Specialty Exams - TEE

Questão	Responda
TEE	Transesophogeal Echocardiogram
A specialized type of cardiac ultrasound by means of the patient's esophagus	TEE
Where is the transducer placed for a TEE?	It is mounted on a flexible gastroscope and positioned behind the heart
Who performs a TEE?	Physician/Cardiologist with the assistance of an echocardiographer and a nurse
What are the 4 types of TEE probes?	Omniplane/Multiplane Biplane Single Plane Pediatric
Which TEE probe mechanically rotates from the horizontal plane to the longitudinal plane, is the most up to date, and provides excellent visualization in multiple views?	Omniplane/Multiplane
Which TEE probe is the same as the multi plane but offers a smaller transducer?	Pediatric
Which TEE probe only shows a single plane that is perpendicular to the transducer (it is very limited and outdated)?	Single plane
Which TEE probe does two simultaneous scans from the same point but only one view can be visualized at a time (also outdated)	Biplane
With the biplane and Omniplane probes, who controls the view?	Biplane - sonographer with a mechanism on the machine Omniplane - physician while performing the exam
What is the virtual TEE website?	www.csecho.ca
If the transducer is at the transgastric position, where is it?	At stomach level (inferior) 40-45 cm depth
What can be visualized in the transgastric position with different degrees of rotation?	Short axis LV, 2 chamber, long axis, short axis RV, TV, and RVIT
If the transducer is in the mid-esophageal position where is it?	Behind the heart 30-40cm
In the mid-esophageal transducer position, what can be visualized?	4 chamber, 2 chamber, long axis, both vena cavas
If the transducer is in the upper esophageal position, where is it?	Superior (at base of the heart) 20-25 cm
What can be visualized in the upper esophageal transducer position?	AOV, short axis of AOV (with and without PV), long axis of aorta, long axis of aorta with AV and MV
True/False: the orientation of TEE is more like a "true view" or anatomical correct view of the heart	True
What can be visualized if the transducer is in the descending thoracic aorta position?	Short and long axis of the aorta, long axis of aortic arch
What is the orientation of TEE?	Opposite of transthoracic echo; ventricles (apex) located at bottom of screen; atriums at top of screen; short axis, LV Posterior is at top, anterior at bottom; left sided structures are right of screen
Name 4 of the 8 TEE indications	Thrombus, CSOE (cardiac source of emboli; infective endocarditis; prosthetic heart valve dysfunction; a disease of the aorta (I.e. Dissection); pre-cardioversion (patient with Afib); intracardiac masses; congenital heart disease; complications with an MI
This is performed during open heart surgery to check adequacy of valve procedures, congenital heart disease repair, assess LV function, and is an evaluation of critically ill or injured.	Intraoperative studies
True/False intraoperative studies are technically difficult transthoracic exams	True
Contraindications of TEE	Uncooperative/ unwilling patient; known esophageal pathology; upper GI bleed, unstable respiratory status; trachea may obstruct view
TEE Supplies	BP cuff/device; EKG monitor; pulse oxometer; crash cart; drugs (versed, sterile saline, etc.); emesis basin; topical lidocaine or benzocaine; surgilube; gauze; bite guard; Cidex to disinfect probe
Patient Prep for TEE	NPO for at least 6 hours prior to exam; check with physician about medication (Coumadin stopped in advance; possibly heart medicines; antibiotics to possibly deter endocarditis)
What is the procedure for TEE?	Physician passes the probe RN administers drugs and assesses patient Sonographer records images, controls, machine settings, and can assist with monitoring the patient if needed Keep an eye on temperature of probe! (Over 104 degrees the probe automatically shuts off)
What is the post TEE procedure?	Equipment is removed and the probe is disinfected by sonographer
What are TEE complications from the PROBE?	Sore throat (most common); accidental tracheal intubation (usually into the right main bronchial) causing bronchospasm; chipped tooth or lacerated tongue; mild abrasions or bruising (because anti-coagulation contraindicated); effects from over sedation; bacteremia; transient vocal cord paralysis (rare); esophageal perforation (rare)
What % of TEE patient have bacteremia?	3.2% - 12%
What organisms are responsible for bacteremia in TEE patients?	Staphylococcus aureus, staphylococcus epidermidis, and ahemolytic streptococci
Complications from the procedure	Respiratory compromise (laryngospasm, bronchospasm, hypoxia)
What cardiovascular complaints could occur as a complication from the TEE procedure?	Tachyarrhythmia - V-tach, Supraventricular tachycardia, bradyarrhythmia's - 3rd degree AV block, transient hypotension or hypertension, chest pain, precipitation of heart failure, methemoglobenemia
Unique and rare complication in TEE using topical spray anesthetic (Hurricane 20% benzocaine) - especially when inhaled or heavy amounts	Methemoglobenemia
How does one get methemoglobenemia?	The topical agent gets into the bloodstream where it oxidizes the hemoglobin and changes it into methemoglobin (methemoglobin does not carry oxygen - like carbon monoxide poisoning
True/False most people have an enzyme present that turns the abnormal red blood cell back to hemoglobin	True - a few do not and these are the patients to monitor closely but unless they've had a reaction before it may not be known
Unique signs of methemoglobenemia	Cyanosis unresponsive to O2 at 100% and in absence of cardiopulmonary symptoms Venous blood is chocolate brown Oxygen saturation should be confirmed with blood gas
Treatment of methemoglobenemia	intravenous methylene blue (return you into hemoglobin) 1-2 mg/kg of body weight
Maintenance of TEE probe	Probe must be treated very carefully - check often for cracks, erosions, or abrasions; NEVER autoclave a probe; usually cleaned with soap then soaked in Cidex solution for a brief time

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Specialty Exams - TEE

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	Criado por ecmarchese mais de 10 anos atrás