Transcript
- Hello everyone.
Welcome to the Fujifilm Sono site behind the scan webinar.
We're gonna wait just a little bit for some more people
to enter the room and then we'll get going.
Once again, welcome to the behind the scan webinar.
We'll be getting going here in just a second as soon
as some more people get in the room.
Okay, it looks like our participants have leveled out.
So welcome to the Fujifilm Sono site
behind the scan webinar entitled The Importance
of Simulation Training
for Transesophageal Ultrasound at the Point of Care.
Before we begin, please be advised all attendees are muted
and you can type your questions into the q
and a box in the toolbar located at the bottom
or the side of your screen at any time,
and we'll answer those questions at the end
of the presentation or via the q and a box.
If time doesn't permit that this webinar will be recorded
and will be available later on sonos site.com.
Now it's my pleasure to introduce our moderator,
Paul Baki from our clinical market Development team.
I take it away, Paul.
- Yeah, good morning everyone,
and let me express echo Chris's welcome
to our next in our series of trans esophageal ultrasound
webinar series behind the scan.
This webinar today is based on the importance of the use
of simulation in trans esophageal ultrasound and
and trans esophageal echocardiography.
Prior to Dr.
Wright's talk, I just wanted to give a brief
talk on the evolution of simulation simulation training.
Ironically enough, trans esophageal echocardiography
or TE was really the genesis of simulation training.
The issue was that it was only performed
by skilled trans esophageal experts that kind
of lived in cardiology or cardiac anesthesiology.
And when it was learned, it was learned one by one,
one patient at a time over time, which took time
to complete the training.
And it took several years for those physicians
and those experts to become proficient at it.
And it also limited the expansion of the modality outside,
outside of these expertise.
So it was sort of walled within cardiology
and cardiac anesthesiology.
The first concept for simulation training in TE was focused
on those experts to shorten their pathway to get
to be experts in it in the time needed
to become experts at the use of trans esophageal ultrasound.
It also gave those experts the teaching skill
that would allow them to practice on real patients
to quickly improve their skills.
It allowed them a pathway to improve their diagnostic skills
and the simulation became more acceptable
as an education tool.
Over time, those requirements changed.
It came from just 2D imaging
and m mo to Doppler point of care measurements
and cardiac calculations.
And over that time, that duration
training has moved in transthoracic echocardiography or TEE
and ob gyn
and more recently for the use of point
of care ultrasound at the point of care.
So all, all for the same reasons, to expand the use model
to assure the best patient care at the point
of care at the bedside to assure patients who cared for.
Next slide please. To encapsulate the Fujifilm
overall view, it's really to drive a, a new pathway for,
for the use of transesophageal echocardiography
and we're terming it as transesophageal ultrasound,
which is really the next step in simulation along the way
for, for that use
and targeting three different areas, primarily anesthesia,
not cardiac anesthesiologist necessarily,
but anesthesia monitoring during non-cardiac surgeries,
monitoring patients postsurgery,
and just long-term monitoring,
whether it's in the surgical ICU, et cetera.
And the critical care environment where really the use
of transesophageal ultrasound is growing just in general
to improve the visualization of the heart over te
or transthoracic echo
to make improved reproductive images, reproducible images
on patients in spite of their condition
of their body habitus.
And we can also use it to obviously cause find the cause
for the patient's instability
and answer those diagnostic questions
after hour when cardiology
or cardiac anesthesiology may not be
available in the hospital.
And the real growing and emerging trend is
for use in the emergency department during CPR
during compression to CPR.
The use of transesophageal ultrasound during CPR is shown
to improve the time of pulse checks.
Pulse checks over traditionally use transthoracic echo
and also to assure the appropriateness of,
of the appropriateness of the compressions to assure
that you are doing the job most effectively and correctly.
And also we can be used, it can be used then
to visualize the cause of cardiac arrest
to help better treat the pavement patient in the long run.
I, our first speaker today will be
Dr. Susan Wright,
who is a consultant anesthesiologist at St.
Barmy Hospital in London.
Dr. Wright was born and educated in Mbba
and she graduated in Medical University of London,
subsequently gained a fellowship at the Royal College
of Anesthesia in the uk.
She has worked as an anes anesthetist in Southern Africa
and the UK and has achieved E-A-C-V-I-T-E-E
accreditation with two colleagues.
She co-invented heart work echocardiography simulation in
2008, has continued
to develop the tool since Dr. Wright has directed theater
and simulation-based tow courses regularly
and has co-authored a TEE E-learning program
and participated in tow educational activities worldwide.
With that said, I now will hand off the presentation
to Dr. Susan Wright, who will give us an overall scope
of view on the importance of simulation in healthcare
and at the point of care, Dr. Wright.
- Okay, well thank you very much Paul,
and thank you to Sono site for inviting me
to take part in this webinar.
I've been asked to give something of an overview
of the development of simulation training in TEU.
And much of what I'm going
to say really is based on my personal experience
because I was lucky enough to be one of the co-developers
of one of the first commercially available
TE simulators.
I'm a cardiac anesthesiologist, this is my home base.
And I trained in anesthesiology at a time when
intraoperative perioperative TE was just emerging
as a useful tool in the field of cardiac surgery.
And I completed a fellowship in perioperative TEE in the
US before returning to the UK to share this new skill
with my colleagues and
to establish a training program in TEE.
And this grew very rapidly and
and attracted very quickly participants from
around the world, and importantly part participants from a
wide range of clinical specialties.
So we weren't only teaching anesthesiologists,
we were teaching cardiologists, cardiac surgeons,
intensivists, emergency medicine physicians, radiologists,
quite a broad range
of specialties were showing some interest.
And as I spent hours
at the elbow of, of students learning this new skill,
it became apparent to me that there were certain steps
in acquiring the skill.
And it crystallized my thoughts in planning,
teaching going forward.
And I was able to identify the training needs
of people learning the new skill of TEE from
from the very beginning.
It was obvious that central to understanding the skill
of TEE was a very clear
and detailed knowledge of cardiac anatomy.
And I realized that actually when I was training,
I learned cardiac anatomy kind of in the form
of a physiological cartoon.
And when I started learning TEI had to learn cardiac anatomy
and the anatomy of the esophagus and,
and the stomach virtually from scratch.
This is an example of a kind of learning aids
that we were dependent on in the beginning.
There wasn't very much that was accurate.
There was certainly nothing when we looked online, nothing
that was animated or terribly interactive.
You could see that in the early days of our course,
we had a perspex ultrasound plane that we were trying
to teach people how, how that cut through the heart
to generate ultrasound images, everything pretty primitive,
but you have to know the anatomy to be able
to acquire the imaging planes.
And most importantly, you need to know the relationships
between structures in the chest to be able to move
between imaging claims.
So I sat down with colleagues
with whom I taught TEE,
and we decided that in the absence
of any existing accurate model
of the heart, we would make one.
So we actually made contact
with a post-production company,
their normal businesses in the film industry and CGI.
So very interesting people.
We sat down with them and created this model of the heart.
We moved on very quickly to recognize that one
of the training needs was also to be able
to recognize structures in the image
and to be able to correlate
what was visible in a 2D image
with actually the 3D structure from which the ultrasound
image was derived.
And some people find this quite a difficult correlation.
It's not helped at all by the fact that the orientation
of the image isn't always terribly intuitive.
So in this image of the left ventricle, for example,
we can see that inferior structures
are represented at the top of the screen
and the superior structures at the bottom of the screen.
And so what we did was to move on
to generate an ultrasound image,
a simulated ultrasound image from the 3D model
of the heart that we had made.
And this allowed people to visualize how
the ultrasound plane cut through the heart
and to correlate what they were seeing in their 2D image
with the underlying structure of the,
of the cardiac structures they were examining.
It was then another step forward for us to recognize
that it would be useful to be able to create a haptic
so that people could learn the motor skills.
So mastering the motor skills
of probe manipulation so
that we can position our ultrasound plane where we want to
in the thorax and image structures that we're interested in
takes a lot of practice.
And actually what we found that was that the introduction
of this haptic interface allowed us to remove training from,
from the clinical scene.
And that has a lot of advantages
because we, you're no longer dependent on trying
to fit your training around clinical timings.
And also, of course, patients aren't exposed to the risk
of injury when they're having a TEE performed by a novice
who may not be very skilled.
And certainly the morbidity
and mortality attached to esophageal
and gastric injury is
- Considerably significant.
One of the troubles
- When teaching how to acquire TEE images is trying
to explain to people where the prop tip,
where the transducer is in the thorax,
and how the ultrasound plane emitted
by the transducer intersects with the heart.
You can't see the end of a TOE probe, TEE probe, sorry,
when it's in the thorax,
but we can certainly show where it is on a simulator.
And that aids understanding of the manipulation
of the probe that's required
to acquire the imaging planes
having a haptic interface
and a very
accurate representation of TEE
practice allows learners
to actually perform deliberate practice.
And we know that repeated deliberate practice
improves skill.
So what we have found is that we,
we actually give our clinicians free access
to our simulators 24 hours a day.
And our trainees do actually go
and spend time just practicing the, the manual skills,
the probe manipulation skills that they will need
to acquire
- Imaging claims competently.
The first, the next
- Stage on, of course is to interpret the images
that you have acquired.
There are several companies, several manufacturers
that have created ultrasound simulators.
Many of them like ours, actually have a range
of pathological heart models within them.
And this allows learners actually to learn
what the ultrasound features of different disease states are
and enhances their diagnostic skills.
So you can see here is an image of an aortic dissection,
and you can see the correlation between 3D model on one hand
and the ultrasound image that's generated as a result
of interrogating the aorta with ultrasound.
So we've actually reached the point now
where TEE simulation is used in a number of settings
clinically, first of first of all
of course is supervised practice,
which which might take place in a sim lab.
But what we have found very powerful is
to actually have a simulator positioned quite close
to the point of care, for example, in the operating theater.
If we know that we are going to
move into study a patient having aortic valve surgery
with a trainee, we can, we can rehearse all
of the aortic valve imaging planes
and also the pathological appearances that we can expect
to see when we then move into the operating theater.
And this ability to rehearse
and practice the practical maneuvers really does
reduce the risk to patients
because the trainees basically are skilled
by the time they have exposure to patients.
In real clinical studies,
of course simulation is used a lot in courses
where it's combined with multimodality
multimodality teaching such as lectures.
A lot of courses also have online
content which learners can access
before they actually join a course.
Self-directed learning, of course, a lot of simulators have
learning management systems within them,
and that facilitates self-directed learning.
As I said, we, you know, our colleagues have access
to our simulators 24 hours a day.
We encourage our trainees
to spend 10 minutes if they have a bit of downtime
during nighttime duty, spend a bit of time sitting
with the simulator consolidating on their practical skills
as well as their theoretical knowledge.
And we actually, we find quite senior people
who are already trained in TE sitting down on the simulator.
And what they're doing often is just
reinforcing their existing knowledge, theoretical knowledge
of TEE and ultrasound findings,
but also keeping their hand in to some extent,
and the practical skills
and the hand eye coordination that's required
to generate ultrasound in the practical clinical setting.
And that's particularly useful for people who don't actually
perform that many studies in a clinical setting.
Finally, TEE simulation has been absorbed into
accreditation processes.
This might be on a local level just within an institution,
but national accreditation processes have also
adopted TEE as a way of assessing practical skill.
And the advantage of course of using TEE simulation
for this is that examiners can standardize the pathology
being examined on
and can, can standardize the examination conditions,
which ensures a degree
of fairness in the examination process.
So from our quite humble start of wanting to just make
a model of the heart, actually our project
evolved and mushroomed into what has spread to be
TEE simulation used worldwide
for training clinicians in this skill.
And a lot of this evolution has been driven by
a massive increase in the use
of TEE in acute clinical
- Sessions.
Thank you for your time,
- Dr.
Arro. Excuse me.
Dr. Wright, thank you again for, for taking your time
and giving us really great insight into
really the beginnings of simulation.
And I think it really drives home the importance of that.
We appreciate all you've done for us and, and all you do
and continue to do for physicians learning and,
and for your patient base.
I encourage folks that are listening to, again, answer,
put any questions into the q and a box
and we will follow up with a question
and answer session following the completion
of today's webinar.
Thank you again, Dr. Wright.
- A pleasure. - It it, it's now my esteem pleasure
to introduce Dr.
Maria O'Rourke. Dr.
Maria O'Rourke is the executive me medical director
of the Emergency Medicine and Critical Care Institute.
She's an emergency medicine physician
and is board certified with over 20 years
of experience in academic and community settings.
She graduated from Tufts University above medicine
and completed her EM residency
and EM ultrasound fellowship at the Mount Sinai School
of Medicine in New York City.
DR work works clinically in California at a community based
setting and teaches in hospitals, teaches hospitalist focus
or point of care ultrasound procedures.
Dr. O'Rourke was co-chair
of the A CEP Community ultrasound committee
for the last two years
and created the A CEP community ultrasound guidelines
and is currently working with a group of experts
to update the new emergency medicine TEE
2023 guidelines.
Dr. Oor has been teaching TEE in the emergency
and emergency medicine critical care setting since 2016,
and it is my esteem pleasure to offer
to introduce you, Dr.
O'Rourke and your talks on implementation of TEE in,
in the real life setting
and how you use simulation to do that.
So once again, welcome.
- Good morning everyone. I wanna thank Paul SonoSite
and Fijiri for having me today here.
Thank you Sue. It's good to see you.
Over the last eight years I've been able to use
simulation methods to teach resuscitative non-operative
trans esophageal ultrasound in the intubated patients.
Today I would like to talk about the importance of
how simulation training is essential in learning point
of care ultrasound, especially trans esophageal ultrasound.
Thank you for the introduction.
I do wanna say that my love of POCUS started when I deployed
on active duty in the war zone
and I use the SonoSite 180 to save a life.
I specifically am a business owner
and I do an eight hour hands-on TE course
and I've helped multiple programs start their own point
of care TEU program around the country.
So why use simulation training?
Well, we know multiple specialties use point
of care ultrasound in emergency medicine.
The Academy College
of Emergency Physicians has been promoting point
of care ultrasound, specifically cardiac point
of care ultrasound to look for shock states help
with cardiac arrest patients
and of course to supplement with procedures.
More importantly, users
of simulation technology can replicate pathology
and abnormal presentations
that are not always there readily available in live patients
use for practicing.
It takes the pressure off the learner
for presenting stat situations
and removing that stat environment.
But TE is different.
It, as Sue said, we need a different skillset.
The TE probe, unlike TTE, provides an unobstructed view
of the heart and the great vessels.
When you do a TE
- Echo, you're looking at the heart
with no obstructions.
- Upon my initial visit to the OR
with a cardiothoracic surgeon in 2016
to learn trans esophageal ultrasound,
I would occasionally see first
and second year residents learning te
and they had no training at all with pocus, unlike myself
who did a fellowship in ultrasound.
This is the moment I realized that the absolute necessity
for SIM training when using TE e when learning TE e.
And you know, cardiac training is really no different than
other high intensity training pilots use it
for airline simulation.
And as an army veteran, I trained
to save lives on a battlefield using
simulated combat training.
And this really ignited my passion
for SIM training and education.
And I've been teaching with high fidelity simulation
technology since 2016.
Simulation based endovascular training has been a novel
method and has been present for many years.
So we know that SIM training is not new.
It has shown to advance and enhance the knowledge
and coordination necessary
for endovascular technical skills.
And what's ideal is that the same way
that the endovascular used it
to navigate the learning curves with surgical skills
and to move from the simulation lab straight
to the operating room
or to the endovascular suite, is the same way
that we can use simulation learning in emergency medicine.
Using high fidelity vascular simulation in the endovascular
surgery enables hands-on procedural training the same way
it allows the cardiothoracic anesthesiology residents
to excel in TE of note,
cardiothoracic anesthesia residents have no POCUS training
prior to learning TE in the or.
Most recently in the article just published this month in
January, 2023 in JAMA Cardiology, there was a
randomized control trial that looked at the effectiveness
of simulation-based training in TE learning.
And as you can see here, it had 324 participants
and it took half the amount of students
and did one online didactic teaching session.
And then they did two 30 minute teaching sessions
with a TE simulator.
The other half did the traditional methods,
which just involved didactic teaching.
And what you can see here, which I felt was fascinating
and I've learned and known for now since 2016, is
that the cardiology fellows in the simulation group had
significantly better scores on post-training tests
of TE knowledge and skills versus those in the
traditional teaching group.
So for T one needs to learn a different skillset,
the probe, the TE probe.
Unlike transthoracic probe,
the TTE probe provides an unobstructed view
of the heart and great vessels.
When you do a transthoracic echo,
you're looking at the heart and fighting lung tissues
and body habitus versus performing transesophageal echo.
Now you're looking from behind the heart
with no obstructions.
This allows clinicians
to accurately evaluate heart function, the quality
of chest compressions
and perform resuscitative measures
with a probe still in place.
And that's what really separates the two
in my courses Since 2016, we believe the best delivery
for T technique is to harness
and develop hand eye coordination
and this involves the complexity of probe manipulation
and NI biology.
And this really elevates the TE skill to a whole new level.
As physicians, we have learned the anatomy and blood flow
and leaflets, but
through repetition on the simulator in the ability
to translate a 2D image at the same time while using
and visualizing the virtual reality live heart is not
something that can be easily learned from a book.
Unfortunately.
Here you can see the common transesophageal windows
that when I'm teaching to give our learners respect
a perspective of what they're looking at
on the 2D image versus in reality
when initiating a T examination, the tip
of the scope can be angled upward or downward by a lever
and much like a bronchoscope or a flexible laryngoscope.
In addition, the scope has a flathead
that resembles a miniature brick,
which houses a movable transducer or multiplane.
This multiplane is steered by a button that can be reached
with the thumb of the hand holding the probe handle.
The clinician's other hand may be positioned at the
patient's mouth where it should be used
to prevent the scope from turning
or inadvertently sliding in and out.
The different views are obtained by roading the multiplane
and directing the tip of the probe.
TEU or trans esophageal ultrasound allows,
allows the provider to determine
what is going on in in the pit patient.
TE can provide a wealth
of valuable diagnostic information about an intubated
patient quickly and with limited risk.
The views can reveal the patient's volume status left
and right ventricular function and the effectiveness of CPR
and it can detect previously unknown pathologies such
as tamponade, pulmonary embolism,
and acute aortic dissection or rupture.
This valuable information can aid resuscitation
and guide the placement of an intra arterial pump
and other procedural guidance.
For example, it's a game changer for ecmo.
The T probe is relatively easy to maneuver
and importantly doesn't interfere with CPR.
What I mean by save the beans is that when you go in
and you can see that there is limited wall motion
or abnormal wall motion with the T probe.
When the cardiology takes that patient to the cath lab,
they can avoid giving them contrast if they know
which vessel is the culprit.
In conclusion, I would like to reiterate
that simulation training is essential
in learning point of care.
Ultrasound, especially trans esophageal ultrasound
studies have proven
that simulation learning increases skillsets
and comprehension of TEE and also it can be a lot of fun.
Thank you for your time today.
I would like to open up space for some questions
or comments you may have now.
Thank you.
- Well, Dr. O'Rourke, thank you again for,
for your presentation
and for including that that JAMA cardiology article that
being hot off the press, like that should open a lot of ice
for folks intended here.
Again, thank you both Dr. Dr. Wright and Dr.
Ro for your time today.
I do have a couple of questions that have come through
and Dr. Wright, I'll, I'll start with you if, if
that's okay since you started off here.
What are the developments that you see in the future
of simulation training?
- Well, it's quite interesting actually
because having started off being inspired really
by our own intuition about
what we felt would be useful in a training tool,
we are now very responsive to feedback from users.
And you know,
what we develop going forward will be very dependent on
what, what we hear from people who are using simulators in,
in their training.
From our own perspective, we're developing congenital
AB abnormalities in a pediatric simulator
and also refining a lot of the 3D simulation
that we've already created.
I think I can imagine going forward that, you know,
apart from developing more pathological models
and of course the, the congenital ones have very difficult
anatomy in places we might perhaps
think of simulating TEE guided procedures such
as ECMO cannula placement or CBC placement
or different imaging modalities such as intracardiac echo.
We'll wait to hear what users ask for.
- Excellent, thank you. Our script a little,
do you applications in pediatric
transesophageal echo, do you see any changes there in, in,
in your, as you work through the simulation for that
or are the applications a lot the same there?
- It's very similar.
I think for the pediatric congenital abnormalities, it,
it takes longer to acquire the knowledge of cardiac anatomy
and so to actually have a 3D model of a congenitally
abnormal heart will be incredibly
useful we believe.
And actually we've always thought this would be the primary
use of the development of abnormal heart models would be
for these complex congenitals.
- Excellent. We look forward, look forward to that one.
One other question came up when it comes to simulation.
What do you think simulation's most valuable
contribution has been to specifically around TEE and TEU?
What do you think the, the most valuable
contribution has been there?
- You know, I think when we started out on our project,
our aim was for primarily to teach people cardiac anatomy.
And then as we carried on to de develop further,
our primary aim became helping people
to develop the hand eye coordination required
for probe manipulation and image acquisition.
And actually still now,
I think these have been the major contributions
easing the acquisition of anatomical knowledge
and easing the development of psychomotor skills.
- Excellent. Great. Thank you again doctor.
And I think time allots, I have well, one
or two questions for Dr.
O'Rourke. If, if, if you don't mind, when you,
when you look at simulation training, what, what,
what sets simulation apart from typical patient oriented
training or the learning environment you would typically
have with nons simulated training?
- Oh yes, thank Paul. That's a great question.
So, you know, simulation training really allows
for real life anatomy in real time to practice
with expert guidance.
Simulation is essential
because it allows you to show simulated actions in which you
can adjust the position of the t probe,
the ultrasound plane,
and showing the results in the position
of the ultrasound plane in relation
to the 3D model of the heart.
Also saving time
and supplies by presenting many different abnormal cases in
common pathologies that we,
we visualize in real life situations.
- Yeah, that's awesome. I, I know in my limited experience
with it, it's been very helpful to have that 3D image to
clearly see through and see and, and think through it.
So yeah, I I I would concur with that.
Another question here came up,
what actual skill can one learn using simulation
training for te?
Is it much different than working on a live patient?
Is it in practicality? Does it work?
- You know, it does work. That's a great question.
It does work. You know,
with the simulator you can practice
multiple times.
The repetition will allow you to advance the probe,
withdraw the probe turn and adjust the OmniPlan
and flex the tip of the probe.
I think the hardest thing
that most learners have is understanding OmniPlan
and seeing the different planes of the heart,
the cuts of the heart.
And when you're doing that on the live patient,
that could be very stressful.
Most importantly, for hands-on anatomy,
you can see the varying cardiac structures
and the different orientations and angles to each other.
And so this, you know, the simulator
and the 3D rec is really the exact replica
of the human anatomy
and it enables being able
to simulate pathological presentations really on demand
with exact patient anatomy and di disease sequelae.
- Excellent. Yeah, I think that hearkens back very well
to the, the evolution part that I tried to speak to earlier.
Well, I think we're, we're kind of at the end of,
of our allotted time here.
Again, I would like to thank our, our, our panelists,
Dr. Susan Wright and Dr.
Maria O'Rourke for taking the time to help us
and enlighten us today.
And more importantly, to help continue the wave
of introduction for transesophageal ultrasound
at the point of care.
And to those of you who are listening online,
we encourage you to enter, answer
or enter any questions that you may have
and we will get those back to you.
On behalf of the entire ccy team, I thank you all
for joining and thank you again Dr. Wright and Dr.
Ro.
Transesophageal Ultrasound (TEU) has evolved over the last decade and become a valuable tool at the point of care. Simulation training is essential when learning the skills necessary for the use of transesophageal ultrasound. This webinar will discuss the evolution of TEU simulation training within the Acute Care and Anesthesia environments.
What You'll Learn
Upon viewing this webinar, viewers will have a better understanding of the:
- Development of SIM training for the use of Transesophageal Ultrasound.
- Evolution and role of TEU simulation training in Emergency Medicine, Critical Care and Anesthesia.
- Use of SIM training for implementing a TEU program at the point of care.
Dr. Wright was born and educated in Zimbabwe. She graduated in medicine from the University of London and subsequently gained a fellowship at the Royal College of Anaesthetists in the UK (United Kingdom). She has worked as an anaesthetist in Southern Africa and in the UK and has achieved EACVI TEE accreditation.
She established and led the peri-operative echocardiography service at the Heart Hospital, London, before moving to her current post as a consultant cardiac anesthesiologist at St. Bartholomew’s Hospital in London.
With two colleagues she co-invented the HeartWorks echocardiography simulator in 2008 and has continued to develop this teaching tool since. Dr. Wright has directed theatre- and simulator-based TOE courses regularly, co-authored a TEE e-learning program and participated in TOE educational activities worldwide.
Dr. O’Rourke is an Emergency Medicine (EM) board-certified physician with over 20 years’ experience in academic and community settings. She graduated from Tufts School of Medicine and completed her EM residency and EM Ultrasound Fellowship at the Mount Sinai School of Medicine in NYC. Dr. O’Rourke works clinically in California in a community-based setting and teaches the hospitalist POCUS.
Dr. O'Rourke was Co- Chair of the ACEP Community US Committee for the last 2 years and created the ACEP Community US Guidelines and is currently participating with a group of experts to update the new EM TEE 2023 guidelines.
Dr. O’Rourke has been teaching Limited TEE in the Emergency Medicine and Critical Care setting since 2016 and has started multiple EM based TEE programs around the country.
This educational webinar is intended for healthcare professionals and not for patients or consumers. The material is provided for general educational purposes, as a reference and a supplement to professional experience, education and training, and should not be considered the exclusive source for this type of information. This educational webinar is not intended to recommend any device for a particular indication or to provide indications for use for any device. At all times, it is the professional responsibility of the practitioner to exercise independent clinical judgment in each particular situation. Fujifilm assumes no responsibility or liability for any misuse of the information imparted in this webinar. This educational webinar does not supplement, replace, or supersede device labeling, including instructions for use, which accompanies any FUJIFILM Sonosite product.