Specifics regarding echo rotation关于回声旋转的细节.doc

Perioperative TEE Rotation MHMC.Course Director: Charles Smith, MD.Faculty:Don Voltz, MDMatthew Joy, MDAugusto Torres, MDCharles Smith, MDElizabeth Steele, MD Objectives.1. Understand the physics of ultrasound and its incorporation into currentechocardiography technology. 2. Learn the basic principles of 2D echo, color flow, and spectral doppler.3. Learn to recognize the basic cardiac anatomy through the various echocardiographic views. 4. Have the basic knowledge necessary to evaluate right and left ventricular function as well as regional wall motion. 5. Be familiar with the basic valvular pathophysiology and the intraoperativeassessment of heart valves and the aorta. 6. Learn the use of intraoperative echo in measuring hemodynamics, i.e., pressure gradients, valve areas. 7. Develop the skills to interpret the use of echo as a diagnostic tool in management ofhemodynamically unstable and critically ill patients. 8. Be aware of the common interpretation errors, artifacts, equipment pitfalls, andlimitations of echocardiography Specifics.1. Review the handouts and introductory CDs.2. Read 2 chapters of Sidebotham TEE text each day. Start on day 1. 3. Review the CD ROM of standard TEE views with movie clips that correspond with each chapter. Study and memorize 8 views: mid-esophageal 4 chamber, mid esophageal 2 chamber, mid esophageal long axis, mid esophageal aortic valve short axis, mid-esophageal aortic valve long axis, RV inflow- outflow, Bicaval, transgastric basal short axis, transgastric mid papillary long axis4. Study and memorize 4 transthoracic views: parasternal long axis, parasternal short axis, apical 4 chamber and apical 2 chamber5. Check each day if there are any intraoperative TEEs. Any heart case is a potential TEE case. Review the preop echo (TTE or TEE). Assist with room preparation and lunches in the heart room per the CT Attending.6. If no heart case, contact cardiology echo fellow each day in order to observe TEEs performed for cardiology indication. They will usually be done on the 3rd floor. 7. In your spare time, introduce yourself to the cardiology echo staff in the noninvasive reading room, 3rd floor. Try and observe at least 5 transthoracic echo studies being read in the echo reading room every day. Reading Material.Handouts:1. Memo to Anesthesia Providers re Periop TEE using the IE33. You need to be familiar with this memo in order to run the machine.2. Memo: TEE/ Hearts with Dr Smith. Always use a bite block. The tip of the TEE probe is fragile. Be careful when handling + transporting the probe, especially the distal end (lens/crystal).3. Shanewise J. Transesophageal Echocardiography. In Practical Approach to Cardiac Anesthesia. Frederick A Hensley, Donald E Martin, and Glenn P Gravlee.4. Shanewise JS et al: ASE/SCA guidelines for performing a comprehensive intraoperative multiplane TEE examination. Anesth Analg 1999;89:870-845. Oxorn D et al. An introduction to TEE. Clinical applications. Can J Anaesth 1996;43:278-946. Miller JP et al. The adequacy of basic intraoperative TEE performed by experienced anesthesiologists. Anesth Analg 2001;92:1103-107. Lambert S et al. Improved evaluation of the location and mechanism of mitral valve regurgitation with a systematic TEE exam. Anesth Analg 1999;88:1205-128. Sawchuck C. Confirmation of internal jugular guide wire position using TEE. Can J Anesth 2001; June:688-909. Memtsoudis SG et al. The usefulness of TEE during intraop cardiac arrest in noncardiac surgery. Anesth Analg 2006;102:1653-710. Hartman GS et al. Severity of aortic atheromatous disease diagnosed by TEE predicts stroke. Anesth Analg 1996;83:701-811. Couture P et al. Impact of routine use of intraop TEE during cardiac surgery. Can J Anesth 2000;47:20-612. Cahalan MK et al. ASE and SCA task force guidelines for training in periop TEE. Anesth Analg 2002;94:1384-8CDs1. Intraop TEE. Introduction. Philips2. Periop TEE. Video Atlas. Philips3. Practical Periop TEE. Sidebotham et al. Core Text Practical Perioperative Transoesophageal Echocardiography: Text with CD-ROM. David Sidebotham, Alan Merry, Malcolm Leggett. A good start in echo for anesthesiologists. Supplementary texts:1. A Practical Approach to Transesophageal Echocardiography. Albert C Perrino and Scott T. Reeves. Easy to read with review questions at the end of each chapter. 2. Echocardiography, Sixth Edition. Harvey Feigenbaum, William F. Armstrong, and Thomas Ryan. Great DVD of images. The cardiologists at Metro routinely refer to this text and DVD of images. This is also a key resource for anyone interested in TTE.3. Textbook of Clinical Echocardiography. Catherine Otto. Another standard cardiology text by a top notch author. 4. The Echo Manual. Jae K Oh, James B Seward, and A. Jamil Tajik. This is a Mayo Clinic book. Another standard cardiology echo text with superb TEE and TTE chapters. 5. Atlas of Intraoperative Transesophageal Echocardiography: Surgical and Radiologic Correlations, Text with DVD. Donald Oxorn and Catherine M. Otto. The title of this book explains it all. Very nice atlas, fun to read. The surgical and TEE images in the textbook are superb. 6. Comprehensive Textbook of Intraoperative Transesophageal Echocardiography. Robert M Savage, Solomon Aronson, James D Thomas, and Jack S Shanewise. There are some great chapters in this book, especially the ones on mitral valve surgery. Web based Resources:1. ASE web based material. /2. SCA web based material: /sca3/rounds/index.html and /index.html3. Anesthesia and Analgesia Echo Rounds. /4. Yale Atlas of Echo. /intmed/cardio/echo_atlas/views/index.htmlAttestation:I have received the handouts, CDs and Sidebotham textbook. I will return the Sidebotham textbook and Sidebotham CD Rom at the end of my echo rotation.Signed: _Date:_TO:Anesthesia ProvidersFROM:Dr C. SmithDate:March 21, 2008Re:Perioperative TEE Using the IE33 machine1. Insure that informed consent has been obtained and that there are no contraindications to TEE2. Transport probe in a pillow case in plastic container. TEE probes are stored in the workroom with bronchoscopes. A probe cover should cover the lens + crystal to prevent damage during transport. 3. Power on machine + press PATIENT DATA. Enter patient data: name, MRN, encounter # (accession #), DOB, surgeon requesting exam, sonographers name, study description= IOTEE, Study type= ADULT ECHO, BP, height + weight4. Press ACQUIRE to store the patient data screen as your initial image5. Empty stomach with OG. Use bite block for all patients6. Use surgilube in mouth + ultrasound gel for TEE probe insertion remove the reusable probe cover7. Document probe insertion + time of insertion in anesthesia record 8. Connect cable to IE33. Press S7-2 OMNI to initialize. Press the TEE PRESET9. Before you start the TEE, attach ECG. 10. In room 18, the cable is already attached to the back of the anesthesia monitor. Simply plug it in to the IE33 (use bottom plug)11. Also attach the Ethernet connection if you are acquiring images in Room 1812. Perform study. Save images by pressing ACQUIRE or use the middle foot pedal. 13. Optimize images Adjust FOCAL ZONE and FOCUS RANG