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WINFOCUS’ BASIC ECHO (WBE)

Practical Echocardiography
and Ultrasound in Critical Care

Colin K. Grissom, MD
Critical Care Medicine, Shock Trauma ICU
Intermountain Medical Center, Murray, Utah
Professor of Medicine, University of Utah
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WINFOCUS’ BASIC ECHO (WBE)

Practical Echocardiography
and Ultrasound in Critical Care

Colin K. Grissom, MD
Critical Care Medicine, Shock Trauma ICU
Intermountain Medical Center, Murray, Utah
Professor of Medicine, University of Utah
© WINFOCUS’    CRITICAL CARE ECHOCARDIOGRAPHY
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WINFOCUS

• World Interactive Network Focused on Critical

Ultrasound (www.winfocus.org)
• International Organization
• Bringing quality “Point-of-care” Ultrasound to
the patient in all out-of-hospital and in-hospital
“critical” scenarios, by developing and fostering,
on a global and multi-disciplinary
basis, Ultrasound Education, technological
Development, Evidence-based Research, and
International Teamwork. 

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Critical Care Echocardiography
WINFOCUS
Price, S. Cardiovascular
Ultrasound 2008, 6:49

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Echocardiography Training Levels
American)College)of)Cardiology)
Competence)Statement)on)Echocardiography)
Table&1.&of&Cardiology&(ACC)&Training&Requirements&for&Performance&and&
Interpreta?on&of&Adult&Transthoracic&Echocardiography&(Quinones&et&al.&J&
Am&Coll&Cardiol&2003&)&
Dura8on)of)Training) Number of Examinations

Level)1) 3)months) 150 interpreted

(includes 75 exams performed)
Level)2) 6)months) 300 interpreted
(includes 150 exams performed)
Level)3) 12)months) 750 interpreted
(includes 300 exams performed)
Level)1)training)is)not)sufficient)to)allow)independent)interpreta8on)
Level)2)training)permits)independent)performance)and)interpreta8on)
Level)3)training)is)for)directorship)of)a)clinical)echocardiography)lab))

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Indica0ons  for  Cri0cal  Care  Echo:


ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/
SCMR 2011 Appropriate Use Criteria for
Echocardiography. J Am Soc Echocardiogr
2011;24:229-67.

Common  Accepted  Indica/ons  for  TTE  in  Cri/cal  Care  
• Evaluation of hypotension or hemodynamic instability
of uncertain or suspected cardiac etiology
• Evaluation of respiratory failure with suspected
cardiac etiology
• Evaluation of patient with known or suspected acute
pulmonary embolism to guide therapy (i.e.,
thrombectomy and thrombolytics)
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Competence in Critical Care
Ultrasonography

American College of Chest Physicians/La Societe
de Reanimation de Langue Francaise.
Chest 2009;135:1050-1060.
Echocardiographic  pa8erns  
•Global LV size and systolic function
•Homogeneous/heterogeneous LV contraction
pattern
•Global RV size and systolic function
•Assessment for pericardial fluid/tamponade
•IVC size and respiratory variation
•Basic color Doppler assessment for severe valvular
regurgitation
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Competence in Critical Care
Ultrasonography

Chest 2009;135:1050-1060
Recogni/on  of  Clinical  Syndromes  Using  Echo  
Severe hypovolemia
Small hyperdynamic ventricles, small IVC with
respiratory variation
LV failure
Global LV systolic dysfunction
Heterogeneous contractile pattern
LV cavity dilation
RV failure
RV dilation, paradoxical septal motion, RV
dysfunction
Tamponade
Acute massive left-sided valvular regurgitation
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Competence in Critical Care Ultrasound


Chest 2009;135:1050-1060.
• Pleural Ultraosonography
• Lung Ultrasonography
• Abdominal Ultrasonography
• Vascular Access Ultrasonography
• Ultrasonography for Diagnosis of DVT
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Critical Care Ultrasound

Education Resources

• WINFOCUS (World Interactive Network Focused

on Critical Ultrasound) www.winfocus.org
• Society of Critical Care Medicine (SCCM)
Fundamentals of Critical Care Ultrasound and
Advanced Ultrasound Courses www.sccm.org
• American College of Chest Physicians (ACCP)
Training Programs in Critical Care Ultrasound
(ACCP/La Societe de Reanimation de Langue Francaise Statement on
Competence in Critical Care Ultrasonography. Mayo PH, et. Chest 2009)

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National Board of
Echocardiography
• Examination of Special Competence in Adult
Echocardiography (ASCeXAM)  
• Examination of Special Competence in Advanced
Perioperative Transesophageal Echocardiography
(Advanced PTEeXAM)
• Passing the exam confers “Testamur” status
• Board Certification is a separate application that
requires Testamur status and documentation of
training

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American)Society)of)Echocardiography)

•  h4p://www.asecho.org)
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Thank You

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