TEE in critical care

[MDAforthewin]

TEE sounds like a great skill to have in the ICU. However with turf wars going on all the time it seems like cards would have a monopoly on these procedures and thus you would always get bumped out of those situations. I'm still early in my education so my apologies if this an elementary question. I know what TEE is capable of but its seems like everyday usage of it in the ICU is widely variable across settings and geography. Can anyone speak to this?

Basically, if you are TEE certified (not testamur) how do you use TEE in your everyday ICU setting.

Thanks.

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[codeb1ue]

I am very interested in knowing the answer to this as well. I have the opportunity to become basic TEE certified next year at my residency program and want to make sure it is worth the effort (TEE boards are at the same time as anesthesia boards).

By the way, I really dislike the term MDA. I hope your program doesn't regularly use this term to differentiate yourselves from CRNAs.

 

[B-Bone]

I find that TEE is rarely used in ICU's routinely. Most ICU questions that require echocardiography can be answered with TTE which is quicker and much less invasive. This is frequently performed by intensivists (of whatever flavor) or cardiologists. Anesthesiologists tend not to get much exposure to TTE in residency given that it is pretty much never useful intraop and we focus on TEE for cardiac surgery rather than ICU applications. However, once you have a good conceptual understanding of TEE, TTE is relatively easy to understand. If you do a CC or CV fellowship, you may get significant TTE exposure, depending on where you train. I had no TTE training in residency. I have read a few books and spent a lot of time looking at stills and clips as well as just throwing a TTE probe on my partners and patients for practice, and I'm getting the hang of it. In Europe, where all anesthesiologists are also CC docs, they tend to focus a lot more on TTE for anesthesiologists. The FATE (focused assesed transthoracic echocardiography) program from Denmark has been around for about 10 years, and is a nice intro to TTE (usabcd.org). They do one and two day courses throughout Europe if you're ever looking for a tax deduction on your European vacation.