Updated 11/22/24UW & HMC ECHO I
TEE Resources:
Responsibilities:
DO AS MANY SCANS AS POSSIBLE!!
Run/monitor all DSEs: typically outpatient procedures. Follow the protocol for administering dobutamine +/- atropine. You are in the room monitoring the patient for hemodynamic changes, symptoms, and arrhythmias while the dobutamine is titrated up.
Message the primary reader before starting the DSE (some attendings wish to be present in the room)
Atropine is contraindicated in patients who are status post-heart transplant. It can cause profound bradycardia
Run treadmill stress tests (TMEs) as necessary, including all treadmills for indications other than CAD (higher risk).
Helping answer clinical questions from our nurses/sonographers: this includes helping assess patients in the echo lab, ECG interpretation, pushing bubbles/echo contrast, and occasionally helping decide if the correct test was ordered for the study indication
Learning to interpret TTEs
Performing and interpreting inpatient and outpatient TEEs (at HMC and VA only). The advanced fellow does all TEEs at UWMC, but you take these over if they’re not available. Inpatient TEEs won’t get scheduled until you triage them and talk to the lead sonographer. You decide if anesthesia is required vs moderate sedation.
SCANNING: This is the most important priority
Refer to sonographers as sonographers, not “techs.” Our sonographers are extremely friendly and knowledgeable. Start by just getting to know the sonographers and then each week practicing a focused parts of the exam (eg a complete AoV evaluation).
Learn “knobology” and practice getting windows on everybody you can find.
Aim for >20 scans per month. You should be scanning all the DSEs and TMEs that you are apart of, in addition to asking to join a sonographer in the morning to scan with.
echo interpretation
Proactively address goals with the attending to focus and improve the teaching/learning.
I would highly trust the sonographer’s preliminary reads/interpretations. Ask them questions if you are not sure about something they wrote. They are an incredible teaching resource.
Additional resources: 2nd year fellow, Otto’s book, weekly conferences, American Society of Echo website has great guidelines which are searchable. You should follow topics out of Otto to make sure you are covering all topics and not just those that happen to show up in the lab that day.
Harborview specific INFo
Practice taking the small Phillips machine located in the echo reading room and practice scanning inpatients when you have down time (it’s a fully functional echo machine and much better then the cardiac Sonosites available on the ICU floors). You can save and download images to the echo server with the machine. The sonographers can help you become familiar with the machine and it will be helpful when you are on call and just want to evaluate LV function or effusions yourself.
Attend HMC case conference every Tuesday at 12:00-1:00 PM. Bring a case to discuss. No need to prepare a formal presentation but know your case well.
daily Schedule:
8:00 AM - 5/6:00 PM
When you arrive, check out the day’s schedule in the echo office (across from the consult room). Check in with the lead sonographer to set up any ordered but not yet scheduled TEEs or DSEs.
Familiarize yourself with DSE patients: know the study indication, medical/cardiac history, and review their prior echos and current medications (particularly beta blockers, CCBs, etc). Consent the DSE patients and monitor the stress tests as scheduled.
During your down time, learn hands-on echos from the sonographers
Interpret TTEs during the morning and afternoon
If you get paged for a STAT echo, make sure you communicate this to the lead sonographer and then make sure it is read as soon as it is completed. May need to call/page your attending to finalize the read if they are not in the reading room with you.
Key Numbers/Door Codes:
Please refer to the Logistics Tab —> Contacts or Door Codes
Conferences:
Occurs weekly on Thursday from 0730-0830 on zoom. Alternates between:
EchoSAP: Echo board review questions. Sessions are led by a 2nd or 3rd year fellow.
Attending lecture series: Echo lectures given by imaging attendings at UW and visiting lecturers.
Echo Case Review: Review of interesting echocardiograms
Plan to present 1-2 cases with discussion points
Echo Case Review: Put together a loose "presentation" (really not a presentation but simply a guideline for organization)
The goal is to have these conferences revolve around cases that teach about a particular theme
Examples: RV quantification, MR quantification by PISA method, pulmonary HTN, ASD (can go through types, have examples of each)
Structure/Format Per Case:
Intro and review of images (5 min)
Basics of whatever you are discussing (i.e. RV size, RV quantification and pitfalls of each method) (5-10 min)
Wrap up, discussion (5 min)
UW specific info
DAILY Schedule:
7:30-5:00 PM
The morning is a good time to practice scanning. Introduce yourself to the sonographer and the patient and ask if you can scan, usually at the end of the study or at the end of each set of views. If you’re learning, it’s good to watch more than one complete study to see how they’re done. When you’re first starting out, practice getting windows on everyone and perfecting the basic views.
After you have scanned a few in the morning, you’ll have time to read echos. The goal in the first month is to read 3-5 per day or so.
One suggestion is to focus on one topic (chamber measurement, Aortic stenosis, mitral regurgitation) especially in the first week. Proactively address goals with the attending to focus and improve the teaching/learning.
Additional resources: 2nd year fellow, Otto’s book, twice weekly conferences, American Society of Echo website has great guidelines which are searchable. You should follow topics out of Otto to make sure you are covering all topics and not just those that happen to show up in the lab that day.
