title: Limited transthoracic echocardiogram: so easy any trauma attending can do it.
abstract: BACKGROUND
  Limited transthoracic echocardiogram (LTTE) represents an attractive alternative to formal transthoracic echocardiogram (TTE), because it does not require an echocardiogram machine. Our hypothesis is that trauma attendings can learn LTTE effectively with minimal training.
  
  
  METHODS
  Seven attendings at a Level I trauma center received didactic and hands-on training in LTTE and performed this test on hypotensive patients to evaluate for contractility, fluid status, and pericardial effusion. Therapy to improve perfusion (administration of fluids, ionotropes, or vasopressors) was guided by LTTE findings. Perfusion status was determined by serum lactate level before and 6 hours after LTTE. Findings were compared with cardiology-performed TTE.
  
  
  RESULTS
  Range of postresidency training was 1 year to 29 years. LTTE teaching entailed 70 minutes of didactics and 25 minutes of hands-on. In all, 52 LTTEs were performed; two patients were excluded due to blunt trauma arrest. Age ranged from 22 years to 89 years with an average of 55 years. Admission diagnosis was blunt trauma (n = 34), penetrating trauma (n = 3), and intra-abdominal sepsis (n = 13). Average time for LTTE was 4 minutes 38 seconds. Cardiology-performed TTE was obtained in all patients, and correlation with LTTE was 100%. A total of 37 patients received intravenous fluid, 9 received vasopressors, and 4 received ionotropes as guided by LTTE findings, with lactate reduction in all patients (p < 0.00001). Attendings scored a mean of 88% in a written test after training.
  
  
  CONCLUSIONS
  Trauma attendings can successfully learn LTTE with minimal training and use the technique as a resuscitation tool in the hypotensive patient.
authors.affiliation: Department of Trauma, Critical Care and Emergency Surgery, Virginia Commonwealth University, Richmond, Virginia 23298, USA. pferrada@mcvh-vcu.edu
authors.forename: Paula
authors.initials: P
authors.lastname: Ferrada
authors.forename: Rahul J
authors.initials: RJ
authors.lastname: Anand
authors.forename: James
authors.initials: J
authors.lastname: Whelan
authors.forename: Michel A
authors.initials: MA
authors.lastname: Aboutanos
authors.forename: Therese
authors.initials: T
authors.lastname: Duane
authors.forename: Ajai
authors.initials: A
authors.lastname: Malhotra
authors.forename: Rao
authors.initials: R
authors.lastname: Ivatury
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003479:Curriculum; D004452:Echocardiography / Q000379:methods*; D004503:Education, Medical, Graduate; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007022:Hypotension / Q000000981:diagnostic imaging* / Q000628:therapy*; D007318:Inservice Training; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000000981:diagnostic imaging*; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000000981:diagnostic imaging* / Q000628:therapy*