Jeff Granton

Focused transesophageal echocardiography for emergency physicians—description and results from simulation training of a structured four-view examination

BackgroundTransesophageal echocardiography (TEE) offers several advantages over transthoracic echocardiography (TTE). Despite these advantages, use of TEE by emergency physicians (EPs) remains rare, as no focused TEE protocol for emergency department (ED) use has been defined nor have methods of training been described.ObjectiveThis study aims to develop a focused TEE examination tailored for the ED and to evaluate TEE skill acquisition and retention by TEE-naïve EPs following a focused 4-h curriculum.MethodsAcademic EPs were invited to participate in a 4-h didactic and simulation-based workshop. The seminar emphasized TEE principles and views obtained from four vantage points. Following the training, participants engaged in an assessment of their abilities to carry out a focused TEE on a high-fidelity simulator. A 6-week follow-up session assessed skill retention.ResultsFourteen EPs participated in this study. Immediately following the seminar, 14 (100 %; k = 1.0) and 10 (71.4 %, k = 0.65) successfully obtained an acceptable mid-esophageal four-chamber and mid-esophageal long-axis view. Eleven (78.6 %, k = 1.0) participants were able to successfully obtain an acceptable transgastric short-axis view, and 11 (78.6 %, k = 1.0) EPs successfully obtained a bicaval view. Twelve participants engaged in a 6-week retention assessment, which revealed acceptable images and inter-rater agreement as follows: mid-esophageal four-chamber, 12 (100 %; k = 0.92); mid-esophageal long axis, 12 (100 %, k = 0.67); transgastric short-axis, 11 (91.7 %, k = 1.0); and bicaval view, 11 (91.7 %, k = 1.0).ConclusionThis study has illustrated that EPs can successfully perform this focused TEE protocol after a 4-h workshop with retention of these skills at 6 weeks.

8th Annual Toronto Critical Care Medicine Symposium, 30 October–1 November 2003, Toronto, Ontario, Canada

The eight annual Toronto Critical Care Symposium was held from October 30th to November 1st 2003, in downtown Toronto, Ontario, Canada. This symposium is Canadas premier critical care conference and attracts participants from across the country, the United States, Europe, Australia and Asia. This year the attendance was in excess of 900 people and included the disciplines of medicine, nursing, respiratory therapy and other allied health care professionals. The themes of this years meeting included sepsis, organ donation, blood conservation strategies, acute lung injury and ethics. In addition, many of the plenary addresses reviewed the recent SARS crisis. The discussion surrounding SARS was particularly poignant, as Toronto was the North American city most affected by the outbreak.