Transesophageal Echocardiography (TEE) for Resuscitation Disclaimer: TEE examinations carry risks of complications and should only be performed in the appropriate clinical situation by a trained provider. This section does not provide a comprehensive overview of TEE but highlights the most useful views for resuscitation and diagnostic assistance in critically ill patients. It should be noted that TEE is complimentary to TTE, and for [...]
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Rob Arntfield, MD, FRCPC and Atul Jaidka, MD, PGY2 takes us through the fundamentals of performing a transesophageal echocardiography (TEE). This video uses a live demonstration to introduce probe manipulation, how to obtain different views, and how to landmark for these different views. The techniques being presented will help you in performing goal-directed TEE in critically ill patients, whether it be for visualizing valvular [...]
Critical Care Transesophageal Echocardiography (TEE) For most point-of-care needs, one can do both basic and more advanced applications of echocardiography with transthoracic scanning. However, there ARE times whereby having ability to perform transesophageal echocardiography (TEE) can be extremely helpful in the point-of-care. This is especially true when windows are hard to obtain in transthoracic echo (TTE) during a technically difficult study, or when a more sensitive and specific [...]
In this case a sudden deterioration in the emergency department prompts a TTE which shows some concerning physiology. It is not until the TEE is inserted, however, that the culprit disease can be identified. *Images courtesy of Dr. Drew Thompson, Division of EM, Western University https://www.youtube.com/watch?v=i8gAObUA-vY Case Highlights: *TEE in the ED is valuable for critically ill patients *TEE has advanced diagnostic potential, including the identification [...]
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 [...]
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 (as well as some fellows) being trained in TEE use, [...]
This is a 74yo F with a past medical history significant for ESRD and severe PVD who was transferred to the ICU overnight with presumed septic shock thought to be related to left foot osteomyelitis. She had presented to the ED with refractory hypotension and altered LOC necessitating intubation and high dose vasopressors. The POCUS team went to do a focused cardiac exam, primarily to see if there was a cardiogenic component to his shock. The following TTE images were taken and the decision was made to perform a point-of-care TEE. What do you think is going on?
This is a case of a 52 yo F trauma patient with severe traumatic brain injury. She was intubated and transferred to the ICU where, given the severity of her TBI, an intraparenchymal ICP monitor was placed by neurosurgery. The ICP monitor was initially showing an ICP of 10. Overnight, however, despite no apparent clinical change, the ICP waveform was inconsistent and the readings were now showing values around 40-50. We thus performed a point-of-care TCD to help determine whether her ICP was truly elevated or whether the ICP monitor was giving spurious information. Have a look at the following images. Do you think the TCD spectral waveform is consistent with markedly elevated ICP?
This is a 54 yo M who presented with acute hypoxic respiratory failure necessitating intubation and ICU admission. Post-intubation he had a P/F ratio of 54 despite a relatively unremarkable CXR. The PEEP was increased to try to improve oxygenation. A CTPA was ordered which was negative for PE and showed just a small right lower lobe consolidation. Given that the refractory hypoxia seemed discordant with the pulmonary pathology, concern was raised for an intracardiac shunt. A point-of-care TEE was performed including a bubble study. Have a look at the selected clips below and see what you think!
This is a case of a 56 yo F admitted with sepsis and MSSA bacteremia. A CT Head revealed several lesions concerning for septic emboli. She had known chronic significant mitral valve pathology documented prior to her admission. The POCUS team keen to see this pathology and to look for any additional signs of infective endocarditis. What do you notice about the valve on the 2D echo images and what specifically do you see on its colour doppler interrogation?