DK2985_C000 1..28 - AlSharqia Echo Club

Equipment, Complications, Infection Control, and Safety 145Table 7.3Equipment Required for TEE ExaminationCrash cartInstruments and accessories for intubationSuctionOxygenPulse oxymetryBlood pressure monitorEKG monitorBite blockGloves, mask, protective glasses, gownMedication: atropine, epinephrine, lidocaine spray, midazolam,propofol, flumazenil, naloxone, sodium citrateobtained, such as in the case of aortic dissection, nativeand prosthetic valvular dysfunctions, endocarditis andsource of emboli (7), as well as a monitoring device inperioperative and emergency care. TEE is indicated whenevertransthoracic echocardiography (TTE) is inconclusiveand when further information could significantly alter thetherapeutic management. The general approach to TEE issummarized in Fig. 7.3 and the indications for use arereviewed in Chapter 25 (see also Table 7.4).B. EvaluationBefore proceeding to the TEE examination it is importantthat the patient be informed of the aims, technique, andrisks of the procedure. The patient’s informed consentshould be documented in his/her medical record. Thepre-procedure evaluation should include a review of theindications, present and past medical history, allergies,current medication, and pertinent physical examinationfindings. Potential contraindications to the examinationshould be anticipated (Table 7.5). Significant dysphagiashould be regarded as indirect evidence of narrowing ofthe upper gastrointestinal tract and constitutes a relativecontraindication to immediate insertion of the TEEprobe. The diagnosis should be clarified by a bariumswallow or a gastroenterology consultation. Adequateairway, mouth opening (sometimes reduced in diabeticpatients with stiff joint syndrome), neck mobility and stabilityshould be confirmed, particularly when cervicallesions are suspected such as with trauma or severe rheumatoidarthritis. Older patients are prone to occult esophageallesion, arthritis, and diabetic gastroparesis. Adultcongenital heart patients may present specific problemsfor sedation and airway management (8): for example,patients with Down’s syndrome may have atlantoaxialFigure 7.3General approach to the use of TEE (ACC, American College of Cardiology; AHA, American Heart Association).