Imaging (Echocardiography) —
Training activity: 21

Details

Adapt protocol and report to cater for critically unwell patients

Type

Developmental training activity (DTA)

Evidence requirements

Evidence the activity has been undertaken by the trainee​.

Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.

An action plan to implement learning and/or to address skills or knowledge gaps identified.

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

• Before this activity, what are the common cardiac issues that might arise in critically unwell patients (e.g., sepsis-induced cardiomyopathy, haemodynamic instability)?
• How does the echocardiography protocol need to be adapted for a rapid and focused assessment in a critical care setting?
• What are the key parameters to assess and prioritise in this situation?
• What key elements should be included in the echo report for a critically unwell patient?

In action

• How are you modifying the standard echo protocol for a critically unwell patient, considering limitations such as patient positioning, ventilation, and the need for rapid assessment? Which specific views and measurements are you prioritising to answer the clinical question at hand (e.g., assessing left ventricular function in shock, evaluating for pericardial effusion in tamponade)? How are you planning to structure your report concisely and focus on the most critical findings? Are you adapting your imaging approach based on the patient’s condition and tolerance? Are you prioritising specific views or measurements that will provide the most clinically relevant information quickly? Are you deciding which findings require immediate communication to the clinical team? Are you comfortable performing a focused echocardiographic examination in a time-sensitive and challenging clinical environment? Are you consciously prioritising the most important information and avoiding unnecessary detail?

• Are you successfully acquiring the necessary images despite the technical challenges? Are you obtaining the key measurements needed to answer the clinical question? Are you gaining a better understanding of how echocardiography can provide crucial information in the management of critically ill patients? Are you learning to adapt your scanning technique and interpretation skills to these challenging situations? Are you applying your knowledge of critical care cardiology, relevant echocardiographic findings in acute conditions, and your ability to perform a rapid and focused examination?

• Would limited views or qualitative assessments be sufficient in this situation? Is there a role for point-of-care ultrasound (POCUS) principles? If you encounter unexpected findings or are unsure about the clinical significance of your observations in the context of the patient’s critical illness, would you immediately seek advice from a senior colleague or the attending physician? Are the protocol adaptations and the interpretation of findings in critically unwell patients within the scope of your current training and under appropriate supervision?

On action

• Describe the specific challenges and considerations for imaging a critically unwell patient. Outline how you adapted the standard echo protocol, considering factors such as limited mobility and the need for rapid assessment. Note the key features you focused on in the report.
• Reflect on your understanding of performing echocardiography in critically unwell patients. Did you gain a better understanding of adapting protocols for this setting? Were there any challenges in image acquisition or interpretation? How does this relate to acquiring and interpreting cardiac images for pathological conditions?
• Identify any specific aspects of imaging critically unwell patients where you need to enhance your knowledge and skills. How will you approach adapting protocols in the future? What resources or guidance will you seek?

Beyond action

• Have you performed echocardiography on critically unwell patients in various settings (e.g., intensive care unit)? How did the urgency and complexity of these cases influence your approach to protocol adaptation and reporting? Have your subsequent experiences in this area refined your techniques?
• How has your ability to adapt echo protocols to obtain essential diagnostic information in critically unwell patients, often with limited windows and challenging conditions, improved? Are you now more skilled in prioritising views and measurements to provide timely and relevant information to the clinical team?
• How will your experience with echocardiography in critical care settings inform your ability to provide crucial diagnostic support in urgent situations? What did you learn about the importance of efficient and focused examinations in this context?

Relevant learning outcomes

#	Outcome
# 1	Outcome Acquire and interpret cardiac images for a range of normal and pathological conditions.
# 2	Outcome Explain imaging results to patients and other health care professionals.
# 3	Outcome Distinguish and justify actions based on clinical and ECG findings.
# 5	Outcome Appraise new guidelines and evidence to inform practice.
# 6	Outcome Demonstrate safe practice in line with local, national and international guidelines and standards.
# 7	Outcome Assess and evaluate a patient’s clinical presentation and make recommendations for cardiac imaging.
# 8	Outcome Evaluate cardiac care pathways.
# 9	Outcome Summarise complex information into a concise and logical reports for specialist and non-specialist audiences.