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Home > empem.org » EMPEM Podcast Feed > UltraSound uses in Pediatric Emergency Medicine


	Podcast:		empem.org » EMPEM Podcast Feed
	Episode:		UltraSound uses in Pediatric Emergency Medicine
	Category:		Science & Medicine
	Duration:		00:39:07
	Publish Date:		2011-10-20 09:08:11
	Description:		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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