OSCE - NH-TNE - McGill program

Written instructions:

Part 1: Image Review on PACS

You will be provided with echocardiographic images on PACS. Please go through the NeoCardioLab Folder on the GlobalShare Drive and select OSCE Cases. Copy paste the folder address on SYNGO using the "folder read" function. You are expected to:

1. Review the echocardiogram systematically.

2. Perform relevant measurements, such as:

   • Left and right ventricular function (fractional shortening, ejection fraction, TAPSE, FAC)

   • Pulmonary pressure estimation (TR jet, PDA shunting, septal position)

   • Systemic blood flow estimation (SVC flow, LVOT VTI, ductal flow)

   • Myocardial performance (MPI for LV and RV)

Part 2: Interpretation & Diagnosis

1. Summarize your echocardiographic 

2. Provide a structured report

Part 3: Management Plan

Based on your findings, formulate a plan:

1. Interpret hemodynamic significance of echocardiographic findings.

2. Provide recommendations for clinical management, such as:

   • Ventilation Strategy: Considerations for optimizing lung inflation and reducing pulmonary vascular resistance.

   • Cardiovascular Support: Need for volume expansion, pulmonary vasodilators, inotropes, or vasopressors.

   • Pulmonary Hypertension Management: Assessment of response to iNO, potential escalation (e.g., sildenafil, milrinone).

   • Follow-up Imaging: When to repeat the TNE and what to monitor over time.

   • Involvement of other consultants or other imaging modalities

Expected Key Objectives for the Fellow:

1. Systematic Approach to NH-TNE in Critically Ill Infants

2. Interpretation of TNE findings in light of the clinical information

3. Categorize cardiovascular phenotype of the patient to tailor therapy

4. Integration of Echo Findings with Clinical Data: Using targeted neonatal echocardiography to refine management decisions and guide therapy.