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Pediatric Radiology

, Volume 38, Supplement 4, pp 679–684 | Cite as

Bedside pediatric emergency evaluation through ultrasonography

  • Ann M. DietrichEmail author
  • Brian D. Coley
ALARA: BUILDING BRIDGES BETWEEN RADIOLOGY AND EMERGENCY MEDICINE

Abstract

Bedside US has emerged as a valuable technology for the emergency department physician. It impacts clinical decision-making and the safety of procedures, and it decreases the time and increases the efficiency for completion of procedures. The portability, accuracy and noninvasive nature of US make it an ideal tool for the trained clinician. Bedside US can improve clinical decision-making for the pediatric patient by helping the clinician to identify critical pathology, direct therapeutic maneuvers and determine the futility of resuscitations. Many pediatric procedures, such as vascular access, lumbar puncture and bladder catheterization, are typically performed blindly. Bedside US enhances the success of procedures, minimizes complications and limits the number of attempts necessary to complete a procedure. Bedside US can be a valuable adjunct for complicated and time-sensitive disease processes such as ectopic pregnancy, testicular torsion and hypovolemia by providing information to guide diagnostic and therapeutic interventions that subsequently improve outcomes.

Keywords

Bedside ultrasonography US guidance Vascular access Lumbar puncture Focused sonography 

References

  1. 1.
    Karakitsos D, Labropoulos N, De Groot E et al (2006) Real-time ultrasound-guided catheterization of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Crit Care 10:R162PubMedCrossRefGoogle Scholar
  2. 2.
    Leyvi G, Taylor DJ, Reith E et al (2005) Utility of ultrasound-guided central venous cannulation in pediatric surgical patients: a clinical series. Paediatr Anaesth 15:953–958PubMedCrossRefGoogle Scholar
  3. 3.
    LaRue GD (2000) Efficacy of ultrasonography in peripheral venous cannulation. J Intraven Nurs 23:29–34PubMedGoogle Scholar
  4. 4.
    Nomura JT, Leech SJ, Shenbagamurthi S et al (2007) A randomized controlled trial of ultrasound-assisted lumbar puncture. J Ultrasound Med 26:1341–1348PubMedGoogle Scholar
  5. 5.
    Coley BD, Shiels WE, Hogan MJ (2001) Diagnostic and interventional ultrasonography in neonatal and infant lumbar puncture. Pediatr Radiol 31:399–402PubMedCrossRefGoogle Scholar
  6. 6.
    Chen L, Hsiao AL, Moore CL et al (2005) Utility of bedside bladder ultrasound before urethral catheterization in young children. Pediatrics 115:108–111PubMedCrossRefGoogle Scholar
  7. 7.
    Blankstein A, Cohen I, Heiman Z et al (2001) Ultrasonography as a diagnostic modality and therapeutic adjuvant in the management of soft tissue foreign bodies in the lower extremities. Isr Med Assoc J 3:411–413PubMedGoogle Scholar
  8. 8.
    Blankstein A, Cohen I, Heiman Z et al (2000) Localization, detection and guided removal of soft tissue in the hands using sonography. Arch Orthop Trauma Surg 120:514–517PubMedCrossRefGoogle Scholar
  9. 9.
    Tayal VS, Hasan N, Norton HJ et al (2006) The effect of soft-tissue ultrasound on the management of cellulitis in the emergency department. Acad Emerg Med 13:384–388PubMedGoogle Scholar
  10. 10.
    Robben SG (2004) Ultrasonography of musculoskeletal infections in children. Eur Radiol 14S:L65–L77Google Scholar
  11. 11.
    Galicinao J, Bush AJ, Godambe SA (2007) Use of bedside ultrasonography for endotracheal tube placement in pediatric patients: a feasibility study. Pediatrics 120:1297–1303PubMedCrossRefGoogle Scholar
  12. 12.
    Pisarka MD, Carson SA, Buster JE (1998) Ectopic pregnancy. Lancet 351:1115–1120CrossRefGoogle Scholar
  13. 13.
    ACEP Clinical Policies Committee and Clinical Policies Subcommittee on Early Pregnancy. American College of Emergency Physicians (2003) Clinical policy: critical issues in the initial evaluation and management of patients presenting to the emergency department in early pregnancy. Ann Emerg Med 41:123–133CrossRefGoogle Scholar
  14. 14.
    Stovall TG, Kellerman AL, Ling FW et al (1990) Emergency department diagnosis of ectopic pregnancy. Ann Emerg Med 19:1098–1103PubMedCrossRefGoogle Scholar
  15. 15.
    Abott J, Emmans LS, Lowenstein SR (1990) Ectopic pregnancy: ten common pitfalls in the diagnosis. Am J Emerg Med 8:515–522CrossRefGoogle Scholar
  16. 16.
    Shih C (1997) Effect of emergency-performed pelvic sonography on length of stay in the emergency department. Ann Emerg Med 29:348–352PubMedCrossRefGoogle Scholar
  17. 17.
    Burgher SW, Tandy TK, Dawdy MR (1998) Transvaginal ultrasonography by emergency physicians decreases patient time in the emergency department. Acad Emerg Med 5:802–807PubMedCrossRefGoogle Scholar
  18. 18.
    Jehle D, Davis E, Evans T et al (1989) Emergency Department sonography by emergency physicians. Am J Emerg Med 7:605–611PubMedCrossRefGoogle Scholar
  19. 19.
    Adhikari S, Blaivis M, Lyon M (2007) Diagnosis and management of ectopic pregnancy using bedside transvaginal ultrasonography in the ED: a 2-year experience. Am J Emerg Med 25:591–596PubMedCrossRefGoogle Scholar
  20. 20.
    Moore C, Todd WM, O’Brien E et al (2007) Free fluid in Morison’s pouch on bedside ultrasound predicts need for operative intervention in suspected ectopic pregnancy. Acad Emerg Med 14:755–758PubMedCrossRefGoogle Scholar
  21. 21.
    Lam WW, Yap TL, Jacobsen AS et al (2005) Colour Doppler ultrasonography replacing surgical exploration for acute scrotum: myth or reality? Pediatr Radiol 35:597–600PubMedCrossRefGoogle Scholar
  22. 22.
    Kalfa N, Veyrac C, Lopez M et al (2007) Multicenter assessment of ultrasound of the spermatic cord in children with acute scrotum. J Urol 177:297–301PubMedCrossRefGoogle Scholar
  23. 23.
    Sefidbakht S, Assadsangabi R, Abbasi HR et al (2007) Sonographic measurement of the inferior vena cava as a predictor of shock in trauma patients. Emerg Radiol 14:181–185PubMedCrossRefGoogle Scholar
  24. 24.
    Chen L, Kim Y, Santucci KA (2007) Use of ultrasound measurement of the inferior vena cava diameter as an objective tool in the assessment of children with clinical dehydration. Acad Emerg Med 14:841–845PubMedGoogle Scholar
  25. 25.
    Salen P, Melniker L, Chooljian C et al (2005) Does the presence or absence of sonographically identified cardiac activity predict resuscitation outcomes of cardiac arrest patients? Am J Emerg Med 23:459–462PubMedCrossRefGoogle Scholar
  26. 26.
    Moore CL, Molina AA, Lin H (2006) Ultrasonography in community emergency departments in the United States: access to ultrasonography performed by consultants and status of emergency physician-performed ultrasonography. Ann Emerg Med 47:147–153PubMedCrossRefGoogle Scholar
  27. 27.
    Moore CL, Gregg S, Lambert M (2004) Performance, training, quality assurance, and reimbursement of emergency physician-performed ultrasonography at academic medical centers. J Ultrasound Med 23:459–466PubMedGoogle Scholar
  28. 28.
    Coley BD, Mutabagani KH, Martin LC et al (2000) Focused abdominal sonography for trauma (FAST) in children with blunt abdominal trauma. J Trauma 48:902–906PubMedGoogle Scholar
  29. 29.
    Emery KH, McAneney CM, Racadio JM et al (2001) Absent peritoneal fluid on screening trauma ultrasonography in children: a prospective comparison with computed tomography. J Pediatr Surg 36:565–569PubMedCrossRefGoogle Scholar
  30. 30.
    Taş F, Ceran C, Atalar MH et al (2004) The efficacy of ultrasonography in hemodynamically stable children with blunt abdominal trauma: a prospective comparison with computed tomography. Eur J Radiol 51:91–96PubMedGoogle Scholar
  31. 31.
    Noble VE, Nelson BP, Sutingco AN et al (2007) Assessment of knowledge retention and the value of proctored ultrasound exams after the introduction of an emergency ultrasound curriculum. BMC Med Educ 7:40PubMedCrossRefGoogle Scholar
  32. 32.
    Mandavia DP, Aragona J, Chan L et al (2000) Ultrasound training for emergency physicians—a prospective study. Acad Emerg Med 7:1008–1014PubMedCrossRefGoogle Scholar
  33. 33.
    Maitino AJ, Levin DC, Rao VM et al (2005) Do emergency medicine physicians perform ultrasound and conventional radiography in the emergency department? Recent trends from 1993 to 2001. J Am Coll Radiol 2:274–278PubMedCrossRefGoogle Scholar
  34. 34.
    Maitino AJ, Levin DC, Parker L et al (2003) Practice patterns of radiologists and nonradiologists in utilization of noninvasive diagnostic imaging among the Medicare population 1992–1999. Radiology 228:795–801PubMedCrossRefGoogle Scholar
  35. 35.
    Gaspari RJ, Dickman E, Blehar D (2006) Impact of bedside right upper quadrant ultrasonography on radiology imaging. Emerg Radiol 13:3–5PubMedCrossRefGoogle Scholar
  36. 36.
    Jacoby JL, Kasarda D, Melanson S et al (2006) Short- and long-term effects of emergency medicine sonography on formal sonography use: a decade of experience. J Ultrasound Med 25:233–236PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Quality Improvement and Risk Management, Section of Emergency Medicine, Department of Pediatrics, Nationwide Children’s HospitalOhio State University College of MedicineColumbusUSA
  2. 2.Section of Ultrasound, Department of Radiology, Nationwide Children’s HospitalOhio State University College of MedicineColumbusUSA

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