title: A new parameter for the diagnosis of hemorrhagic shock: jugular index.
abstract: OBJECTIVE
  The purpose of this study is to investigate whether there are any significant changes in the diameter and the area of the internal jugular vein (IJV) during the hemorrhagic shock.
  
  
  METHODS
  Healthy volunteers donating blood were included in the study. Arterial blood pressure, pulse rate, anteroposterior (AP) and transverse diameter, and area measurements of the IJV during inspiration and expiration were performed on the volunteers before and after 450 mL of blood donation.
  
  
  RESULTS
  A total of 35 volunteers were enrolled in the study. The IJV prehemorrhagic AP diameters during inspiration and expiration were 4.9 ± 2.2 and 7.9 ± 3.1 mm, and the posthemorrhagic values were 2.7 ± 1.6 and 6.6 ± 3.1 mm (respectively, P < .001 and P = .007). The jugular index-AP was 36% ± 15% before hemorrhage and 58% ± 17% after hemorrhage (P < .001). The IJV areas during inspiration and expiration were 0.40 ± 0.28 and 0.81 ± 0.51 cm(2) before hemorrhage and were 0.14 ± 0.15 and 0.61 ± 0.47 cm(2) after hemorrhage (for both, P < .001). The jugular index-area was found as 47% ± 18% before hemorrhage and as 73% ± 18% after hemorrhage (P < .001).
  
  
  CONCLUSIONS
  We believe that measurement of the IJV and the jugular index is a reliable indicator of class 1 hemorrhagic shock. It may be used as a part of focused abdominal sonography for trauma in clinical practice.
authors.affiliation: Emergency Medicine Department, Konya Training and Research Hospital, Konya, Turkey.
authors.forename: Nazire Belgin
authors.initials: NB
authors.lastname: Akilli
authors.forename: Basar
authors.initials: B
authors.lastname: Cander
authors.forename: Zerrin Defne
authors.initials: ZD
authors.lastname: Dundar
authors.forename: Ramazan
authors.initials: R
authors.lastname: Koylu
mesh_terms: D000328:Adult; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008297:Male; D062072:Patient Acuity; D011446:Prospective Studies; D012771:Shock, Hemorrhagic / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D015599:Trauma Severity Indices; D014463:Ultrasonography