Neck vein distension

Hypotension without neck vein distension suggests hypovolemia. Hypotension with neck vein distension suggests the presence of a tension pneumothorax or pericardial tamponade. Beck's triad (hypotension, neck vein distension, and muffled heart tones) is very unreliable for diagnosing pericardial tamponade ( Wlson┬╗.!^.! Bassett.196.6); muffled heart tones are often missed, and neck vein distension may not occur while the patient is hypovolemic.


External blood loss is usually obvious, except perhaps from the scalp, and is managed by direct manual pressure on the wound. However, internal blood loss may be much greater and is easily missed. Blood losses seen with various fractures are usually at least 1000 to 2000 ml for a fractured pelvis, 500 to 1000 ml for a fractured midshaft femur, and 250 to 500 ml for other long-bone fractures. Hematomas the size of a fist usually represent at least 500 ml of blood. An increase of 2.5 cm in circumference in the thigh usually represents at least 500 ml of blood, and an increase of 2.5 cm in the circumference of the abdomen represents about 1000 ml of blood. Any decrease in breath sounds on one side of the chest usually represents at least 500 ml of blood, and complete loss of breath sounds probably represents at least 1500 to 2000 ml of blood.

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