Updated 7/19/23UW & HMC ECHO I
Responsibilities:
DO AS MANY SCANS AS POSSIBLE!!
Run/monitor all DSEs: typically outpatient procedures. Follow the protocol for administering dobutamine +/- atropine. You are in the room monitoring the patient for hemodynamic changes, symptoms, and arrhythmias while the dobutamine is titrated up.
Run treadmill stress tests (TMEs) as necessary, including all treadmills for indications other than CAD (higher risk).
Helping answer clinical questions from our nurses/sonographers: this includes helping assess patients in the echo lab, ECG interpretation, pushing bubbles/echo contrast, and occasionally helping decide if the correct test was ordered for the study indication
Learning to interpret TTEs
Performing and interpreting inpatient and outpatient TEEs (at HMC and VA only). The advanced fellow does all TEEs at UWMC, but you take these over if they’re not available. Inpatient TEEs won’t get scheduled until you triage them and talk to the lead sonographer. You decide if anesthesia is required vs moderate sedation.
SCANNING: This is the most important priority
Refer to sonographers as sonographers, not “techs.” Our sonographers are extremely friendly and knowledgeable. Start by just getting to know the sonographers and then each week practicing a focused parts of the exam (eg a complete AoV evaluation).
Learn “knobology” and practice getting windows on everybody you can find.
Aim for >20 scans per month. You should be scanning all the DSEs and TMEs that you are apart of, in addition to asking to join a sonographer in the morning to scan with.
echo interpretation
Proactively address goals with the attending to focus and improve the teaching/learning.
I would highly trust the sonographer’s preliminary reads/interpretations. Ask them questions if you are not sure about something they wrote. They are an incredible teaching resource.
Additional resources: 2nd year fellow, Otto’s book, twice weekly conferences, American Society of Echo website has great guidelines which are searchable. You should follow topics out of Otto to make sure you are covering all topics and not just those that happen to show up in the lab that day.
See templates for DSE and TME interpretation below.
Harborview specific INFo
Practice taking the small Phillips machine located in the echo reading room and practice scanning inpatients when you have down time (it’s a fully functional echo machine and much better then the cardiac Sonosites available on the ICU floors). You can save and download images to the echo server with the machine. The sonographers can help you become familiar with the machine and it will be helpful when you are on call and just want to evaluate LV function or effusions yourself
daily Schedule:
8:00 AM - 5/6:00 PM
When you arrive, check out the day’s schedule in the echo office (across from the consult room). Check in with the lead sonographer to set up any ordered but not yet scheduled TEEs or DSEs.
Familiarize yourself with DSE patients: know the study indication, medical/cardiac history, and review their prior echos and current medications (particularly beta blockers, CCBs, etc). Consent the DSE patients and monitor the stress tests as scheduled.
During your down time, learn hands-on echos from the sonographers
Interpret TTEs during the morning and afternoon
If you get paged for a STAT echo, make sure you communicate this to the lead sonographer and then make sure it is read as soon as it is completed. May need to call/page your attending to finalize the read if they are not in the reading room with you.
Key Numbers:
Reading Room – 744-5539, 744-5540
Front desk/Scheduling: 744-8448
Sonographers Phone: 744-8382
Conferences:
There is lunch at 12:30 daily at the internal medicine conference.
Typically attendings are comfortable with you attending Wednesday case conference at the UW, but please ask the attending
You can "zoom" the UW imaging conference to watch remotely
UW specific info
DAILY Schedule:
7:30-5:00 PM
All Doors in the Echo lab have code 2341*
The morning is a good time to practice scanning. Introduce yourself to the sonographer and the patient and ask if you can scan, usually at the end of the study or at the end of each set of views. If you’re learning, it’s good to watch more than one complete study to see how they’re done. When you’re first starting out, practice getting windows on everyone and perfecting the basic views.
After you have scanned a few in the morning, you’ll have time to read echos. The goal in the first month is to read 3-5 per day or so.
One suggestion is to focus on one topic (chamber measurement, Aortic stenosis, mitral regurgitation) especially in the first week. Proactively address goals with the attending to focus and improve the teaching/learning.
Additional resources: 2nd year fellow, Otto’s book, twice weekly conferences, American Society of Echo website has great guidelines which are searchable. You should follow topics out of Otto to make sure you are covering all topics and not just those that happen to show up in the lab that day.
