Small case for the new attendings

You have been assigned to take care of the small procedures done in a closet in the PACU. Basically ECTs and cardioversions.

Your next patient is a 76 y/o male 5'9", 315 pounds, short neck, with a beard, mallampati 3, no teeth, DM2, htn, normal previous echo, satting 93 on 3L nasal cannula, visibly short of breath, and complaining of back pain from being in a gurney for too long.

Cardiology wants to do a tee under sedation before cardioverting. They usually do them in the echo lab ahead of time but they think he will not tolerate.

How would you handle it?

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Small case for the new attendings