Procedural Applications of Point-of-Care Ultrasound in Pediatric Emergency Medicine

Shaahinfar, Ashkon; Ghaziaskar, Zahra

doi:10.1016/j.emc.2021.04.006

Cited by 15 publications

(7 citation statements)

References 153 publications

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“…Its ability to provide rapid diagnosis, procedural guidance, treatment monitoring, preoperative planning, bedside assessment and enhancement of patient safety make it an indispensable tool in surgical decision-making. By incorporating PoCUS into their practice, surgeons may optimize patient care, improve surgical outcomes and implement appropriate interventions (20,21).…”

Section: Discussionmentioning

confidence: 99%

PoCUS for the management of Fournier's gangrene in the emergency department: A case report

Vargas‑Roa,

Quintero‑Vanegas,

Zuluaga‑Gómez

et al. 2023

Biomed Rep

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Serious soft tissue infections in the spectrum of rapidly progressive necrosis of the fascia and subcutaneous tissue represent a clinical challenge in emergency department clinical practice. Fournier's gangrene (FG) is a presentation thereof that compromises the urogenital area. A low threshold of clinical suspicion complementary to laboratory evaluation and imaging is necessary to act rapidly and perform diagnostic and therapeutic surgical intervention for this condition. The present study reported the case of a 63-year-old woman who was admitted with buttock skin changes for 72 h. The diagnostic impression was septic shock due to FG. Point-of-care ultrasound (PoCUS) was performed, indicating free fluid in the muscle planes, discontinuity of the muscle fascia and the presence of gas in the subcutaneous cellular tissue. The patient was taken to surgery 2 h after admission. PoCUS was indicated to have an acceptable diagnostic performance that may optimize the care of this type of patient depending on the conditions of the emergency department and the availability of other resources.

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Section: Discussionmentioning

confidence: 99%

PoCUS for the management of Fournier's gangrene in the emergency department: A case report

Vargas‑Roa,

Quintero‑Vanegas,

Zuluaga‑Gómez

et al. 2023

Biomed Rep

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“…Some recent pediatric emergency POCUS reviews ( 90 , 91 ) have also mentioned gastric POCUS, and O'Brien et al rated it as probably useful to identify foreign bodies and HSP, respectively. Other published reviews have not mentioned gastric POCUS ( 92 , 93 ).…”

Section: Discussionmentioning

confidence: 99%

Gastric Point-of-Care Ultrasound in Acutely and Critically Ill Children (POCUS-ped): A Scoping Review

et al. 2022

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IntroductionPoint-of-care ultrasound (POCUS) use is increasing in pediatric clinical settings. However, gastric POCUS is rarely used, despite its potential value in optimizing the diagnosis and management in several clinical scenarios (i.e., assessing gastric emptying and gastric volume/content, gastric foreign bodies, confirming nasogastric tube placement, and hypertrophic pyloric stenosis). This review aimed to assess how gastric POCUS may be used in acute and critically ill children.Materials and MethodsAn international expert group was established, composed of pediatricians, pediatric intensivists, anesthesiologists, radiologists, nurses, and a methodologist. A scoping review was conducted with an aim to describe the use of gastric POCUS in pediatrics in acute and critical care settings. A literature search was conducted in three databases, to identify studies published between 1998 and 2022. Abstracts and relevant full texts were screened for eligibility, and data were extracted, according to the JBI methodology (Johanna Briggs Institute).ResultsA total of 70 studies were included. Most studies (n = 47; 67%) were conducted to assess gastric emptying and gastric volume/contents. The studies assessed gastric volume, the impact of different feed types (breast milk, fortifiers, and thickeners) and feed administration modes on gastric emptying, and gastric volume/content prior to sedation or anesthesia or during surgery. Other studies described the use of gastric POCUS in foreign body ingestion (n = 6), nasogastric tube placement (n = 5), hypertrophic pyloric stenosis (n = 8), and gastric insufflation during mechanical ventilatory support (n = 4). POCUS was performed by neonatologists, anesthesiologists, emergency department physicians, and surgeons. Their learning curve was rapid, and the accuracy was high when compared to that of the ultrasound performed by radiologists (RADUS) or other gold standards (e.g., endoscopy, radiography, and MRI). No study conducted in critically ill children was found apart from that in neonatal intensive care in preterms.DiscussionGastric POCUS appears useful and reliable in a variety of pediatric clinical settings. It may help optimize induction in emergency sedation/anesthesia, diagnose foreign bodies and hypertrophic pyloric stenosis, and assist in confirming nasogastric tube placement, avoiding delays in obtaining confirmatory examinations (RADUS, x-rays, etc.) and reducing radiation exposure. It may be useful in pediatric intensive care but requires further investigation.

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“…The use of POCUS for procedural guidance has an established role in emergency medicine to improve the success and safety of procedures [57], including nerve blocks, intravenous (IV) access, and incision and drainage.…”

Section: High Yield Point-of-care Ultrasound-assisted Proceduresmentioning

confidence: 99%

“…Regional anesthesia, including peripheral nerve blocks, has long played an important role in perioperative pain management and classically has been performed via anatomic landmarks [57,58]. Nerve blocks are a core component of a multimodal pain management strategy and are useful for the management of several common emergency department (ED) presentations including fractures, laceration repair, and abscess incision and drainage.…”

Section: Ultrasound-guided Nerve Blocksmentioning

confidence: 99%

Updates on the clinical integration of point-of-care ultrasound in pediatric emergency medicine

Lee,

Sweetnam-Holmes,

Soffer

et al. 2024

Current Opinion in Pediatrics

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Purpose of review There is expanding evidence for point-of-care ultrasound (POCUS) use in pediatric emergency medicine – this review highlights the benefits and challenges in the clinical integration of high-yield POCUS applications. Specifically, it will delve into POCUS applications during resuscitations, controversies of Focused Assessment with Sonography for Trauma (FAST) in pediatric trauma, POCUS-guided procedures, and examples of clinical pathways where POCUS can expedite definitive care. Recent findings POCUS can enhance diagnostic accuracy and aid in management of pediatric patients in shock and help identify reversible causes during cardiac arrest. The use of the FAST in pediatric blunt abdominal trauma remains nuanced – its proper use requires an integration with clinical findings and an appreciation of its limitations. POCUS has been shown to enhance safety and efficacy of procedures such as nerve blocks, incision & drainage, and intravenous access. Integrating POCUS into pathways for conditions such as intussusception and testicular torsion expedites downstream care. Summary POCUS enhances diagnostic efficiency and management in pediatric patients arriving at the ED with undifferentiated shock, cardiac arrest, or trauma. Additionally, POCUS improves procedural success and safety, and is integral to clinical pathways for expediting definitive care for various pediatric emergencies. Future research should continue to focus on the impact of POCUS on patient outcomes, ensuring user competency, and the expansion of POCUS into diverse settings.

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Procedural Applications of Point-of-Care Ultrasound in Pediatric Emergency Medicine

Cited by 15 publications

References 153 publications

PoCUS for the management of Fournier's gangrene in the emergency department: A case report

PoCUS for the management of Fournier's gangrene in the emergency department: A case report

Gastric Point-of-Care Ultrasound in Acutely and Critically Ill Children (POCUS-ped): A Scoping Review

Updates on the clinical integration of point-of-care ultrasound in pediatric emergency medicine

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