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The clinician presses firmly over either the right upper quadrant of the abdomen (i.e., over the liver) or over the center of the abdomen [2] for 10 seconds with a pressure of 20 to 35 mm Hg while observing the swelling of the internal jugular vein in the neck and also observing to be sure the patient does not perform a Valsalva maneuver.
A man with congestive heart failure and marked jugular venous distention. External jugular vein marked by an arrow; however, JVP is not measured by looking at the external jugular vein even but is instead measured by pulsations of the skin from the internal jugular vein, which is not visible in this image.
The patient is positioned in the supine position tilted up at 45 degrees if the patient can tolerate this. The head should rest on a pillow and the arms by their sides. The level of the jugular venous pressure (JVP) should only be commented on in this position as flatter or steeper angles lead to artificially elevated or reduced level respectively.
This impaired filling causes the increased blood flow to back up into the venous system, causing the jugular vein distention (JVD) and is seen clinically in the internal jugular veins becoming more readily visible.
The internal jugular vein is formed by the anastomosis of blood from the sigmoid sinus of the dura mater and the inferior petrosal sinus.The internal jugular runs with the common carotid artery and vagus nerve inside the carotid sheath.
Shock is the state of insufficient blood flow to the tissues of the body as a result of problems with the circulatory system.Initial symptoms of shock may include weakness, tachycardia, hyperventilation, sweating, anxiety, and increased thirst. [1]
The jugular veins are relatively superficial and not protected by tissues such as bone or cartilage.This makes them susceptible to damage. Due to the large volumes of blood that flow through the jugular veins, damage to the jugulars can quickly cause significant blood loss, which can lead to hypovolæmic shock and then death if not treated.
The signs and symptoms of Lemierre's syndrome vary, but usually start with a sore throat, fever, and general body weakness. These are followed by extreme lethargy, spiked fevers, rigors, swollen cervical lymph nodes, and a swollen, tender or painful neck.