TTE
Is Bradycardia an appropriate diagnosis for an echo according to our appropriate use document?
No, only symptomatic Bradycardia or some other cardiac sign or symptom included with it.
Cleaning TEE probes- How many oz of metrizyme cleaner do you need for 1 gallon of water?
2 oz!
Name a contraindication to a dobutamine stress echo?
LBBB, Resting ST segment depression >1mm, ST elevation, Uncontrolled A-fib, Paced rhythms, HOCM, Uncontrolled HTN, WPW
Name an appropriate indication for a STAT echo?
Hemodynamic compromise (trauma or shock)
Question of pericardial effusion and tamponade
Acute MI with complication
Suspected Aortic dissection
Gift of Life scans
How often do we need to clean the filters on the Ultrasound machines?
Monthly
To confirm a L - R shunt on echo, this specific type of echo study can be performed.
Bubble study!
Best TEE view of mitral valve for 3D
en fac or "surgical view" obtained from mid-esophageal position
What are the 4 stages of images you acquire images for a dobutamine stress echo?
Rest
Low dose (5-10 mcg)
Mid dose (20-30 mcg)
Peak dose (when patient reaches 85% MPHR)
What are a few critical findings that should be reported to the cardiologist immediately?
Suspected cardiac tamponade
Thrombus in transit
complications of MI (example pseudoaneurysm)
acute RV dysfunction with PE
LV assist device complications
severe valve obstruction in prosthetic or native valves
suspected aortic dissection
What is the wet time for Protex wipes?
4 minutes
What does an early closure of the Mitral Valve suggest on echo?
Severe Aortic Stenosis
What cleaning wipes are approved to wipe down the TEE probe storage bins if you cannot take them to sterile processing?
Purple top wipes
Which type of stress echo should you not use Definity?
Low does dobutamine stress echo for AS gradients
What steps should you take for reporting a Definity reaction?
Document allergy in EHR with a note about the severity and reaction type
Add it to the echo report in CPACs
Submit a PSR
Adverse event report needs to be submitted by phone call to Lantheus
Name some common ergonomic hazards in sonography?
The classic triad for clinical diagnosis of infective endocarditis is?
Blood cultures, Fever of unknown origin, new murmur
What 3 PPE are required during the reprocessing of the TEE scopes?
Gloves
Eye protection/shield
Fluid resistant gown
What wall segment areas are supplied by the LAD region?
Anterior wall
Anteroseptal wall (anterior two-thirds of IVS)
Apex
Anterolateral wall
sometimes the Apical inferior wall
Is a verbal order appropriate for a bubble study?
No, needs to be a written order.
Where can you find the location to file a PSR/WVR?
Bronson intranet, under the applications tab (Patient safety reporting link)
Patient has severe LVH, systolic anterior motion of the mitral valve (SAM) and a dagger-shaped late peaking Doppler pattern in the LVOT with turbulent flow. What might they have?
Hypertrophic Obstructive Cardiomyopathy (HOCM)
What should you wipe the steering mechanism, cable and connector with?
70% isopropyl alcohol and short cloth and make sure it is dry!
How long are each stage for an exercise stress echo?
3 minutes
Immediately replace the original cap and be disposed of as a non-hazardous waste.
How do you ensure optimal image quality during an exam?
Protocols, image optimization, echo enhancement agent, patient positioning