Physical examination maneuver
Physical Exam
Neck Vein Inspection
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With the patient reclining initially at about 30° to 45°, the head turned slightly away, and the neck muscles relaxed, use tangential lighting to inspect the right internal jugular venous pulsations. Adjust the degree of recline as needed to bring the top of the venous column into view. Identify the venous pulsation by its soft, undulating, multiphasic character that is not palpable and that varies with respiration and position. Note the height of the venous column and its waveform.
How to Interpret
Showing 4 of 5 findings
Atrioventricular Nodal Reentrant Tachycardia
Witnessed rapid regular neck pulsations
Rule in
HelpfulDerived CI
Rule out
Not helpfulDerived CI
Evidence:Moderate
Heart Failure
Jugular venous distension
Rule in
Helpful
Rule out
Minimally helpful
Evidence:Strong
Abdominojugular reflux positive
Rule in
Somewhat helpful
Rule out
Not helpful
Evidence:Strong
Shock
Elevated neck veins (jugular venous pressure >7 cm H2O) in a hypotensive patient
Rule in
Somewhat helpfulWide CI
Rule out
Somewhat helpfulWide CI
Evidence:Moderate
Related Bedside Tests
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Jugular Venous Pressure
Rule in:VHShock, HRight Ventricular Infarction, SHElevated Pulmonary Capillary Wedge Pressure +14 more
Rule out:HRight Ventricular Infarction, SHElevated Pulmonary Capillary Wedge Pressure, SHPulmonary Hypertension +14 more
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Cardiac Auscultation
Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy +37 more
Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy, VHRight-sided Valvular Lesion +37 more
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Oxygen Saturation
aka Pulse oximetry
Rule in:HMortality, SHPneumonia, MHCardiac Tamponade +8 more
Rule out:ICCardiac Tamponade, NHHepatopulmonary Syndrome, NHMortality +8 more
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Abdominojugular Reflux
aka Hepatojugular reflux
Rule in:SHElevated Pulmonary Capillary Wedge Pressure, SHHeart Failure, IEConstrictive Pericarditis +1 more
Rule out:ICElevated Pulmonary Capillary Wedge Pressure, NHHeart Failure, IEConstrictive Pericarditis +1 more
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Lung Auscultation
Rule in:VHChronic Obstructive Pulmonary Disease, VHPneumothorax, HMainstem Bronchus Intubation +29 more
Rule out:VHChronic Obstructive Pulmonary Disease, HPleural Effusion, SHInterstitial Lung Disease +28 more
🎬Video coming soon
Lower Extremity Inspection and Palpation
Rule in:VHDiabetic Foot Osteomyelitis, VHKnee Osteoarthritis, HAchilles Tendon Rupture +7 more
Rule out:SHAchilles Tendon Rupture, SHDiabetic Foot Osteomyelitis, SHKnee Osteoarthritis +7 more