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Principles I Test 4

TEE

QuestionAnswer
Which is the most common TEE view used? Mid-Esophageal (ME) 4 chamber view
What structures of the heart can you identify on the ME 4 chamber view? left & right atrium, left & right ventricle, mitral valve, tricuspid valve
What 4 things can the ME 4 chamber view assess? valve disease, ventricular function, ASD, effusions
What position is the probe in for the ME 4 chamber view? 30 - 35 cm down in the esophagus, 0 degree plane
How do you adjust the probe from the ME 4 chamber view to see the ME 2 chamber view? turn the probe 90 degrees (so that the LA and LV are isolated)
What structures can be identified on the ME 2 chamber view? left atrium, left ventricle, mitral valve, coronary sinus, left atrial appendage (LAA)
What 4 things can the ME 2 chamber view assess? mitral valve disease, left ventricular size, left ventricular function, LAA thrombus
Which views are used to assess for a thrombus? ME 2 chamber view or ME AV SAX view
What 4 heart structures can the ME LAX (long axis view) identify? mitral valve, aortic valve, left ventricular outflow tract (LVOT), septum
How do you turn the probe to see the ME LAX view? turn the probe 120 to 130 degrees.
What can be assessed on the ME LAX view? left ventricular outflow tract (LVOT), aortic valve disease, anterior mitral valve leaflet (AMVL), posterior mitral valve leaflet (PMVL)
Describe the position of the probe for the transgastric mid SAX view? 40 - 45 cm, probe at 0 degrees plane
What can be identified on the transgastric mid SAX view? 6 left ventricular segments
What 5 things can be assessed on the transgastric mid SAX view? left ventricular size, left ventricular function, ejection fraction, effusions, and volume status
How do you orient the probe to see the ME AV SAX view? 30 - 35 cm, probe at 45 degrees plane
What structures can you identify on the ME AV SAX view? aortic valve, size of the left atrium, atrial septum, left atrial appendage (LAA)
What can be assessed on the ME AV SAX view? ASD, aortic valve disease, thrombus is left atrial appendage (LAA)
True or false: the left atrial appendage (LAA) can only be seen with TEE, not with a TTE. True! This is crucial in patient's with new onset a-fib before a cardioversion is to be performed.
True or false: it is important to keep the probe in a locked position when inserting. False!!! Probe must be in unlocked position ("neutral") or you will punch a hole in the esophagus.
How many centimeters is the probe inserted for an upper esophageal view? 20 - 30 cm
How many centimeters is the probe inserted for a mid esophageal view? 30 - 40 cm
How many centimeters is the probe inserted for a transgastric view? 40 - 45 cm
What frequency does TEE use? 2 - 10 Mhz
Air is viewed as what color on a TEE? light white
Blood or fluid is viewed as what color on a TEE? dark
Color doppler imaging is good for evaluating regurgitation. What colors are displayed? away flow = blue; toward flow = red
Which is better at identifying an MI, TEE or EKG? TEE - MI shows up here before it is seen on the EKG!
What does a Category I clinical indication mean? TEE improves clinical outcomes, and this is supported by stron evidence or expert opinion.
What does a Category II clinical indication mean? TEE may improve outcomes, but is supported by weaker evidence or expert consensus.
What does a Category III clinical indication mean? TEE infrequently improves outcomes & may even be harmful. There is little current scientific evidence or support for use.
What are some advantages TEE has as a monitor of overall heart functioning? doesn't interfere with surgical field, probe is stabilized, image distortion likely since sound waves pass only through esophagus, ischemia can be detected through regional wall abnormalities sooner than on an EKG
What is the only absolute contraindication for performing a TEE? esophageal surgery
What are some relative contraindications for performing a TEE? inexperiences anesthetist, hx of dysphagia, esophageal varicose or strictures, hiatal hernia, coagulopathy, cervical spine instability, mediastinal radiation, upper airway pathology
What is the utility of the basic TEE intraoperative exam? unexplained hemodynamic instability, PE, hypovolemia, depression myocardial function (AWM indicative of acute ischemia), pneumothorax, pericardial effusions, cause of PEA
What is the usefulness of TEE during resuscitation? can identify reversible causes of PEA, can identify images during chest compressions (esophageal damage during compressions = rare), can deliver shock (probe is electrically isolated), ME 4 chamber view used to monitor effective chest compressions
Created by: Mary Beth