Rescue TEE
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One of the most fundamental applications of perioperative echocardiography is the evaluation of unstable patients. Opportunities arise all the time (if you have the skill) but it can be very challenging. You need to perform, interpret, and process images in real time in a very difficult clinical environment. It takes significant training and expertise to do it well. You literally cannot see enough of this! This quiz is a work in progress, and I’ll be adding more and more questions as I’m able.
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Question 1 of 4
1. Question
This trauma patient is profoundly hypotensive, what’s going on here?
Correct
Boom, you got it! This patient had a penetrating trauma, having been stabbed in the chest with an orange knife which perforated the RV. This image shows compression of the right atrium and right ventricle with an echodense “mass” which in this case represents blood.
Incorrect
Other things may be going on, of course, but the biggest problem we have here is tamponade. This image shows compression of the right atrium and right ventricle with an echodense “mass” which in this case represents blood.
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Question 2 of 4
2. Question
This patient acutely decompensated during a total hip arthroplasty. What happened?
Correct
You got it! You can see both RV dysfunction as well as a hint of an embolus in transit in the RA. Remember, the clot that made the patient hypotensive is NOT the one on the screen. That’s the one that will make the patient re-arrest, so stay alert!
Incorrect
Well, no. There may be other issues (and there is certainly RV dysfunction) but most specifically this is a PE case. You can see both RV dysfunction as well as a hint of an embolus in transit in the RA. Remember, the clot that made the patient hypotensive is NOT the one on the screen. That’s the one that will make the patient re-arrest, so stay alert!
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Question 3 of 4
3. Question
This patient became profoundly hypotensive in the middle of an ex lap. What do you think is going on?
Correct
Exactly! This heart is totally empty, consistent with profound hypovolemia. If it’s not completely obvious, always considering a quick mental “time out” to consider where the blood is.
Incorrect
This heart is totally empty, consistent with profound hypovolemia. If it’s not completely obvious, always considering a quick mental “time out” to consider where the blood is.
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Question 4 of 4
4. Question
This patient became profoundly hypotensive after induction of anesthesia and has responded poorly to a variety of vasoconstrictors and inotropes. What do you see here?
Correct
Incorrect