Stephanie J. Doniger

Point-of-Care Ultrasonography by Pediatric Emergency Physicians

Point-of-care ultrasonography is increasingly being used to facilitate accurate and timely diagnoses and to guide procedures. It is important for pediatric emergency physicians caring for patients in the emergency department to receive adequate and continued point-of-care ultrasonography training for those indications used in their practice setting. Emergency departments should have credentialing and quality assurance programs. Pediatric emergency medicine fellowships should provide appropriate training to physician trainees. Hospitals should provide privileges to physicians who demonstrate competency in point-of-care ultrasonography. Ongoing research will provide the necessary measures to define the optimal training and competency assessment standards. Requirements for credentialing and hospital privileges will vary and will be specific to individual departments and hospitals. As more physicians are trained and more research is completed, there should be one national standard for credentialing and privileging in point-of-care ultrasonography for pediatric emergency physicians.

Ingested foreign bodies: a case series demonstrating a novel application of point-of-care ultrasonography in children.

Abstract In an era of recognizing the risks of radiation exposure, it is important to develop alternatives to radiographs. Bedside ultrasound has become an important adjunct to clinical diagnoses and procedural guidance in the emergency department. We present a case series of two patients who presented to a pediatric emergency department after witnessed coin ingestions. Point-of-care ultrasonography was able to accurately identify the location of each of the coins, at the thoracic inlet and in the stomach, as confirmed by chest radiography. To our knowledge, point-of-care ultrasonography has not been previously utilized to detect and localize esophageal foreign bodies in the emergency department.

Subungual wooden splinter visualized with bedside sonography.

Abstract Bedside ultrasound has become increasingly important as an adjunct to clinical diagnosis and procedures in the emergency department. It is only recently that this modality, which involves no ionizing radiation, has become incorporated into the pediatric emergency department. We report a case of a 10-year-old boy with a suspected subungual wooden foreign body. Bedside ultrasound was used to identify and characterize the foreign body before removal and then to evaluate for any residual foreign body after removal. A brief review of the technique is presented, including the use of a water bath to enhance visualization of the object and decrease the patient’s discomfort. This case highlights the utility of ultrasound in detecting radiolucent soft tissue foreign bodies.

Botfly larva masquerading as periorbital cellulitis: identification by point-of-care ultrasonography.

Abstract Myiasis, or the infiltration of the botfly larvae, is a relatively frequent problem encountered by travelers to parts of Latin America. This is a novel case report that documents a Dermatobia hominis infestation of the left facial region with secondary periorbital cellulitis diagnosed by point-of-care ultrasonography.

Point-of-Care Ultrasonography for the Rapid Diagnosis of Intussusception: A Case Series.

Abstract We present a case series describing an infant and a child who presented with abdominal discomfort and their conditions were diagnosed with intussusception by point-of-care ultrasound. These cases illustrate how point-of-care ultrasound led to the expeditious diagnosis of intussusception.

Point-of-care ultrasonography for the identification of 2 children with optic disc drusen mimicking papilledema.

Abstract We present 2 cases of asymptomatic patients who were found to have raised and blurred optic discs on physical examination, suggestive of papilledema. Evaluation in the emergency department revealed 2 well-appearing children with normal vital signs and neurologic evaluation results, without symptoms of increased intracranial pressure. Point-of-care ocular ultrasonography was performed on both children, demonstrating calcification at the optic nerve, which is diagnostic of optic disc drusen. Optic disc drusen is caused by the deposition of calcified axonal debris and is often buried within the optic disc in pediatric patients. It can cause some changes in visual acuity and visual fields, but patients who are otherwise asymptomatic can be easily diagnosed through point-of-care ultrasound, thereby sparing patients an aggressive workup if their clinical picture is otherwise reassuring.

The Use of Point-of-Care Ultrasound to Evaluate for Intestinal Foreign Bodies in the Pediatric Emergency Department.

Abstract We present the use of point-of-care ultrasound to evaluate two patients with examinations concerning for appendicitis who were found to have multiple magnets ingested and subsequent bowel perforations. These cases illustrate the consequences of magnet ingestion as well as the application of point-of-care ultrasound for the identification of intestinal foreign bodies in children.

Icterus and abdominal pain: an unexpected, rare sonographic finding in a Peruvian Emergency Department

BackgroundThe use of point-of-care ultrasound (POCUS) has become increasingly important in resource-limited settings. It can rapidly diagnose both tropical infectious diseases and more common pathology at the bedside. In these practice settings, POCUS can have a significant impact on management strategies and patient care. Ultrasonography has been the gold standard for the diagnosis and staging of Echinococcus disease. However, even in the “classic” clinical scenario and setting, the clinician must maintain a broad differential diagnosis. Point-of-care ultrasound can be helpful in performing the rapid diagnosis and therefore direct appropriate treatment strategies based on the results.Case presentationWe present a case of a 27-year-old woman presenting to an emergency department in Peru with jaundice and abdominal pain. Initially given the region of her origin, the working diagnosis was an Echinococcus cyst. However, when POCUS was performed, the findings were not consistent with hydatid disease. Ultimately, surgical pathology revealed a choledochal cyst, a rare finding in adulthood.ConclusionsThis case initially appears as a “classic” finding of Echinococcus disease. It is important for the clinician sonographer to appreciate the features consistent with Echinococcus cysts and distinguish from those features that are more consistent with other pathology.

Erratum to: Pediatric emergency medicine point-of-care ultrasound: summary of the evidence

The utility of point‐of‐care ultrasound is well supported by the medical literature. Consequently, pediatric emergency medicine providers have embraced this technology in everyday practice. Recently, the American Academy of Pedi‐ atrics published a policy statement endorsing the use of point‐of‐care ultrasound by pediatric emergency medicine providers. To date, there is no standard guideline for the practice of point‐of‐care ultrasound for this specialty. This document serves as an initial step in the detailed “how to” and description of individual point‐of‐care ultrasound examinations. Pediatric emergency medicine providers should refer to this paper as reference for published research, objectives for learners, and standardized reporting guidelines.

Neonatal Gallstones Serendipitously Discovered by Point-of-Care Ultrasound in the Pediatric Emergency Department.

Abstract Cholelithiasis in children was once thought to be uncommon, but the prevalence has increased in recent years. We present a case of a 3-month-old infant brought to the pediatric emergency department for vomiting and increased fussiness. A point-of-care ultrasound was performed to rule out pyloric stenosis but revealed multiple stones within the gallbladder. Ultrasound findings and a review of technique for ultrasound of the gallbladder are presented.