Echo-of-the-Day

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AMA Category 1 Credit for Physicians Only.
ASRT CME is not available.

Echo-of-the-Day Information

The Case-of-the-Week is a presentation of 8 or more video loops to present an important topic in echocardiography. Please reveiw the image or video loops and then answer the questions below. After you have answered the questions you can view the explanation and obtain CME credit (if available).

You can change the size and the format of the image or video loops by using the links below the image or video loop.

= Windows Media Video	= MP4 Video
= QuickTime	= WebM Video
= Flash	= Ogg Video
= JPG Image	= GIF Image
Image/Video Sizes
1X = 200x150 pixels 2X = 400x300 pixels	3X = 600x450 pixels 4X = 800x600 pixels

Loop Text Key
Preop	Preop TEE or TTE
Intraop	An Intraop TEE
IntraopPreOp	Intraop TEE or TTE before Operation
IntraopPostOp	Intraop TEE or TTE after Operation
IntraopEnd	Intraop TEE or TTE at End of Anesthesia
Post Op	Postop TEE or TTE
	= Legacy/Old Video Formats

Case of the Month Information Table

IntraopEnd is usually a TEE after the Operation and after some event occured to show a change in the TEE

Rub a Dub Dub

Case#: 237

AMA CME Units: 0.25 Units
Estimated Time: 15 minutes.

Presentation:
A patient presented with the following echo loops:

Loop(s):

Case Discussion

While you cannot see the hand on the heart, this is an echo of internal cardiac massage. The patient has a PFO causing a left to right shunt that is small. The heart is asystolic.

Echo in Life Support (ELS) has been studied to determine if echo exams during cardiac arrest would be feasible and helpful in the outcome of a patient. ELS can indicate volume status of the heart, tamponade and/or pericardial effusions, pleural effusions, shunts, regurgitation, dissection, pulmonary embolism (2D or 3D) and wall motion abnormalities that could impact the outcome of the patient who requires cardiac life support. One study showed that 12% of patients had an intervention from the echo results. Wall motion of the ventricle had a positive predictive value of 55%. Absence of ventricular wall motion had a negative predictive value of 97%. In another study ELS altered therapy in 78% of patients. In both studies, 94% of patients had an adequate echo study for diagnosis and assessment.

A single day training course did not compromise the outcomes of cardiac arrest patients and novice providers were able to obtain views in a short period of time (10 seconds) during a cardiac arrest. The echo exam was built into the ALS protocol in this situation.

CME Section

Please answer the following questions correctly to obtain your CME.

Web Links/References

An evaluation of echo in life support (ELS): is it feasible? What does it add?
Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial.
Emergent bedside real-time three-dimensional transesophageal echocardiography in a patient with cardiac arrest following a caesarean section.
Peri-resuscitation echocardiography: training the novice practitioner.
Echocardiography in cardiac arrest.

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This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of University of Nebraska Medical Center, Center for Continuing Education and JLS Interactive, LLC.

The University of Nebraska Medical Center, Center for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

This activity is approved by the American Society of Radiologic Technologists (ASRT) as sonography-related continuing education (CE). Credit(s) issued for successful completion of ASRT-approved CE activities are accepted by the American Registry of Diagnostic Medical Sonography, American Registry of Radiological Technologists, Cardiovascular Credentialing International and Canadian Association of Registered Diagnostic Ultrasound Professionals. Contact the applicable registry for additional information / restrictions on their acceptance of ASRT CE credit.