1. What reference level is used as zero?
ANS: The sternal angle (angle of Louis).
2. What are the upper limits of normal for jugular pulsation in the (a) supine and (b) 45° position with the sternal angle as zero?
ANS: a. The supine upper limit is 2 cm.
Venous pressure can be estimated by observing the upper level of internal jugular pulsations above the sternal angle. If it is over 4.5 cm at 45°, it indicates an
Venous pressure can be estimated by observing the upper level of internal jugular pulsations above the sternal angle. If it is over 4.5 cm at 45°, it indicates an b. The 45° upper limit is 4.5 cm. (It is easy to remember 4.5 cm at 45°.)
3. Why is it important to know the venous pressure at 45° rather than supine? ANS: Supine, the top level of a normal venous pressure may not be seen because it could be above the angle of the jaw at mid-face level.
The 2-cm level is above the angle of the jaw in this patient. Therefore, only if her top level of pulsations were lower down at sternal-angle level would the upper level be measurable. At 45°, her top level ofjugular pulsations was below jaw level and was measurable.
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