TEE
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| Which is the most common TEE view used? | Mid-Esophageal (ME) 4 chamber view
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| What structures of the heart can you identify on the ME 4 chamber view? | left & right atrium, left & right ventricle, mitral valve, tricuspid valve
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| What 4 things can the ME 4 chamber view assess? | valve disease, ventricular function, ASD, effusions
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| What position is the probe in for the ME 4 chamber view? | 30 - 35 cm down in the esophagus, 0 degree plane
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| 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)
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| What structures can be identified on the ME 2 chamber view? | left atrium, left ventricle, mitral valve, coronary sinus, left atrial appendage (LAA)
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| What 4 things can the ME 2 chamber view assess? | mitral valve disease, left ventricular size, left ventricular function, LAA thrombus
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| Which views are used to assess for a thrombus? | ME 2 chamber view or ME AV SAX view
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| What 4 heart structures can the ME LAX (long axis view) identify? | mitral valve, aortic valve, left ventricular outflow tract (LVOT), septum
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| How do you turn the probe to see the ME LAX view? | turn the probe 120 to 130 degrees.
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| 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)
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| Describe the position of the probe for the transgastric mid SAX view? | 40 - 45 cm, probe at 0 degrees plane
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| What can be identified on the transgastric mid SAX view? | 6 left ventricular segments
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| What 5 things can be assessed on the transgastric mid SAX view? | left ventricular size, left ventricular function, ejection fraction, effusions, and volume status
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| How do you orient the probe to see the ME AV SAX view? | 30 - 35 cm, probe at 45 degrees plane
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| What structures can you identify on the ME AV SAX view? | aortic valve, size of the left atrium, atrial septum, left atrial appendage (LAA)
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| What can be assessed on the ME AV SAX view? | ASD, aortic valve disease, thrombus is left atrial appendage (LAA)
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| 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.
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| 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.
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| How many centimeters is the probe inserted for an upper esophageal view? | 20 - 30 cm
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| How many centimeters is the probe inserted for a mid esophageal view? | 30 - 40 cm
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| How many centimeters is the probe inserted for a transgastric view? | 40 - 45 cm
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| What frequency does TEE use? | 2 - 10 Mhz
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| Air is viewed as what color on a TEE? | light white
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| Blood or fluid is viewed as what color on a TEE? | dark
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| Color doppler imaging is good for evaluating regurgitation. What colors are displayed? | away flow = blue; toward flow = red
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| Which is better at identifying an MI, TEE or EKG? | TEE - MI shows up here before it is seen on the EKG!
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| What does a Category I clinical indication mean? | TEE improves clinical outcomes, and this is supported by stron evidence or expert opinion.
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| What does a Category II clinical indication mean? | TEE may improve outcomes, but is supported by weaker evidence or expert consensus.
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| 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.
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| 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
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| What is the only absolute contraindication for performing a TEE? | esophageal surgery
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| 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
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| 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
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| 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
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Created by:
Mary Beth
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