DIP Episode 490 - The Clutch TEE Podcast

Welcome, my name is Divine. This is episode 490 of the Divine Intervention Podcast. In this podcast I'm going to be discussing the Clotch Trans-Sovagil Echo Cardiogram Podcast. The Clotch Trans-Sovagil Echo Cardiogram Podcast. Here's a thing. On the USML is... They love to test Echo Cardiography. And sometimes you see an answer that says Trans-Dorassic Echo Cardiogram. A lot of the times you see an answer that says Trans-Sovagil Echo Cardiogram. Many people massively struggle with. Man, when do I pick Trans-Dorassic, when do I pick Trans-Sovagil? If I listen to the podcast, I'll settle all those issues for you. But I guess before I go into it, the Clotch Cardiography is basically ultrasound to look at the heart. Simple as that. You can also look at the uterus pretty well with the Necocardiogram. There are two major types of Echo Cardiograms. There's the Trans-Dorassic. Basically, they slap the ultrasound probe on your chest straight up. And then there's the Trans-Sovagil where you put the ultrasound probe in your suffigus. Why would they do that? Well, here's the thing. It just so happens to be that the Asophagus is posterior to the lefty trim. That's a high-yield factor, no, for your exams. Right? The Asophagus is posterior to the lefty trim. So if you put an ultrasound probe there, you're going to get just beautiful views of the heart.

So in general, in situations where you want better sensitivity, better specificity, you're going to maybe go ahead and do a Trans-Sovagil Echo Cardiogram. Now, you can already begin to see how they can make a question real quick from a big classic complication of Trans-Sovagil Echo Cardiography. It's very rare. But this is probably the most dangerous complication. To give you a question about a person, the person just got a TE, right? And then you notice that this person, 30 minutes later, they have inshotness or breath, they have fevers, they have subcutaneous infosima. That's the end of the neuroopter. Right? You know, remember, as a neuroopter, it's certainly a big complication of Trans-Sovagil Echo Cardiography that you want to know for your exams. Right? Obviously, in that case, you're going to take them to surgery. Well, if you want to confirm the diagnosis, one way you can do that is with gastrographic. That's water-soluble contrast, animal. Right? Water-soluble contrast. Water-soluble contrast. Please use barium. If you suspect the person is also a rupture, they use barium. That's not a good idea. Barium gets into your mediasinum. You're going to have a lot of other problems besides just as a jaw rupture. So just never, never do that, please. Okay. So now that we've kind of set that baseline, let's talk about the classic uses. There are many uses of T Es, but I want to tell you the ones that they love to test on every USM in the exams. They're one step to step three.

First one, let's say they give you a question about a person that their lower extremities, they've had the sudden onset of lower extremity weakness, left lower extremity weakness, and you're told that the person has a histroof effect or they've recently had an MI. Well, the thing is that person has a stroke. You probably have an ischemic stroke and it's probably an emboleic kind. It probably started from the lefty term, right? Because remember, when you have a effect or you have had a recent MI, the heart is not contracting very well. So your heart is kind of squiggling about, squiggling about, squiggling about, squiggling about. When that happens, right? You're kind of, that blood steases is going to form an emboleus, and then you can flake off and go to, I guess in this case, the anterior cerebral artery. Probably the right anterior cerebral artery, since it's the lefty or extremity that's weak. So if you want to evaluate, if a person has an emboleic stroke, again, obviously you're going to follow the classic stroke workout, going to get the non-conhead CT, and make sure your signs of ischemia, blah, blah, blah, blah, blah, or make sure you're nothing, right? If you suspect the cardiogenic source of a person's stroke, you certainly have to go ahead and do a trans-is of a gel echocardiogram, okay? At some point in the person's hospital course, so that you can see there's anything going on.

And also if a person has just had an MI, remember, and this can happen weeks or even once later, you can have like a left ventricular aneurysm. When you have that left ventricular aneurysm, your left ventricular kind of like bulges out a lot. So there's a lot of space for blood to just kind of hang around. I just like to think of a lot of something that needs to keep flowing, right? If he keeps hanging around, like, oh, let's chill, let's have fun, let's play as friends. Then the stuff in this crazy interaction, your form and boil, pressing gets into a lot of trouble actually. Okay, so that's number one use. Number two use, what if they give you a question about some IV drug user? And this IV drug user has been having fevers, difficulty sleeping at night, and it tells you that you hear a new murmur somewhere. Obviously that's going to be infectious endocraditis. If infectious endocraditis, remember, these people at some point while they're in the hospital, they're going to need a TEE, they're going to need a transness of a gel echocardiogram. When you do that though, you're going to do that after you've done the blood cultures and the anti-biotics, right? Those are the things you should always do for an endocraditis person. But the third step is going to be a TEE, right? You can do this after antibiotics. It just helps you see the extent of the damage. It just helps you see many things.

You can also help you evaluate the hemodynamic characteristics of the persons of vegetation. Okay, number three indication. Again, I want to make this podcast as short and sweet and high-yield as possible. What if they give you a question about a person that is 6'5 inches tall, and the person has very severe chest pain? And in the teleonochestics rate, they notice the left side of the plural of fusion. What is that? That's the hearing dissection. Right? Hearing dissection is another indication for TEE. But it's not every case of hearing dissection that gets a TEE. Right? So if you have a hearing dissection, the first thing you've got to think of for your exam is, is this person's stable or unstable? Stable means their blood pressure is fine. They're not crazy tacky cardiac. They are maintaining properly unstable. Man, their blood pressure is pretty low. Right? It's like in the double digits, it's stomach. It's pretty low. They're not maintaining well. They're on a responsive, blah, blah, blah, blah. When your repressing has a hearing dissection, and they're hearing what they're looking at, stable, you're going to go ahead and do a TEE, a transess of a gel, a coquadriogram. Please, do not do a CT-chest angiogram with contrast. CT-chest angiogram with contrast is the only you have the hearing dissection and your hemodynamically stable. Remember, you're going to see that in the mouth, blah.

And those people are either going to be treated for the hearing dissection, depending on how bad it is. But again, that's not a problem of this podcast. Okay, indication number four. We have to give you a question about a patient, DVT two weeks ago. And then now, the person is having right lower facial and right upper extremity weakness. You see that? What is that? What is the person who has a PFO, a patent for immunoval? Do they have some kind of agioreceptor defect? That's causing them to have this issue. We're being, wait, what? Yeah, let me explain why. Here's the thing. If you have a DVT, the thing that's logical next step is a PE. Right? Travels, blah, blah, blah, blah, through your veins to the right, you should remember all the veins in the body, emptying to the right, you should for the most part. That's not entirely true, but it's fine enough for you to examine. So, right, you should try to right ventricle bone, lodging your bone area arteries or your bone area capillary, or whatever, causes a PE. That's what's supposed to happen. So, if you have a PFO though, a patient for a mental valley or an ASD, even a VSD, right, that embolus can go from right, right in front of the lefty trim, straight up, skip the lungs or from, you know, right ventricle to left ventricle. And then it can go into the systemic circulation and include, I guess, in this case, for this situation I gave, your left MCA, your left MCA, right?

Remember that you're homunculus, your breakthrough medias on your face is MCA territory. Resume through that if you're a little confused. So, when you suspect the PFO, right, that's a cryptogenic stroke. In that case, you're going to do a transness of a gel, echo-quartever. Many times you're going to do it a bubble study, right? You'll see those bubbles traveling, you know, from the right side of the heart to the left side of the heart, tells you that, ooh, gee, that's not good. This person has a PFO. Okay, what if they give you a question about a patient? This patient, they tell you that, you know, the person has the shrewian EKG, you don't see that the cure is complex, is a narrow species between them are unequal, and you're told that this patient is being considered for cardiovascular version. You know, electrical cardiovascular version. In this case, it's obviously going to be a synchronized cardiovascular version. And then they'd say, oh, what should be considered before the person is cardiovascular? Well, actually, into a TE, this person has a fib. Remember, NARQRS tells you that it's an etral arrhythmia, and you see the species are not equal, right? So it tells you it's an etrofibrilation, irregularly irregular. So some people, their e-fibri can be snapped out of e-fibri doing synchronized cardiovascular version.

But many times for these people, one thing you'll classically want to do is you want to do a transition to a gel-like quadrogram to evaluate for an embolus in the left etral appendage. Well, what's one really good way to see the left etral appendage? A TE, right? It so happens that the esophagus getting exposure to the left etral. Second, like the second time I'm repeating that point, not because I love to hear myself talk, but because it's very, very high your point to know for your exams. Now, what if they give you a question? So we've done five indications so far. Let's go to indication number six. What if they give you a question about a patient? And they tell you that this patient, you know, for the last two weeks, the person has been having shortness or breath. The person gets very winded after walking just a little distance. And obviously for a question like this, they're going to try to mess you up by throwing an genus and answer, you'll put like pd as an answer, or something crazy. But then they'll tell you that, and recently this person had a mechanical valve placed in their heart, in one of their cardiac valves. And then they tell you that, you know, they show you like, you know, their bilirubin is elevated, and it's mostly an indirect type of bilirubinemia. And you're like, who, and your heart will blow, your blood is low, and you're like, man, what is going on? Well, this person, their prosthetic valve that you placed is literally sloshing and slicing.

They're able to tell us, that's a valve you're like, immolices. That's actually something that's pretty high to know for your exams. This person clearly has an issue with a valve that was placed. You suspect any valve you like, issue like your place to valve, and it doesn't seem to be working great on your exams. It's usually pretty, pretty smart to go ahead and get a transist of a gel echocardiogram, right? You want to see stuff like really well, so you're not going to be messing around in this case. You're going to get a transist of a gel echocardiogram. Okay, indication number seven. What if they give you a question, about a 35-year-old male, your total of the last three months is lost like 10 pounds. He has fever,

nights,

nights,

and he's going to get a little bit of a problem. He's going to get a little bit of a problem. He's going to get a little bit of a problem. He's going to get a little bit of a problem. He's going to get a little bit of a problem. He's going to get a little bit of a problem. He's going to get a little bit of a problem. He's going to get a little bit of a problem. He's going to get a little bit of a problem. He's going to get a little bit of a problem. He's going to get a little bit of a problem. He's going to get a little bit of a problem. He's going to get a little bit of a problem. He's going to get a little bit of a problem. He's going to get a little bit of a problem. Only the exams, why? Because the secrets come into account before taking them to surgery. A TEE is exactly what you're supposed to do. That's the situation where we're going to do a TEE. This should be indication number nine is if, for example, you've done a TTE, you've done a transphoracic echocardiogram. It's not showing you a deadly squat. You're like, man, this person has some cardiac vein. Why is this TTE showing me nothing? Go ahead and do a TEE in that case. Then a 10th indication and that will be it. It's basically, what if they give you a question about a person that got a new heart a few weeks ago, and then he looks like the heart is not working great? Well, the heart is not working great.

You need to, if you're trying to evaluate for like a transplant, a heart transplant complication, transes of a chelococardiogram is exactly what you want to use, honestly. That's exactly what you want to use. Okay, that's exactly what you want to use. It's pretty great for that purpose. That's exactly what you want to use. That's exactly what you want to use. Very good way for evaluating. Because many times you're going to maybe get some kind of cardiac biopsy when you're doing a cardiac biopsy. Because remember, the coronary vessels, they're running the walls of the heart. If you're doing a cardiac biopsy, you want to make sure that you're seeing what you're doing because you don't want to tear coronary artery or puncture the wall of the ventricle and all those really bad things. So how can you prevent that? Well, if you don't want to be going in blind, you want to use the transes of a chelocardiogram in those circumstances. So I think I'm going to go ahead and stop here. Again, I'd offer one or one tutoring for all the USMEL exams. Step one to step three. I have a bunch of review courses for the USMEL exams coming up in December. Test taking course. That's for step one to basically the classes for step one to step three. There's a two and a half hour test taking course. There's the four hour bio stats class and there's the five hour social sciences quality improvement, professionalism, healthcare systems, communications and ethics class.

Many people have attended this class. It's done extremely well on the exams. And then I have a 20 hour step to step three review course. It's also for people that need a very good nice review for their shelf exams. I have that course in December. And then in January, I have a 25 hour step one course. And then in May of 2024, I have a 100 hour step to step three course. That's my most comprehensive class. I've made podcasts on all these days. So just listen to the podcast. You'll give you all the information that you need. And then I have these podcasts on Apple, podcast, Google podcasts and Spotify. And then I have a You Tube channel, Divine Intervention, Glycer, Middle Podcasts and Videos. That's where I post the videos that I make. And then finally, I also have another website called Divine Intervention Lifelesses.com. Many people have said that, wow, Divine, I love your life lessons. So basically, I made a separate website. There's actually an Apple podcast, as you should know, called the Divine Intervention Lifelesses Podcast. But every week, I post like two podcasts and using a biblical perspective, I try to address a life, a life lesson, try to address a life lesson. So today, I want to, I guess, give a very brief life lesson. I want to give a very, very, very, very, very brief life lesson. And this life lesson is on something called Virtue Signalling. Virtue Signalling. Virtue Signalling.

It's kind of painful talking about this stuff, but it's something that I think is kind of wise for people to think about, especially medical students. I don't know, I just feel like we live in a world where people are very incensed here. They don't really mean what they say. They're not really doing things from their hearts. They're just doing things to achieve a certain end. And many people do it these days, right? You see, like, say, for example, and again, I'm going to really try to be careful here with what I say. I don't do this because I'm saying. But you see people and some issue arises out there in the world. And honestly, in their heart of hearts, they don't really care about it, but they want to score some social media points. They want to become more popular. They want to seem like very humanistic people. So they'll put some comment that I stand with x, y, z, or I condemn x, y, z, blah, blah, blah, blah, blah, blah, blah, blah. See, there's nothing wrong with that if you truly mean it. There's literally nothing wrong with that if you truly mean it. But you see many people, you can just tell that they don't mean these things. They just put things out there so that they can seem like some social activist warrior or whatever to people out there. They don't mean it in their hearts. They don't really care.

If you call those people to actually do something to make a change concerning those situations that they're commenting on, they won't do anything about it literally, nothing. They don't really, they literally don't care. But they're like, wow, okay, for residency applications, I can really make myself stand out by doing x, y, z, right? And honestly, like this whole virtue signaling thing, it kind of cuts across to many things. Like there's almost like no point doing certain things if it's not going to be meaningful. Right? If you know that your heart is not in something, don't waste your time doing it. Let me give you another example. Right? You see, there's a lot in pre-meds. And also just people are applying for residency. You read through the applications, and you see a bunch of just trash activities. You can tell that these people, even the way they write about these things, or when you do a more interview, the way they talk about these things, you can just tell that these people just absolutely do not care. Right? They just did this because they just want to check a box on something. Let me tell you this. Don't leave your life checking boxes. Don't. Don't leave your life checking boxes. Right? The thing is, life is too short for you to do things that you don't care about. Honestly, life is too short for you to do things that you don't care about. There's even a part of the Bible that says, whatever your hands find to do, do with all your heart.

Do it all with all your heart. Honestly, if you're not willing to do something with all your heart, just let it go. Just let it go. Don't get me wrong. There's some things that are unpleasant that you have to do to get ahead. But as much as it's possible, try to put your heart into something, even if it's not something you find to be pleasant. Because many times the state of your heart, when you're doing something, determines the amount of effort and how excellent you do that thing. Right? And many people just don't do it. Right? Many people just apply that virtue signaling mentality. They don't really care about that. They're just like, I'm just going to do this to a score point, or become popular, or to achieve this goal or whatever. Right? And honestly, if you're an experienced interviewer, you can see right through all the crap. Honestly, right? I've seen this so many times. I've been on an admissions committee at a major medical school before. I've interviewed so many people. You can just tell like, man, this people are like literally, they're full of it. There's literally no substance to what they're doing. Right? Like I remember, when I was applying for medical school, did I have as many extra curriculuses? Many people? No, I did not. But man, when my curriculers pretty heartfelt. Yes, they were. When I was in college, I used to teach and tutor a ton. Why? Because I actually loved it. Like tutoring for me and teaching is more than just some stuff I do.

No, I actually enjoy it. I feel like that's like my calling. I feel like that's what I'm like on this earth. I'm supposed to do. I can't, there are many other things I'm on this earth to do. But a major thing I'm on this earth for is literally to teach people. Right? So I do it with all my heart. I do it with all my heart. Like these podcasts, I love making these podcasts. It's a lot of fun for me. Right? It's a lot of fun for me, honestly. So please, like, just don't be a virtuous signal. Like don't kind of go through your life. Don't put in your heart into things. Just virtue. Because these days, people want to do everything for social media points. They want to do something for a while. This person must really care about this social issue that everyone is talking about right now. But they don't really care. They don't really care. Honestly, like you'll get a lot more from life. You'll get a lot more from what you're doing if you just put your heart into it. Honestly, like, you live a fuller life having that kind of a perspective. But many people just don't. Many people just don't. They just do things because wow, it's popular in the world or wow. You know what? I'll get many retweets. I guess it's now X these days. But a lot of retweets, a lot of likes. Right? The thing is, just ask yourself that, do you have happiness in your heart when the camera cameras go off? Right? Don't leave your life for clicks.

Honestly, that's one of the reasons why social media is such a big source of mental health problems. Because people, if they don't get the appropriate likes, tweet retweets or whatever, they feel like everyone doesn't like things. Right? And that's the thing. That's why many of the things you see on social media these days, like on many of these social media platforms. You can't believe it. A lack of any of it. Because people present their also perfect lives. But that's not what their lives really look like in the real world. I guess I'm a bit of a kind of rambling. But please, I'll just encourage you. Don't be a virtuous signal. No. Like, just do things with your heart. Right? Put heart into what you're doing. Don't do things just because it's popular. No, the fact that something is popular doesn't necessarily mean that's the right thing to do. Or doesn't necessarily mean that it's the thing you're supposed to be doing with your life. Right? So just don't be a virtuous signal in kind of person. It's really distasteful. Right? And again, the thing is people that have a lot of life experience can see right through the charade very quickly. Very, very quickly. Right? I just see this a lot. Many people in medicine. They just don't care. They just don't literally do not care. Right? But they're just doing certain things so they can achieve some goal. You see, they have all these extracurriculars. And they're really embellishate.

But man, they only spent like 12 hours on this thing. Like, come on. No, no, no. No, I wasn't playing for residency. Again, did I have a ton of extracurriculars? No. But man, the extracurriculars I had, where do you think that I really enjoyed doing? Where do you think we are? I would like, oh, even without your reward, I would do absolutely. Right? So I would just encourage you, like, just kind of a lay off that mentality. It's very common. Many people are pretty shallow these days. You don't want to be a shallow person. You want to be better than that. Honestly, you really want to be a lot better than that. Okay, I'm going to stop rambling now. I will see you in episode 491. Have a wonderful weekend. God bless you. Bye for now.

The esophagus is located posterior to the left atrium (LA).

After blood cultures have been drawn and antibiotics have been initiated.

Pneumopericardium (or pneumothorax).

Suspected aortic dissection in a hemodynamically stable patient.

A bubble study performed during TEE.

The esophagus.

Barium sulfate (due to risk of mediastinal contamination).

1) Post-MI/Left Ventricular Aneurysm; 2) Atrial Fibrillation/Cardioversion planning.

Bubbles passing from the right side of the heart to the left side of the heart.

Evaluating prosthetic valve dysfunction or planning cardiac biopsy/transplant evaluation.

The esophagus.

Barium sulfate (due to risk of mediastinal contamination).

1) Post-MI/Left Ventricular Aneurysm; 2) Atrial Fibrillation/Cardioversion planning.

Bubbles passing from the right side of the heart to the left side of the heart.

Evaluating prosthetic valve dysfunction or planning cardiac biopsy/transplant evaluation.