Certificate in Clinician Performed Ultrasound (CCPU) Syllabus. Rapid Cardiac Echocardiography (RCE)

Transcription

1 Certificate in Clinician Perfrmed Ultrasund (CCPU) Syllabus Rapid Cardiac Echcardigraphy (RCE) Page 1 f 10 07/16 Australasian Sciety fr Ultrasund in Medicine PO BOX 943, Crws Nest NSW 1585, SYDNEY, AUSTRALIA P (61 2) F (61 2) E asum@asum.cm.au W

2 Rapid Cardiac Echcardigraphy (RCE) Syllabus Purpse: This unit is designed t cver the theretical and practical curriculum fr Rapid Cardiac Echcardigraphy. The Rapid Cardiac Echcardigraphy unit aligns with the Cllege f Intensive Care Medicine s Fcused Cardiac Ultrasund requirement in the Intensive Care syllabus (CICM FCU). The FCU will be a mandatry requirement fr CICM trainees in rder t btain their Fellwship f CICM. Dctrs wh cmplete the CICM FCU requirement r any critical care dctr wh btains RCE via the ASUM pathway will be cnsidered by CICM and ASUM t have equivalent qualificatins. T be awarded the RCE CCPU by ASUM, dctrs will need t cmplete the ther CCPU requirements such current ASUM financial membership and successful cmpletin f the nline physics mdule. The RCA will n lnger be ffered by ASUM. Hwever, dctrs with RCA already awarded will be cnsidered t have satisfied RCE/FCU criteria. Prerequisites: Learners shuld have cmpleted the ASUM Physics Image Optimisatin unit r accredited equivalent. Training: Recgnised either thrugh attendance at an ASUM accredited Rapid Cardiac Ech curse r equivalent. Assessments: Learners are required t perfrm supervised ultrasund scans with dcumentatin in a lgbk. Unit Objectives On cmpleting this unit learners shuld be able t demnstrate: Perfrm safe and accurate basic echcardigraphic examinatins, Demnstrate prficient image acquisitin and ptimizatin, utilising all standard views. Recgnise nrmal cardiac anatmy, physilgy and the anatmical relatinship f the heart t surrunding rgans and structures. Identify majr cardivascular pathlgy, particularly the mre cmmn life threatening cardivascular abnrmalities. Integrate ech int advanced life supprt prtcls. Recgnize the limitatins f the curse and situatins when a referral fr a secnd pinin is indicated. Page 2 f 10 07/16 Australasian Sciety fr Ultrasund in Medicine PO BOX 943, Crws Nest NSW 1585, SYDNEY, AUSTRALIA P (61 2) F (61 2) E asum@asum.cm.au W

3 Unit Cntent The unit will present learners with the fllwing material: General & Technical Knwledge Ultrasund Physics Cmmn artefacts The ultrasund machine and Instrumentatin Prbe and preset selectin Image ptimisatin adjusting depth, frequency, gain, TGC Freeze, scrll, measure, label, Save images and measurements, ech lp acquisitin Basic Critical Care Echcardigraphy Applicatins and limitatins f transthracic echcardigraphy in the critically ill patient Principles f 2D Ech Examinatin Acustic Windws Imaging Planes Nrmal 2D Echcardigraphic Anatmy Parasternal, apical and subcstal views Nrmal 2D Echcardigraphic Measurements Cardiac Anatmy & Physilgy Left Heart Assessment Left ventricle chamber size, wall thickness & cntractin M-mde and its limitatins Left atrium size Mitral valve nrmal 2D ech anatmy Artic valve nrmal 2D ech anatmy Artic rt Right Heart Assessment Right Ventricle chamber size, wall thickness & cntractin Interventricular septum psitin, shape & mvement Right Atrium size Tricuspid valve nrmal 2D ech anatmy Page 3 f 10 07/16 Australasian Sciety fr Ultrasund in Medicine PO BOX 943, Crws Nest NSW 1585, SYDNEY, AUSTRALIA P (61 2) F (61 2) E asum@asum.cm.au W

4 TAPSE Pericardium Pericardial cntur Pericardial effusins Inferir Vena Cava Size and shape: AP diameter Respiratry variatin (cllapsibility/ distensibility) Other structures Lung Pleural effusin Liver Stmach Majr Critical Pathlgy Assessment f Vlume Status and recgnitin f hypvlaemia LV and RV chamber size and cntractin LA and RA size Measurement f IVC size and respiratry variatin Recgnitin f LV systlic failure LV size including chamber dimensins and wall thickness Assessment f glbal LV cntractin Basic assessment f segmental LV cntractin Assessment f ejectin fractin Recgnitin f RV systlic failure, acute and chrnic cr pulmnale/pulmnary hypertensin RV size, shape and wall thickness Assessment f glbal RV cntractin Use f tricuspid annular peak systlic excursin (TAPSE) Psitin, shape and mvement f interventricular septum Identificatin f Pericardial Effusin and Tampnade Understanding f tampnade physilgy Page 4 f 10 07/16 Australasian Sciety fr Ultrasund in Medicine PO BOX 943, Crws Nest NSW 1585, SYDNEY, AUSTRALIA P (61 2) F (61 2) E asum@asum.cm.au W

5 Identificatin and quantificatin f pericardial effusin Differentiating pericardial and pleural effusins Recgnising 2D signs f tampnade, including diastlic cllapse f the RV free wall and RA wall, and inferir cava size and cllapsibility. Other Pathlgy Thracic artic dissectin and aneurysm Artic rt and ascending arta diameter Abnrmal artic valve mrphlgy and mvement Pericardial effusin Pleural effusin Differentiatin frm pericardial effusin Limitatins and Pitfalls The curriculum des nt cver: Assessment f LV diastlic functin Evaluatin f valvular functin Assessment f LV filling pressures Calculatin f cardiac utput Calculatin f pulmnary artery pressures Assessment f cnstrictive pericarditis Teaching Methdlgies All units accredited tward the CCPU will be cnducted in the fllwing manner: A pre-test shall be cnducted at the cmmencement f the curse which fcuses learners n the main learning pints Each curse shall cmprise at least 8 hurs f teaching time f which at least 5 hurs shall be practical teaching. Stated times d nt include the physics, artefacts and basic image ptimizatin which shuld be prvided if delegates are new t ultrasund Learners will receive reference material cvering the unit curriculum. The lectures presented shuld cver substantially the same material as the nes printed in this curriculum dcument. An apprpriately qualified clinician will be invlved in bth the develpment and delivery f the unit and curse (they d nt need t be present fr the full duratin f the curse). The live scanning sessins fr this unit shall include sufficient live patient mdels t Page 5 f 10 07/16 Australasian Sciety fr Ultrasund in Medicine PO BOX 943, Crws Nest NSW 1585, SYDNEY, AUSTRALIA P (61 2) F (61 2) E asum@asum.cm.au W

6 ensure that each candidate has the pprtunity t scan. Mdels will include nrmal subjects and patients with apprpriate pathlgies. If the latter are unavailable, there will be at least ne image interpretatin statin with cinelps demnstrating the apprpriate pathlgy. A pst-test will be cnducted at the end f the curse that includes this unit as frmative assessment. Assessment and Lgbk Evidence f satisfactry cmpletin f training sessins Evidence f assessment f cmpetence (summative assessment) signed ff by a suitably qualified assessr (DDU, Cardilgist, DMU r AMS r sngrapher registered with NZ MRTB in the relevant field, CCPU in the relevant field r ther qualificatin apprved by the CCPU bard). The riginal cmpleted cmpetence assessment frm is t be sent t ASUM with the candidate s cmpleted lg bk. Lgbk requirements need t be cmpleted, and lgbks need t be submitted within tw years f cmpleting a curse. Frmative Assessments 2 frmative assessments (directly supervised with suggestins and advice prvided during the scan) Summative Assessment Summative assessment is t be perfrmed by a suitably qualified assessr (see abve) using the cmpetence assessment frm supplied at the end f this dcument (r equivalent if deemed sufficient by ASUM at their discretin). Lgbk Requirements Lgbk requirements need t be cmpleted, and lgbks need t be submitted within tw years f cmpleting an accredited curse. All cases must be cmpared with gld standard findings (such as cmprehensive imaging, pathlgical findings r if these are unavailable then clinical curse). All lgbk cases must be signed ff by a suitably qualified supervisr (DDU, Cardilgist, DMU r AMS r sngrapher registered with NZ MRTB in the relevant field, CCPU in the relevant field r ther qualificatin as apprved by the CCPU bard) Cmplete 30 case studies. 10 psitives required (candidates are nt required t submit images) At the discretin f the ASUM CCPU Certificatin Bard candidates may be allwed an alternative mechanism t meet this practical requirement. Page 6 f 10 07/16 Australasian Sciety fr Ultrasund in Medicine PO BOX 943, Crws Nest NSW 1585, SYDNEY, AUSTRALIA P (61 2) F (61 2) E asum@asum.cm.au W

7 ASUM CCPU Cmpetence Assessment Frm Rapid Cardiac Echcardigraphy (RCE) Candidate: Assessr: Date: Assessment type: Frmative (feedback & teaching given during assessment fr educatin) Summative (prmpting allwed but teaching nt given during assessment) T pass the summative assessment, the candidate must pass all cmpnents listed Prepare patient Psitin Cnsent/Explanatin Cmpetent Prmpted Fail Prepare Envirnment Lights dimmed if pssible Prepare Machine Crrect Psitin Prbe & Preset Selectin Can change transducer Selects apprpriate transducer Selects apprpriate preset Data Entry Enter patient details Image Optimisatin Apprpriately adjusts machine t ptimise image: Depth Frequency (if required) Fcus (if required) Gain / TGC Image Acquisitin Anatmy Parasternal lng axis view Technique Aligns n lng axis Identifies (and measures where apprpriate*) Left atrium* Mitral valve Anterir and psterir leaflets Chrdae tendinae Papillary muscles Left ventricle* (end diastlic and systlic diameters) Artic valve Artic rt* Interventricular septum* Right ventricle Page 7 f 10 07/16 Australasian Sciety fr Ultrasund in Medicine PO BOX 943, Crws Nest NSW 1585, SYDNEY, AUSTRALIA P (61 2) F (61 2) E asum@asum.cm.au W

8 Mderatr band Mycardium Pericardium Descending arta Lung Parasternal shrt axis view Cmpetent Prmpted Fail Technique Aligns n shrt axis and scans frm base t apex Identifies Artic valve Pulmnary valve and trunk Right ventricle Tricuspid valve Right atrium Interatrial septum Left atrium Mitral valve leaflets Papillary muscles Left ventricle Right ventricle Aligns in crrect rientatin Apical 4 & 5 chamber view Cmpetent Prmpted Fail Technique Can adjust frm 4 t 5 chamber view Identifies Cardiac chambers Cardiac valves Inter ventricular and atrial septae Subcstal view Technique Optimises view Identifies Liver Stmach Mycardium and septae Pericardium and pericardial space Cardiac chambers Cardiac valves Inferir vena cava Cmpetent Prmpted Fail Technique Attains lngitudinal view Attains transverse view Measures apprpriately Nrmal Physilgy Cmpetent Prmpted Fail Describes nrmal LV size, functin and assessment Describes nrmal MV / TV appearance and functin Describes nrmal AV appearance Page 8 f 10 07/16 Australasian Sciety fr Ultrasund in Medicine PO BOX 943, Crws Nest NSW 1585, SYDNEY, AUSTRALIA P (61 2) F (61 2) E asum@asum.cm.au W

9 and functin Describes nrmal artic rt size Describes nrmal RV size, functin and assessment Describes nrmal IVC size, appearance and respiratry variatin Pathlgy Cmpetent Prmpted Fail Describes changes cnsistent with hypvlaemia Cardiac chambers Interatrial septum IVC Describes changes cnsistent with RV systlic failure RV size, shape, wall thickness RV cntractility incl. TAPSE Interventricular septum Describes changes cnsistent with LV systlic failure LV size, wall thickness Reduced ejectin fractin and its assessment Describes appearance f pericardial effusin Identificatin and quantificatin Differentiates pleural and pericardial effusins Tampnade Understands the physilgy Describes 2D Changes n ech (RV / RA / IVC) Artic rt Describes appearance f grssly dilated artic rt Valve Dysfunctin Describes appearance f grssly abnrmal valve functin Regurgitatin Stensis Understands Limitatins NOT designed t assess fr valve functin Althugh grss dysfunctin may be detected it may be missed NOT able t exclude dissectin NOT able t exclude pulmnary emblism NOT designed t assess fr reginal wall mtin abnrmality NOT designed t assess fr diastlic dysfunctin NOT designed t give measurements f left r rightsided pressures Recrd Keeping Stres / prints apprpriate images Writes apprpriate reprt May use reprt prfrma Page 9 f 10 07/16 Australasian Sciety fr Ultrasund in Medicine PO BOX 943, Crws Nest NSW 1585, SYDNEY, AUSTRALIA P (61 2) F (61 2) E asum@asum.cm.au W

10 Machine Maintenance Cmpetent Prmpted Fail Cleans ultrasund prbe apprpriately Stres machine & prbes safely and crrectly Fr Frmative Assessment Only: Feedback f particularly gd areas: Agreed actins fr develpment Examiner Signature: Examiner Name: Candidate Signature: Candidate Name: Date: Page 10 f 10 07/16 Australasian Sciety fr Ultrasund in Medicine PO BOX 943, Crws Nest NSW 1585, SYDNEY, AUSTRALIA P (61 2) F (61 2) E asum@asum.cm.au W