Heidi J Miller, MD, MPH, Katarzyna Wolanin, MD, Pak S Leung, MD. Albert Einstein Healhcare Network
The ability of surgical residents to obtain data regarding a patient’s changing volume status can be valuable for guiding decisions regarding patient care and resuscitation in a surgical intensive care unit. The focused rapid echocardiographic evaluation (FREE) has been shown to be a reliable compliment to the use of invasive monitoring systems. Our objective was to show the efficacy of a short-course training session in teaching residents to obtain, understand and interpret echocardiography.
Surgical residents completed a written pre-test covering ultrasound physics, FREE technique and the clinical interpretation. They participated in a didactic and practical training session. They were tested on their ability to complete a point of care echo exam on a healthy subject. A written post-test exam was completed at the end of the didactic sessions. Data was stratified by PGY status and self-reported comfort with ultrasound prior to the study.
There was significant improvement (mean increased by 25%) between the pre- and post-test evaluations in ultrasound basics, identification and clinical interpretation of FREE images. There was no difference as stratified by PGY status or by self-reported comfort with ultrasonography. All participants were able to obtain and correctly orient the four views of FREE, identify anatomic landmarks and utilize the M-mode.
A half-day didactic and hands on course in echocardiography can prepare surgical residents to use focused rapid echocardiographic evaluation to aid in patient care. These skills can then be transferred into a critical care setting to inform decisions on use of vasopressors, fluid resuscitation and cardiac support.