PerfWeb 5 X-Ray Trans Esophageal Echo. Acute Respiratory Distress Syndrome CT Scan. Lucas Duvall, MD

Learn how to read the basic chest X-Ray, CT Scans, and Trans – Esophageal Echo. A description of a systematic method for examining a chest X-ray and a review of the relevant thoracic anatomyRegister @library.perfusioneducation.comFaculty:Lucas Duvall, MDPatrick O’Toole, CPP PerfusionistJoseph Basha, CPP Perfusionist0:00—Open – Joe Basha, CPP6:30—What is X-Ray. Pros of X-ray7:00—What you can see when you look at x-ray (how to read x-ray) steps: Make sure is the right patient Make sure is correct date of the study Look at the bony structures (clavicles, ribs, spine) Make sure patient do not have clavicle fracture. Look at the soft tissue structures (heart, trachea, bronchial, Diaphragm, stomach, soft tissue in the neck)9:56—Looking at the soft tissues10:00—What are looking at (x – ray) pericardium has been open, etc.#1 Artery coming down to#2 Superior vena cava#3 Arch of the aorta#4 Left lateral border of the heart#6 Pulmonary arteries of the veins#7 Around the left ventricular#8 moving down to subsegmental pulmonary artery veins#9 Right border of the heart#10 lung field#11 Inferior vena cava as well diaphragm#12 Reflection of pericardium to diaphragm and to gastric region11:44—Particular X-ray has few different things to look at: Intubated patient11:53—Trachea tube12:00—EKG leads12:18—Patient with significant pneumonia or ARDS (Acute Respiratory Distress Syndrome)15:30—X-Ray white spots indicates some sort of pathology16:58—Classic x ray funding subsegmental pulmonary embolism17:22—Lungs full of fluid18:23—Bone structures normal, identify trachea, Diaphragm19:27—Large hernia defect19:38—Air bobble in the stomach (chest pain)20:42—Lungs problems (x-ray)21:48—Massive pulmonary embolism23:22—Representation of ARDS24:15—Vascular congestion24:44—Vascular congestion vs ARDS (Acute Respiratory Distress Syndrome), Cephalization of Vessels25:10—Pulmonary Edima38:54—Localization of Swan – Ganz Catheter (chest radiograph)49:38—Diagram where balloon pump to be (systole, diastole) Faculty: Lucas Duvall, MD1:29:40—Trans Esophageal Echo (TEE)1:30:00—Echo tutorial: Echocardiogram probe placement (Echocardiography for Medical Students)1:33:43—Looking to the mitral valve1:54:40—P1 vs P21:56:00—Mid esophageal two chamber view (mitral valve)2:01:17—Validating the quality of bypass graft2:01:44—Perfusing brain2:02:12—Mid esophageal mitral commissural2:04:50—Midesophageal Aortic valve short access view (SAX)2:07:15—Mid esophageal Aortic valve long access view (LAX)2:12:43—Mid esophageal Bicaval2:15:22—Tricuspid valve2:19:30—Perfect view for positioning cannulas2:20:00—Transgastric two chamber2:21:37—Massive LV thrombus (Parasternal long access view shows a large mass coming into and out of the plane of the video. there is also significant wall motion abnormality noted in the inferolateral wall and anteroseptum)2:26:18—Mitral/tricuspid endocarditis (Trans Esophageal Echo view shows a large vegetation adherent as well as large vegetation along mitral valve)2:26:40—Doppler views of the tricuspid valve show more then one leaflet is involved and that there is severe tricuspid regurgitation by color Doppler. Closer look at the mitral valve shows the posterior leaflet is primarlly involved with resultant eccentric regurgitation over the anterior leaflet. The aortic valve was a free of disease. This individual went on to have mitral and tricuspid valve surgery.2:39:54—Mechanical assist devices, pacemakers – transesophageal echocardiography improves image quality in many ways over transthoracic echo.2:40:34—The descending aorta and distal arch can be seen in SAX at 0 degrees by rotating torward the aorta from the mid esophageal position and slowly withdrawing a probe. In newer TEE systems with 3D capabilities, x plain is often used to view the aorta in both short axis (left) and long axis (right) to ensure that dissection and atheroscleortic plaque are not missed.2:42:46—Deep transgastric view, 0 degrees, 2D view (the deep transgastric view is similar to the apical 5 chamber view obtain in transthoracic imaging. Wave cursor can be oriented essentially parallel to the aortic valve from this view to allow accurate measurement of gradients across the aortic valve to assess degree of AS/AR. Deep transgastric views are the best TEE views assessing aortic stenosis and regurgitation, because in general the TEE probe can be oriented parallel to the direction LVOT and aortic valve. The deep transgastric views are obtained by advancing TEE probe deep in to stomach and gentle anteflexing.2:53:21—TEE removing air from LV S/P CABG3:17:05—CT Scan thyroid gland (esophagus, SVC) size of the CT scan cuts3:18:12—CT Scan of the liver, spleen, kidney, pancreas3:18:36—Different types of views CT Scan3:21:50—CT scan of aorta view (angiogram)3:41:49—CT scan of aortic aneurysmFaculty:Lucas Duvall, MD Patrick O’Toole, CPP Perfusionist Joseph Basha, CPP Perfusionist

Learn how to read the basic chest X-Ray, CT Scans, and Trans – Esophageal Echo. A description of a systematic method for examining a chest X-ray and a review of the relevant thoracic anatomy

Register @library.perfusioneducation.com

Faculty:Lucas Duvall, MD

Faculty: Lucas Duvall, MD

Patrick O’Toole, CPP Perfusionist

Joseph Basha, CPP Perfusionist

Joseph Basha, CPP Perfusionist 0:00 —Open – Joe Basha, CPP 6:30 —What is X-Ray. Pros of X-ray 7:00 —What you can see when you look at x-ray (how to read x-ray) steps: Make sure is the right patient Make sure is correct date of the study Look at the bony structures (clavicles, ribs, spine) Make sure patient do not have clavicle fracture. Look at the soft tissue structures (heart, trachea, bronchial, Diaphragm, stomach, soft tissue in the neck) 9:56 —Looking at the soft tissues 10:00 —What are looking at (x – ray) pericardium has been open, etc. #1 Artery coming down to #2 Superior vena cava #3 Arch of the aorta #4 Left lateral border of the heart #6 Pulmonary arteries of the veins #7 Around the left ventricular #8 moving down to subsegmental pulmonary artery veins #9 Right border of the heart #10 lung field #11 Inferior vena cava as well diaphragm #12 Reflection of pericardium to diaphragm and to gastric region 11:44 —Particular X-ray has few different things to look at: Intubated patient 11:53 —Trachea tube 12:00 —EKG leads 12:18 —Patient with significant pneumonia or ARDS (Acute Respiratory Distress Syndrome) 15:30 —X-Ray white spots indicates some sort of pathology 16:58 —Classic x ray funding subsegmental pulmonary embolism 17:22 —Lungs full of fluid 18:23 —Bone structures normal, identify trachea, Diaphragm 19:27 —Large hernia defect 19:38 —Air bobble in the stomach (chest pain) 20:42 —Lungs problems (x-ray) 21:48 —Massive pulmonary embolism 23:22 —Representation of ARDS 24:15 —Vascular congestion 24:44 —Vascular congestion vs ARDS (Acute Respiratory Distress Syndrome), Cephalization of Vessels 25:10 —Pulmonary Edima 38:54 —Localization of Swan – Ganz Catheter (chest radiograph) 49:38 —Diagram where balloon pump to be (systole, diastole) Faculty: Lucas Duvall, MD 1:29:40 —Trans Esophageal Echo (TEE) 1:30:00—Echo tutorial: Echocardiogram probe placement (Echocardiography for Medical Students) 1:33:43 —Looking to the mitral valve 1:54:40 —P1 vs P2 1:56:00 —Mid esophageal two chamber view (mitral valve) 2:01:17 —Validating the quality of bypass graft 2:01:44 —Perfusing brain 2:02:12 —Mid esophageal mitral commissural 2:04:50 —Midesophageal Aortic valve short access view (SAX) 2:07:15 —Mid esophageal Aortic valve long access view (LAX) 2:12:43 —Mid esophageal Bicaval 2:15:22 —Tricuspid valve 2:19:30 —Perfect view for positioning cannulas 2:20:00 —Transgastric two chamber 2:21:37 —Massive LV thrombus (Parasternal long access view shows a large mass coming into and out of the plane of the video. there is also significant wall motion abnormality noted in the inferolateral wall and anteroseptum) 2:26:18 —Mitral/tricuspid endocarditis (Trans Esophageal Echo view shows a large vegetation adherent as well as large vegetation along mitral valve) 2:26:40 —Doppler views of the tricuspid valve show more then one leaflet is involved and that there is severe tricuspid regurgitation by color Doppler. Closer look at the mitral valve shows the posterior leaflet is primarlly involved with resultant eccentric regurgitation over the anterior leaflet. The aortic valve was a free of disease. This individual went on to have mitral and tricuspid valve surgery. 2:39:54 —Mechanical assist devices, pacemakers – transesophageal echocardiography improves image quality in many ways over transthoracic echo. 2:40:34 —The descending aorta and distal arch can be seen in SAX at 0 degrees by rotating torward the aorta from the mid esophageal position and slowly withdrawing a probe. In newer TEE systems with 3D capabilities, x plain is often used to view the aorta in both short axis (left) and long axis (right) to ensure that dissection and atheroscleortic plaque are not missed. 2:42:46 —Deep transgastric view, 0 degrees, 2D view (the deep transgastric view is similar to the apical 5 chamber view obtain in transthoracic imaging. Wave cursor can be oriented essentially parallel to the aortic valve from this view to allow accurate measurement of gradients across the aortic valve to assess degree of AS/AR. Deep transgastric views are the best TEE views assessing aortic stenosis and regurgitation, because in general the TEE probe can be oriented parallel to the direction LVOT and aortic valve. The deep transgastric views are obtained by advancing TEE probe deep in to stomach and gentle anteflexing. 2:53:21 —TEE removing air from LV S/P CABG 3:17:05—CT Scan thyroid gland (esophagus, SVC) size of the CT scan cuts 3:18:12 —CT Scan of the liver, spleen, kidney, pancreas 3:18:36 —Different types of views CT Scan 3:21:50 —CT scan of aorta view (angiogram) 3:41:49 —CT scan of aortic aneurysm

Faculty:Lucas Duvall, MD Patrick O’Toole, CPP Perfusionist Joseph Basha, CPP Perfusionist

Faculty: Lucas Duvall, MD Patrick O’Toole, CPP Perfusionist Joseph Basha, CPP Perfusionist