Thread by @WesElyMD

1/🧵🎥 Hepato-Jugular Reflux (HJR)?
 
Neck Veins tell us a lot about how much fluid people have in their body. Look at this video & you’ll learn a trick doctors use that tips us off about blood volume! (Movie w perm)
 
#medtwitter #nursetwitter #TipsForNewDocs #TipsForNewInterns

2/ My patient had kidney failure & too much fluid, making him short of breath. I press down over his liver & watch his neck veins pop up (or not). When they do, it correlates w high pressures in the heart from too much blood volume.
 
bit.ly/2UDAVkl

#MedStudentTwitter

3/ Another way of seeing this is the CXR (see pic). This simple measurement from a vein to an artery called the Vascular Pedicle Width (VPW) also tells me the heart pressures are too high. His VPW is 84 mm and > 70 is way too much. So he needs to pee a LOT!
 
#LASIX #DIURETIC

4/ 🎥 In the next 24 hours, he peed over 3 liters & felt so much better. You can see that his neck veins no longer demonstrated a Hepato-Jugular Reflux (& it’s reflux NOT reflex). This simple text can be checked each day in heart failure to indicate safe timing for discharge.

5/fin
And look how the vein (SVC) in his chest also reduced in size so that now his VPW measurement is ⬇️ close to 70mm. This means the pressures in his heart are correcting with our treatment. Easy free information like this is too often overlooked for fancy invasive tests!