The transesophageal approach echocardiography has numerous advantages for those providing resuscitation to the critically ill, including those with cardiac arrest. While the transthoracic approach is often quite useful, quality images in ventilated patients are more challenging. Thus, the reliable, high quality image acquisition of TEE is very attractive for the resus room. It is, however, the continuous nature of TEE – due to the probe being left in-situ throughout the resuscitation – that makes this the ideal tool for the resuscitator. Continuous, live updates on the functional and hemodynamic evolution during a resuscitation, including during CPR, is a sublime experience for anybody who has used this approach.
Given these obvious advantages, it is important that emergency physicians be enabled and empowered to engage in this method of image acquisition.
On October 30th, 15 motivated emergency physicians at Western were exposed to a structured 4 hour curriculum on TEE that included:
-didactic lecture and overview of TEE and focused, limited 2D TEE exam protocol
-haptic simulation: inserting TEE probes (using airway mannequins and actual TEE probes)
-image generation simulation: practice generating TEE views on high fidelity simulator
-TEE image review session
Subjectively, the day was a great success Stay tuned for some more objective metrics regarding its success!
For anybody looking for an excellent, free online resource to better understand TEE and the various views should check out this site.
The 2014 Critical Care Ultrasound Course will be offered August 21-22, 2014.
This annual course is offered as the official course of our Critical Care training program and is attended by all critical care fellows. Further, it will be the most comprehensive course offered in the region for the intensivist or resuscitative physician who seeks to acquired fundamental skills in the assessment of:
-Thoracic and lung ultrasound
-Vascular access, including peripheral veins and PICC lines
-Critical Care Echocardiography
The course will be directed by Robert Arntfield.
Additional faculty, agenda and brochure will be announced closer to the course.
If you have interest in attending this course please email Tammy.Mills@lhsc.on.ca who will be able to notify you when registration for this course opens in the spring of 2014.
One of the distinct advantages of point of care ultrasound is the ease of repeatability. This, along with the value of $1000 in tPA in reducing somebody’s intermediate term likelihood of developing thromboembolic disease associated pulmonary hypertension, is well captured here.
This patient had a submassive PE – right heart strain in the absence of shock. Literature would suggest the benefit of thrombolysis here is in the reduction in medium to long term disability from VTE-induced pulmonary hypertension. As bleeding risk is not zero, getting physicians and patients to buy in to the front end risk of serious bleeding for a long term benefit (that may or may not be recognized by the patient, depending on their activity level), makes this a challenging decision for the naturally risk averse practices that many adopt. The right answer is patient specific and with increasing use of point of care echo to stratify pulmonary embolism, as one gains proficiency in this skill, one should be prepared to have this discussion more and more.
On August 24, Dr. Rob Arntfield kicked-off the inaugural Western Medical Student Ultrasound Symposium with this thought-provoking keynote address introducing participants to point of care ultrasound. The talk begins with a compelling case presentation and ultimately delivers an interesting and slightly iconoclastic overview of the current state of affairs with point of care ultrasound, its relevance to medical training and how on earth we got here.
The 2014 Critical Care Ultrasound Course will be offered August 21-22, 2014. This annual course is offered as the official course of our Critical Care training program and is attended by all critical care fellows. Further, it will be the most comprehensive course offered in the region for the intensivist or resuscitative physician who seeks […]
Twelve months ago, point-of-care ultrasound (POCUS) was an ill-defined concept for the majority of medical students at the Schulich School of Medicine & Dentistry. It was a chance exposure to bedside ultrasound that inspired a group of students to team up with local champions to formally launch a POCUS interest group in September 2012. The […]
The Point of Care Ultrasound Interest Group is pleased to announce that the first annual Western Medical Student Ultrasound Symposium will take place August 24 and 25, 2013 at the state of the art Canadian Surgical Technologies and Advanced Robotics facility in London, Ontario. Nearly six months in the making and winner of the Hippocratic Council Innovator Grant, this educational […]
The point of care, critical care ultrasound (CCUS) program at Western University has become enabled with transesophageal echo (TEE) capability. The arrival of new TEE transducers that function on the bedside, point of care machines in all our ICU’s will allow for expanded capabilities in properly trained hands. With several Critical Care Western program faculty […]
For the most recent academic session for the Critical Care Western fellows, the topic was critical care ultrasound (CCUS). This opportunity was intended to provide overview of interesting recent cases from within our own program’s tickle trunk of great studies. This session was carried out over Google Hangout. This was partly inspired by this recent international […]