TEE Rotation Goals and Objectives

The objective of this rotation is to obtain basic knowledge and competency in intraoperative transesophageal echocardiography as a monitor and diagnostic tool in the setting of perioperative emergencies. To accomplish this, residents should be able to:

Medical Knowledge

  • Describe the normal cardiac anatomy as visualized on the comprehensive 20-view transesophageal echocardiographic exam.
  • Explain the coronary vascular anatomy and how various coronary vascular territories are visualized on the tranesophageal echocardiographic exam.
  • Articulate a comprehensive approach to the echocardiographic evaluation of perioperative hypotensive and hypoxemic emergencies and how specific etiologies are visualized on transesophageal echocardiography.
  • Describe the echocardiographic techniques available to make hemodynamic assessments (ie. Cardiac output, RVSP, evaluating sinus rhythm).
  • Understand the basic physics of echocardiographic imaging and the artifacts that can result.
  • Articulate the principles behind the different echocardiographic modalities (ie. color Doppler, pulse wave (PW) Doppler, continuous (CW) Doppler, M-mode) including how and when to apply them.
  • Identify the risks associated with transesophageal echocardiographic probe placement and the indications and contraindications to probe placement.

Patient Care

  • Be able to identify patients with the appropriate indications for perioperative transesophageal echocardiography and describe how they would benefit from echocardiographic evaluation or monitoring.
  • Appropriately evaluate risk factors for transesophageal echocardiographic probe placement in a given patient.
  • Effectively communicate with the primary anesthesia team (ie. in non-cardiac patients) the goals of the echocardiographic exam and the findings. At least 3 exams should be performed in non-cardiac surgical patients.
  • Safely place transesophageal echocardiography probe using atraumatic, 2 –finger technique and/or direct laryngoscopy assistance as needed, including being able to successfully place probe in 5 patients.
  • Describe pertinent findings in the echocardiographic exam and be able to distinguish between normal and abnormal anatomy/function (ie. valvular abnormalities, ventricular dysfunction, wall motion abnormalities)
  • Be able to obtain all 20-views in thecomprehensive transesophageal echocardiographic exam and identify the anatomic structures in these views.
  • Appropriately identify the vascular territories responsible for various myocardial wall motion abnormalities.

Interpersonal Communication Skills

  • Effectively discuss risks and benefits of perioperative transesophageal echocardiography to patients identified for elective intraoperative monitoring.
  • Communicate with the primary teams to help facilliate the availability of intraoperative monitoring/evaluation for their patient.
  • Effectively communicate pertinent echocardiographic findings to the primary anesthesia team as well as surgical team and relevant post-operative care teams (ie. ICU team, medicine co-management team). This includes documenting findings in the patients chart to be reviewed and co-signed by the supervising cardiac attending.
  • Ability to negotiate the multiple anesthetic responsibilities of the primary anesthesia team while performing the intraoperative echocardiographic exam. This may mean assisting the team in various ways to ensure that the echocardiography exam facilitates the management of the patient rather than interferes with it.

Systems-Based Practice

  • Confirm that a transesophageal echocardiography report is complete and signed in EPIC for every patient.
  • Ensure that all echocardiography equipment is well cared for, accounted for and returned to the anesthesia technicians for processing at the end of the procedure.
  • Report equipment damage or problems to Dr. Oakes and Diane Alejandro-Harper so appropriate management can be instituted.

Professionalism

  • Properly introduce themselves to patient and obtain informed consent when reviewing risks and benefits of perioperative transesophageal echocardiography
  • Facilitate the surgical procedure through timely arrival and preparation.
  • Keeps accurate record of all procedure performed and report any complications encountered.

Practiced Based Learning

  • At end of two weeks demonstrate the ability to perform a comprehensive 20-view TEE exam and identify areas of need for continued learning.
  • Read and demonstrate familiarity of the relevant literature (provided in the syllabus).
  • Review and develop competency with the available on-line lecture material (ie. Moodle website) as well as the on-line websites identified in the syllabus (ie. Toronto 3-D TEE, E-Echocardiography).
  • Attend daily teaching sessions with the designated TEE attending (available for ½ day each day), utilize the TEE simulator, and attend the monthly evening TEE sessions

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