UltraSound uses in Pediatric Emergency Medicine

20 October, 2011 by: colinparker

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Everyone’s doing it… Is it time for your Pediatric ED to join the UltraSound craze?  For adult Emergency Medicine, there seems to be a strong following and a reasonable evidence-base.  That may be coming to the kiddy world, but maybe it’s not all that it’s cracked up to be?

In this episode, we discuss the evolution of bedside clinical ultrasound use in the pediatric emergency medicine setting.  As always, we’d love to hear your comments…


Outline: Ultrasound PEMcast

CP: Intro, disclaimer, EBM-light discussion…
Levy & Noble 2008 (Pediatrics) gives a reasonable overview (full reference below).

CP: overview:
Established uses in Adult EM
Translation to PEM setting
Procedural uses in PEM
Diagnostic uses in PEM
New & crazy directions

JCR: What got you interested in UltraSound?

CP: Established uses in Adult EM
Diagnostic: FAST
Aorta
Procedural: CVC
Femoral Nerve Block
JCR: extending diagnostic uses: DVT, resuscitation/shock, Echo, [for experts: gallstones, pneumothorax, retinal detachment, more]
and Procedural uses: vascular access, nerve blocks, fracture reduction [more]

RR: Advantages of translating U/S skills to PEM setting?
no radiation
aid to clinical skills
improved success with procedures
potential to save time
potential to increase parent/patient satisfaction
look cool…

CP: Barriers to implementing U/S in the Paediatric ED:
lack of skilled users
trauma infrequent (& often conservatively managed)
operator-dependent (therefore medicolegal risk with diagnostic studies)
resistance to change (within ED and even Radiology Dept)
less cooperative patients

RR: Procedural uses in PEM
Vascular access esp CVC
Nerve blocks esp Femoral Nerve Block
For the brave:
foreign body localisation & removal
fracture reduction
joint aspiration
abscess incision & drainage
lumbar puncture

JCR [comment]

CP: Diagnostic uses in PEM
Bladder volume (pre-SPA)
Volume status – IVC: Aorta ratio
Hip effusion
For the brave:
appendicitis
pyloric stenosis
pregnancy
intussusception
echo (innocent murmur)

JCR [comment]

JCR: Evidence base supporting the use of UltraSound by Emergency Physicians?

RR: New & crazy directions
ETT placement (confirmation)(either directly scanning trachea, or visualising sliding pleura)
ETT sizing pre-intubation (using a formula)
Raised intracranial pressure (optic nerve diameter)
Fractures of skull, tibia (toddlers fractures missed on X-Ray)
Peritonsillar abscess
Scrotal pain (suspected torsion)
?minor head injury in infants with open fontanelle (risky)

CP: personal track-record theory

JCR: Credentialling in Australia (& worldwide)
Further qualifications in U/S

All: Summary, goodbye

By the way… check out www.UltraSoundVillage.com

Reference

Levy JA, Noble VE.
Bedside ultrasound in pediatric emergency medicine.
Pediatrics. 2008 May;121(5):e1404-12. Review. PubMed PMID: 18450883.

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One Response to “UltraSound uses in Pediatric Emergency Medicine”
  1. Nice EMPEM discussion on USS guys…

    Good to hear an antipodean accent on there for a change Colin!

    BTW, I forgot who taught me that pen lid trick… :-)

    Chris

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