echocardiography:tee:screening_form
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| == Screening Form == | == Screening Form == | ||
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| + | ====== Transesophageal echocardiogram screening form ====== | ||
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| Transesophageal echocardiography is generally considered a safe and low risk procedure. | Transesophageal echocardiography is generally considered a safe and low risk procedure. | ||
| {{: | {{: | ||
| - | | Oropharyngeal | Lip bruising/ | + | | Oropharyngeal | Lip bruising/ |
| - | | Esophageal | Pain with swallowing, trouble swallowing, laceration/ | + | | Esophageal | Pain with swallowing, trouble swallowing, laceration/ |
| | Gastric | Tear of stomach, bleeding | | | Gastric | Tear of stomach, bleeding | | ||
| - | | Miscellaneous | Splenic laceration, compression of mediastinal structures, airway compromise, thermal | + | | Miscellaneous | Splenic laceration, compression of mediastinal structures, airway compromise, thermal injury burn, tongue necrosis | |
| + | ===== Procedure ===== | ||
| + | * Your throat will be sprayed with a medicine to numb it. | ||
| + | * IV (intravenous line) will be placed in your arm. | ||
| + | * The technician then places small pads (electrodes) on your chest. The electrodes are attached by wires to a machine that will record your electrocardiogram (ECG) to track your heartbeat. | ||
| + | * The anesthesia provider will give a medication in your IV to put you to sleep | ||
| + | * Then a thin, flexible tube (probe) is gently guided through your mouth and down your throat. | ||
| + | * A transducer on the end of the probe sends sound waves to your heart and collects the echoes that bounce back. | ||
| + | * These echoes become pictures that show up on a video screen. | ||
| + | * When the TEE is complete, the probe, IV and electrodes are removed, and you will be monitored until you are fully awake. | ||
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| + | ==== Are any of the following true for you? ===== | ||
| | ☐ Yes | ☐ No | Problems swallowing | | | ☐ Yes | ☐ No | Problems swallowing | | ||
| + | | ☐ Yes | ☐ No | History of abnormality of your esophagus (swallowing tube) or stomach such as stricture (narrowing) | | ||
| | ☐ Yes | ☐ No | History of surgery involving your esophagus (swallowing tube) | | | ☐ Yes | ☐ No | History of surgery involving your esophagus (swallowing tube) | | ||
| + | | ☐ Yes | ☐ No | History of radiation to your chest | | ||
| | ☐ Yes | ☐ No | History of cirrhosis or esophageal varices | | | ☐ Yes | ☐ No | History of cirrhosis or esophageal varices | | ||
| + | | ☐ Yes | ☐ No | Ulcer in your esophagus (swallowing tube) or stomach | | ||
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| + | Patient signature __________________________________________________ | ||
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| - | J Am Soc Echocardiogr 2010; | + | J Am Soc Echocardiogr 2010; |
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