Tte

[B-Bone]

Anybody know of a good resource/workshop/course for basic TTE? A few of my group members and I are interested in gaining some experience for basic pre-op/post-op evals, like for when people are crapping out or looking wonky for whatever reason and calling cardiology would take too long/be overkill. There was a brief TTE demo at the SCA/ASE echo course in san diego, but I'm looking for something a bit more comprehensive. I figure there must be something out there, maybe aimed more at ED physicians or ICU guys, but totally applicable to our specialty. Any leads?

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[cchoukal]

UCSF is working on a curriculum in critical care ultrasound for ICU fellows, and this includes limited cardiac ultrasound (LV/RV size and gross function, IVC collapsability). We deliberately avoid the term "echocardiography," as it implies a more thorough, standardized exam, which makes hospital credentialing more difficult and, let's face it, is probably beyond our scope of practice. At this point, the obstacles or limitations are related to defining the scope, designing credentialing criteria (ED physicians have blazed this trail and can be helpful), initial training (the question I think you're asking most directly about), and, most importantly, ongoing assessment of competency.

You can't swing a dead cat without hitting a two-day "ultrasound workshop" that includes cardiac, but, in my opinion, these should be treated like the two-day pain workshops the FP docs are going to in order to learn LESIs. It is just the beginning, and without a mechanism for ongoing QI and competency assessment, in my opinion, we're just playing.

 

[B-Bone]

I just found a three day workshop at Beth Israel Deaconess that covers TTE for "shock" and "critical care" which is aimed at EM and CCM physicians, but also includes anesthesiologists in the list of target audiences (Feb 26-28, 2013 for anybody interested). The curriculum looks pretty good. I agree that cardiac US is probably a better descriptor of what I want to do with this. I run into a situation maybe once a month in the PACU or even in preop where I just want a "full-or-empty"/"pump OK/pump broken" gestalt without stuffing a TEE down some poor guy's throat. I am not looking for any sort of certification. I know our anesthesia/CCM docs in residency did spend like 5 afternoons a week for six months in the echo lab to get some experience for ICU use, but I have a feeling my group would not subsidize that (nor would our cardiologists be interested). Soooooo... weekend workshop here I come!

 

[scudrunner]

Would this fit the bill?

http://www.unmc.edu/anesthesia/Echo.htm

 

[RxBoy]

I figure there must be something out there, maybe aimed more at ED physicians or ICU guys, but totally applicable to our specialty. Any leads?

Have done a ton of Preop/postop TTEs. You don't need a workshop. If you know TEE you already know TTE just need to know how to obtain images.

For TTE all you need is a book, youtube, and some practice.

Know the 3 basic positions (parasternal, apical, subcostal) +/- suprasternal notch (I never use)
Know some basic views for those positions (LAX, SAX, 4chamber, ect)
Know which view yields best diagnosis (pericardial effusion, RWMA, EF, ect)

Watch youtube videos on basic TTE exams. Flip through book of choice for TTE (I like The Echo Manual).

THe most important part: Grab a probe and practice on post op patients. Do this a couple dozen times, you will be an expert.

Start simple... Try a parasternal view to obtain mid papillary SAX. You'll be surprised how easy it is. Move on from there. You can r/o life threatening conditions literally in seconds.

As you get better, you can move onto advanced things like interrogation of valves, estimation of cardiac pressures (RVSP), resp variation of IVC, ect.

I learned all this on my own as a resident, so I am sure you can learn this on your own too. Skip the workshop and do it yourself. You could do 10 TTE exams a day in PACU if you were so inclined.

While your at it, add on a quick US pleural exam and FAST exam and learn them too. You could save someones life.

 

[Oggg]

iTunes U
Search for ultrasound
There is a huge EM ultrasound video lecture library. UC Irvine.

I prefer practicing on asleep patients. You can scan forever and don't have to worry about boobs. It's nice for the 90yo ex laps who get hypotension and you want to make sure they aren't in failure. I used it the other day to help a cardiologist and cardiac surgeon take care of a malignant pericardial effusion/tamponade. I couldve drained it myself with the ultrasound, but that was too much for them to grasp. So I just help the probe over the massive effusion and kept saying, nope, you haven't drained it yet.