Come feedback time, we were all critiqued for not examining every system, not probing harder, not doing a full systemic enquiry - I don;t know if we have become to OSCE oriented that we try to do all histories in 5 minutes, and have parred each examination to the minimum.
We then had a masterclass on Jugular Venous Pulses (JVP)
starting with the normal pulse, and the items we need to describe about each pulse:
- Can you feel the vessel wall?
- Tilt patient's bed backward so they are lying at nearer 30 degrees than the recommended 45 degrees.
- Compare timing of breathing (JVP is higher on expiration)
- Look for bi-phasic nature of pulsation
- Increase pressure my pressing on abdomen over liver
- Check for landmarks - the two heads of sternocleidomastoid, carotid artery, external jugular vein