ALVIN COMMUNITY COLLEGE
DIAGNOSTIC CARDIOVASCULAR
SONOGRAPHY
DSVT 2330 SYLLABUS
Deb Kleinhans, RVT
SUMMER 2016
INSTRUCTOR: / Deb Kleinhans / E-MAIL: /OFFICE: / S148 / PHONE: / 281-756-5663
Cell phone will be given on the first day of class
OFFICE HOURS: / Tuesday 12:30-1 by appointment
WEBSITE: / www.alvincollege.edu
WELCOME TO:
Course Title: Cerebrovascular Evaluation of Pathology II
Course Number: DSVT 2330.01
Credit Hours: 3
Lecture Hours: 32
Lab Hours: 64
Total Contact Hours: 96
Term and Year: Summer 2016
Class Days & Times: Tuesday
Lab 8- 12:20, 3:30-7:20
Lecture: 1-3:20
Classroom Location: Lab: S141, Lecture S147
COMMUNICATING WITH YOUR INSTRUCTOR
The preferred method of communicating with your instructor is through the ACC email or you may call me at 281-756-5663. Please leave your first and last name, a phone number or an e-mail address where I can contact you and explain what you need to discuss with me. I will normally respond within 24 hours Monday-Thursday and by the next business day on Friday-Sunday.
COURSE DESCRIPTION
This course is a continuation of Vascular Evaluation of Pathology I with emphasis on evaluation of cerebrovascular diseases and interventions.
STUDENT LEARNING OUTCOMES
Interpret the etiology, signs, symptoms, and treatment for cerebrovascular disease; and utilize Doppler modalities to evaluate and quantify cerebrovascular disease.
COURSE GOALS AND OBJECTIVES;
Upon completion of this course, the student will be able to:
1. Define the etiology, signs, symptoms, and treatment for cerebrovascular disease.
(C6, C7, F1, F2, F5, F10)
2. Implement methods of recognition, evaluation, and quantification of those diseases utilizing technical skills.
(C7, C9, C16, C18, C19, C20, F7, F8, F9, F13, F17)
3. Understand the pathophysiology and hemodynamic consequences of each disease.
(C5, C6, C7, F10, F12)
4. Recognize and differentiate various cerebrovascular interventions.
(C1, C8, C13, C15, C17, F3, F4)
* See SCANS legend for more details about competencies.
5. Successfully challenge a Capstone scanning experience (85 or better) during lab at the end of the semester.
Students are responsible for and will be tested on all material texts, handouts.
UNIT 1 OBJECTIVES - Review Cerebrovascular Anatomy
By the end of this unit the student will be able to:
1. Identify the vessels of the upper aortic arch, neck, face, brain, and head.
2. Discuss and map ALL the possible collateral blood supply routes.
3. Recognize normal and abnormal characteristics of the Cerebrovascular, vertebrobasilar, and circle vessels commonly imaged during carotid duplex, TCD, or periorbital examinations.
4. Differentiate between the common, vertebral, internal, and external vessels via multiple methods.
5. Locate the vessels of the Circle of Willis on a diagram and map the possible variations.
6. Distinguish the various flow patterns and velocity profiles from the vessels imaged in both normal and diseased states.
7. Identify other potential vascular variations for the Cerebrovascular circulation.
8. Review the hemodynamics of Cerebrovascular blood flow.
Unit 1 Homework Assignments:
1. a. Draw a diagram/model of the normal circle of Willis and diagrams representing each one of the possible variations.
b. Draw a diagram of the different collateral routes to the brain when the CCA or ICA are occluded.
If you are not artistic you may use tracing paper or an overhead/projector blow up of a diagram to trace.
c. Kupinski workbook; Chapter 7.
UNIT 2 OBJECTIVES – Carotid Duplex Evaluation of Pathology
By the end of this unit the student will be able to:
1. Understand the etiology and pathophysiology of cerebrovascular diseases.
2. List the risk factors, signs and symptoms associated with cerebrovascular diseases.
3. Perform duplex ultrasound imaging examination of the cerebrovascular system.
5. Complete a full carotid duplex exam including measurements and calculations.
6. List the different types and possible causes of stroke: ischemic, embolic, obstructive, hemorrhagic, hypertensive.
7. Define and state the difference between CVA, TIA, and RIND.
8. Illustrate the different carotid artery plaque composition and how it appears sonographically.
9. Recognize disease states of the cerebrovascular system including but not limited to: stenosis, thrombus, aneurysm, dissection, carotid body tumor, and FMD via 2D, color flow, Doppler, and velocity characteristics.
10. Define the common medical therapies and interventions used to treat cerebrovascular disease and how or if it is evaluated with follow up duplex exams.
11. Identify the surrounding anatomy and discuss other potential (incidental) findings: thyroid, venous system of the neck, trachea.
12. Grade stenosis accurately using velocity, ratio, plaque appearance, image and Doppler criteria.
13. Identify the methods used to confirm and correlate non-invasive results such as angiogram, MRI, MRA, Cat Scan, etc.
14. Understand the common mistakes, pitfalls, and complications while performing carotid duplex exams.
15. State the purpose and procedure for carotid intimal measurements and how the Framingham score is utilized for determining vascular age and patient management of hyperlipidemia, heart disease and stroke risk treatment.
16. Identify interpretation criteria such as NACET, etc.
17. List and define research being performed in the area of Cerebrovascular disease.
18. Identify the pros and cons of carotid artery screening agencies. (May have a debate.)
Unit 2 Homework Assignments:
Kupinski workbook; Chapters 4 and 5.
Unit 2 Lab Assignments:
Check Schedule on page 3.
UNIT 3 OBJECTIVES – Transcranial Doppler
By the end of this unit, the student will be able to…
1. List the capabilities and uses for transcranial Doppler. (Intraoperative, ICU, Brain Death, Occlusions, AVM’s, sickle cell, SAH, vasomotor reactivity, variations in circle anatomy, trauma, )
2. List the challenges, pitfalls, and limitations of transcranial Doppler.
3. Discuss the physical principles associated with TCD.
4. Prepare the patient for a TCD exam using proper positioning, protocol, techniques, and equipment.
5. Accurately identify each vessel examined using the following criteria: window, depth, direction of flow, velocity, angle, and compression maneuvers.
6. Find each window for obtaining a TCD signal.
7. Perform measurements associated with TCD examination.
8. Discuss the interpretation and significance of findings for TCD and how well this test correlates with other methods.
9. Identify how TCD is being used in conjunction with contrast agents or saline bubble studies to identify patients with PFO related stroke events.
10. Perform TCD scan evaluation in lab for critique by instructor.
Unit 3 Homework Assignment:
Kupinski workbook chapter 6.
Unit 3 Lab Assignments:
Check Tentative Schedule p. 3
PRE-REQUISITE COURSES
DSVT 1300 – Principles of Non-invasive Vascular Sonography
REQUIRED TEXTBOOK AND SUPPLEMENTAL READINGS
Current editions of each of the following:
Daigle, Techniques in Non-Invasive Vascular Diagnosis. ISBN-13: 9780972065368
Rumwell, Vascular Technology Review, ISBN: ISBN: 0-941022-73-0
Kupinski, Ann Marie, The Vascular System. ISBN:978-1-60831-350-1
Workbook, The Vascular System. ISBN 978-1-60831-432-4
For more information about the textbooks, including details about how to order your book online and have it delivered to you, visit the ACC College Store at www.alvinccstore.com.
ADDITIONAL MATERIALS:
· USB/ Jump Drive
· Purchase Ultralinq Renewal from Bookstore – USE the renewal form found in the storage room S107B
· Stretchy shorts.
· General supplies for class: Colored markers, Paper clips, scotch tape, scissors, stapler and staples
· ACC DCVS polo or T-shirt to wear to lab
· ACC DCVS Name Tag to wear to lab
· Ream of printer paper, ink cartridges for lab printer
COURSE OUTLINE:
WEEK / DATE / Outside Scan Homework / UNIT / TOPIC/READING1 / 05-31 / Bilateral Carotid / Begin Unit 1- Review Cerebrovascular anatomy
Start Circle of Willis anomalies / Rumwell pages192-200
Kupinski pages 91-118
2 / 06-7 / Bilateral Carotid / Circle of Willis – anomalies cont.
Start: Cerebrovascular hemodynamics / Rumwell 201-222
Homework Due
Kupinski 35-64
3 / 06-14 / Non-imaging complete LEA / Cerebrovascular hemodynamics
Start- Carotid Duplex
4 / 06-21 / Bilateral Arterial LE / EXAM
Carotid Duplex (cont)
5 / 06-28 / !st scan eval due / Vertebrobasilar Evaluation / Daigle pages 53-70,
Kupinski
6 / 07-5 / Bilateral Venous LE / Transcranial Doppler / Homework Due
7 / 07-12 / Non Imaging Arterial / EXAM
TCD cont. / Rumwell pp. 241-246
Homework Due
8 / 07-19 / Bilateral
Venous LE / Periorbital Doppler / Rumwell pp.213-216
Handouts, Rumwell pp 217-222
9 / 07-26 / Final Scan Eval DUE / Cerebrovascular Interventions / Rumwell pp 251-260 Capstones, Exit Exam Due
Review Book Due Homework Due
Scan eval 2 Due
10 / 08-02 / Bilateral arterial LE / EXAM / Outside Scan Time
11 / 08-9 / Final Exam / Start Reading for Fall semester.
In addition to the bilateral outside scan homework, each student is required to turn in on Ultralinq a bilateral carotid study weekly.
DATE / LAB ASSIGNMENT: All lab assignments will be uploaded to Ultralinq for faculty assessment. All worksheets must be completed fully.1 / 05-31 / Perform a complete Carotid Duplex using the best approach for the vessel being interrogated, and standard ACC protocol with color and Doppler. Complete the report page, including history, assessment, blood pressures (bilateral), and interpretation. Due at the end of lab. Daigle pp.26-33
2 / 06-7 / Perform a complete Carotid Duplex with color and Doppler using the best approach for the vessel being interrogated and using standard ACC protocol. Complete the report pages/worksheets, fill out tech report including history, assessment, blood pressures (bilateral), and interpretation. Due at the end of lab Daigle pp 26-45
3 / 06-14 / Perform a complete Carotid Duplex with color and Doppler using the best approach for the vessel being interrogated and using standard ACC protocol. Fill out computerized report pages/worksheets, fill out tech report including history, assessment, blood pressures (bilateral), and interpretation. Due at the end of lab
Daigle pp. 45-52 before lab class
4 / 06-21 / Perform a complete Carotid Duplex with color and Doppler using the standard ACC protocol. Print out computerized report pages/worksheets, fill out tech report including history, assessment, blood pressures (bilateral), and interpretation. Due at the end of lab
5 / 06-28 / Perform a complete Carotid Duplex with color and Doppler using the standard ACC protocol within 40 minutes. Fill out computerized report pages/worksheets, fill out tech report including history, assessment, blood pressures (bilateral), and interpretation. Include Suprasternal notch image. Due at the end of lab.
6 / 07-5 / MOCK CAPSTONES Perform a complete Carotid Duplex using standard ACC protocol in 40 minutes. Fill out computerized report pages/worksheets, fill out tech report including history, assessment, blood pressures (bilateral), and interpretation. Due at the end of lab.
7 / 07-12 / Perform TCD exam utilizing multiple windows. Try to identify as many vessels as possible and label them. Note the depth, flow direction and TAMV on Doppler. Read Daigle pp. 259-271; Review Rumwell pp. 241-246 before lab class
8 / 07-19 / Perform TCD exam utilizing multiple windows. Try to identify as many vessels as possible and label them. Note the depth, flow direction and TAMV on Doppler. Read Daigle pp. 271-280; Rumwell pp. 247-2 before lab class
9 / 07-26 / Capstones-Complete carotid study using ACC protocol-45 minutes-if pathology is present additional time will be given. Rumwell pp 213-223 before lab class
10 / 08-02 / Finish Capstones if necessary. Due at the end of lab.
11 / 08-8 / FINAL EXAM
EXAMS AND MAJOR ASSIGNMENTS
An exam will be given at the end of each unit. The exams will be averaged with the assignments to calculate the final grade. Any missed exams will be made up on the next class day!! NO EXCEPTIONS!! The comprehensive final exam is required to complete the course; however, the grade will be used to replace the lowest test score. It will not be used against you if the grade is lower than previous test scores. Students may miss one exam and be allowed to make it up. If a second test is missed, the final will be used to replace that grade. Any missed tests after that will be a zero. Example: 1st missed exam - make up, 2nd missed exam - take the final to replace, 3rd missed exam Zero, and so forth.
Bonus Points/Homework Pass
Students may receive up to a maximum of two (2) bonus points, to be added to the final average for this course or to be used as one homework pass by completing any of the following activities.
1.) Attend any related society meeting or educational conference/inservice as announced. (Attendance must be verified – Each one is worth one point)
3.) Any other bonus point activity as announced by faculty.
Students must have a bonus point form signed while at the activity.
Do not ask to have a form signed after the fact.
Capstones, Check Offs and Competency Assessments are considered official exams and fall under the jurisdiction of our academic integrity policy. Students are NOT allowed to use ANYTHING to assist them while performing skills or scan tests of any kind. Students may not have anything with them while they are testing and this includes but is not limited to the following: No phones, No backpacks, No purses, No books, No notes, No cards, No lists, No protocols, no nothing will be allowed while you are testing. The program expects students to know the procedure, protocol, formulas and any and all pertinent information in order to get the job done. If you need a pad to write information and values on while performing the procedure, the pad must be BLANK. No writing on the pad of any kind before you start. The only things we will allow in the room with the student while performing a skill or scan test are the supplies needed, the patient’s chart, patient consent form, a blank pad or paper and the student report or hospital worksheet. This includes all lab and clinical competency assessments.
Additionally, students who are scanning or getting checked off on each other may not help each other, motion to each other, hint to each other, or position themselves or do anything to help their classmate in any way. As the patient, you need to do exactly as you are told when you are told and not before. The program has to be sure that each and every student is fully capable of explaining and performing procedures on patients without assistance from anyone. If you were the real patient you would have the same standard.
Scan EVALS
A complete carotid protocol will be performed and clipped then sent to Ultralinq for review. The protocol must be complete and thorough according to the latest ACC protocol. If there is pathology it should be appropriately interrogated. You will receive extra time if you find pathology as long as you properly evaluate it. You should time yourself and complete it within 40 minutes. Label the start time and end time on the screen when using the Biosound. Be sure to clip the first image when you start and the last image when you finish even if it is after additional measurements are completed. 0.5 points for the first scan eval and 1 point for the second scan eval will be deducted for each minute over 40. Start/End time includes measurements. Both Scan Evals will be averaged together to count as a major grade. Make sure you label these assignments as Scan EVAL #1 and Scan EVAL #2. Scan eval 1-due 6/28 and scan eval 2-due 7/26.