PAs doing TEE

[CritCarePAmom]

Any PAs out there doing TEE? I would love to hear about how you learned and the setting in which you are performing them.

I am a clinical year PA student, interested in CC/EM and PoCUS. I have been reading up on TEE in cardiac arrest. Thought it could be an interesting utilization of a PA in code settings, if one had the skill. 

Thanks! 

[SERENITY NOW]

I've been to conferences in residency where they taught us how to do it but I've never actually done it live.  Pretty cutting edge stuff.  I haven't heard of any PAs doing this in EM, nor doctors for that matter, since graduating residency and being out in practice in the community.  

[bike mike]

I think it would be very difficult for a PA to get credentialed to perform TEE's. Would be a cool skill to have though.  Being able to do a decent bedside echo is a great skill in critical care. Can't tell you how many times I've needed to throw a probe on a patient's chests when they are circling the drain......or halfway down it and its nice to be able to get some good images when you are trying to figure out if they have a huge pericardial effusion, if their anterior wall is down, etc. 

[jk5142]

Not too familiar with the literature there, but the literature/data would need to be compelling enough to overcome a number of barriers to implementation (even for EM/CC physicians with the subsequent trickle down to PAs)

 I haven't heard/seen anyone perform TEE during cardiac arrest in medical ICU settings. Even utilizing GDE/TTE  in code situations doesn't seem to be a given.. perhaps it may be different in other ICU settings where anesthesia/cards involvement is greater? 

I imagine there would be a number of obstacles to implementation..even aside from the turf battle between Cards/anesthesia and ED/CCM 

-privileging for the procedure/demonstrating competency/liability/billing 

-logistics/maintenance/storage of equipment to be quickly accessible in the ED/ICU 

 

 

[MediMike]

Agree with above, while the thought of performing TEE during arrests has been getting thrown around a lot more these days (on podcasts at least) it is far far and away from being put into clinical practice in my experience. 

I currently work in both the CCU of a moderately big named transplant university system as well as moonlight in a general ICU of a private system and there haven't even been rumbles of such a thing.  Logistically it just isn't feasible at the moment for all of the reasons mentioned.  Hell, it's hard to get a Sono-Site in the room in an expedited fashion at times.

[surgblumm]

I have been on the other side of TEE and have an undisolved thrombus in my left atrial appendage that has not move in two years. My friend is the Cardiologist who performed this procedure and I felt more comfortable in that setting with some Versad. If the Doc is going to lose money on a procedure, chances are we will not be performing the procedure.

[CritCarePAmom]

Thank you all for the insight. I recognize this is something very far in the future even for Docs to do in cardiac arrest. 

 

It is exciting to here PAs are doing bedside Echo in ICU @bike mike I am trying to hone this skill as best I can as a student and learn as much POCUS as possible.