Teaching Basic Bedside Transthoracic Echocardiography and Ultrasonography Examination to Evaluate Hypotension and Hypoxemia

Internet Enduring Material Sponsored by the Stanford University School of Medicine. Presented by the Anesthesia Informatics and Media Lab, Department of Anesthesia at Stanford University School of Medicine

Frequently, healthcare professionals are required to handle medical emergencies and manage hemodynamically unstable patients. Recently, new tools and technologies have become available to enhance diagnosis and management of these patients. Small, relatively inexpensive hand-carried cardiac ultrasound (HCU) devices have become available in the inpatient and outpatient settings. Because they are relatively easy to use and portable, HCU's have made powerful echocardiographic diagnostic data available to physicians. Yet, many of today's practicing physicians lack formal training or a thorough understanding of the basic principles of operation of these devices and the diagnostic benefits they offer. This course will provide an evidence-based overview of the use of HCU's at the clinic and the bedside using video based didactics and demonstrations.

This online curriculum is not a replacement for Level 1 or Level 2 training recommendations by the American Society of Echocardiography (ASE) and American College of Cardiology (ACC), which require personally performing and interpreting echo examinations.

However, the curriculum is a didactic and interactive introduction to the topic, designed to motivate practicing physicians to pursue hands-on training to achieve Level 1 or Level 2 ASE HCU training through further study and practice.

In addition to providing an overview and foundational knowledge about the use of HCU’s in the clinical setting, the curriculum is designed to provide an educational roadmap to further training opportunities and courses that will allow practicing physicians to become independently competent in the use of HCU’s to complement their clinical examination and improve their diagnostic skills.

This course is designed for physicians with the following specialties: cardiology, family practice, primary care, general surgery, internal medicine, critical care, pulmonology, and emergency medicine.

• Original Release Date: August 29, 2013
• Latest Review Date: August 12, 2015
• Expiration Date: August 31, 2017
• Estimated Time to Complete: 1.5 Hours
• CME Credits Offered: 1.50
• Registration Fee: FREE

• Review the information below and complete the entire activity.
• Complete the CME Post-test, CME Evaluation Survey, and CME Activity Completion Statement at the end of the activity.
• You must receive a score of 75% or higher on the post-test in order to receive a certificate. You will have two attempts to answer each multiple-choice question (or one attempt for questions with only two options) to pass the post-test.
• Once you attest to completing the entire online activity and have scored 75% or higher on the post-test, your certificate will be generated automatically and will be available on your Dashboard page.
• Physicians will be awarded AMA PRA Category 1 Credits™. All other participants will receive a Certificate of Participation.

At the conclusion of this activity, participants should be able to:

• Develop skills to personally use HCU devices and interpret echo examinations such as identifying cardiac and pulmonary anatomy from HCU exam images and performing a basic HCU exam of the heart and lungs.
• Develop skills to use HCU devices to diagnose and confirm appropriate therapeutic treatment of pneumothorax.
• Develop skills to use HCU devices to assess hypoxemia, hypovolemia, and hypotension.
• Develop skills to use HCU devices to assess presence of cardiac tamponade.
• Develop skills to use HCU devices to assess ventricular function during CPR.

1. Introduction to Transthoracic Echocardiography (3 Minutes)
2. Indications, Limitations, Contraindications (10 Minutes)
3. Overview of Acquiring an Image with Transthoracic Echocardiography (15 Minutes)
4. The Parasternal Window View (5 Minutes)
5. The Apical Window View (11 Minutes)
6. The Subxiphoid Window View (14 Minutes)
7. The Lung Examination (10 Minutes)
8. Putting It All Together (17 Minutes)
9. Course Wrap-up
10. Resoruces and References
11. Help!

The following planners, speakers, and reviewer have indicated that they have no relationships with industry to disclose relative to the content of this activity:

Lawrence Chu, MD, MS
Associate Professor of Anesthesiology
Stanford University School of Medicine
Course Director
Speaker
Reviewer

T. Kyle Harrison, MD
Clinical Assistant Professor of Anesthesiology (Affiliated)
Stanford University School of Medicine
Staff Physician VA Palo Alto Health Care System
Co-Course Director
Speaker

Carlos Brun MD
Clinical Instructor
Staff Physician VA Palo Alto Health Care System
Speaker

Larry Chu, MD, MS – Director
Stanford Anesthesia and Informatics Lab (AIM Lab)

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The Stanford University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Stanford University School of Medicine designates this enduring material for a maximum of 1.50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The Stanford University School of Medicine has received and has used undesignated program funding from Pfizer, Inc. to facilitate the development of innovative CME activities designed to enhance physician competence and performance and to implement advanced technology. A portion of this funding supports this activity.

California Assembly Bill 1195 requires continuing medical education activities with patient care components to include curriculum in the subjects of cultural and linguistic competency. It is the intent of the bill, which went into effect July 1, 2006, to encourage physicians and surgeons, CME providers in the State of California and the Accreditation Council for Continuing Medical Education to meet the cultural and linguistic concerns of a diverse patient population through appropriate professional development. The planners and speakers of this CME activity have been encouraged to address cultural issues relevant to their topic area. The Stanford University School of Medicine Multicultural Health Portal also contains many useful cultural and linguistic competency tools including culture guides, language access information and pertinent state and federal laws.

You are encouraged to visit the portal: http://lane.stanford.edu/portals/cultural.html

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If you are having technical problems (video freezes or is unplayable, can't print your certificate, etc.) you can submit a Help Request to the OpenEdX Team. If you have questions related to CME credit, requirements (Pre-test, Post-test, Evaluation, Attestation) or course content, you can contact the CME Online support team at cmeonline@stanford.edu

Quiñones MA, Douglas PS, Foster E, Gorcsan J 3rd, Lewis JF, Pearlman AS, et al. ACC/AHA clinical competence statement on echocardiography: a report of the American College of Cardiology/American Heart Association/American College of Physicians-American Society of Internal Medicine Task Force on Clinical Competence. J Am Coll Cardiol. 2003;41(4):687-708.

Karabinis A, Fragou M, Karakitsos D. Whole-body ultrasound in the intensive care unit: a new role for an aged technique. J Crit Care. 2010;25(3):509-13. Epub 2009 Sep 24.

Beaulieu Y. Bedside echocardiography in the assessment of the critically ill. Crit Care Med. 2007;35(5Suppl):S235-49.