavicles, CVP increases by 1 cmH2O.

Kussmaul's Sign (not to be confused with Kussmaul Respirations - DKA) is when the distention increases during inspiration - which is opposite of what we would expect to see. If the amount of distention increases with inspiration, use those critical thinking skills and rule out a Right Ventricular Infarction (RVI). We do this by moving V4 to the right side of the chest ​(same anatomical landmarks as the normal 12 lead) and look for elevation in V4R. There's a lot more on that topic, but that's for another post...

-Pass with PASS