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AUTHORS
Robert Stenberg, MD, Emergency Medicine Resident, Department of Emergency Medicine, University of North Carolina, Chapel Hill
Daniel Migliaccio, MD, Clinical Assistant Professor, Department of Emergency Medicine, and Head, Ultrasound Education, University of North Carolina, Chapel Hill
Daniel B. Park, MD, Associate Medical Director, Pediatric Emergency Medicine; Director, Pediatric Emergency Ultrasound; Assistant Professor, Departments of Pediatrics and Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill
PEER REVIEWER
Aaron Leetch, MD, Assistant Professor, Departments of Emergency Medicine and Pediatrics; Program Director, Combined Emergency Medicine and Pediatrics Residency, University of Arizona, Tucson
Ultrasound has emerged as a critical tool for use at the bedside to guide not only diagnosis but treatment strategies as well. The first part of this article focuses on the uses and limitations of cardiac ultrasound in the acute setting. Part II will include discussion of cardiac arrest, congenital abnormalities, pneumothorax, pleural effusion, and pneumonia. — Ann M. Dietrich, MD, FAAP, FACEP, Editor
Introduction
A 3-year-old male with no remarkable past medical history presents with lethargy. He is noted to have increased work of breathing, and is tachycardic, hypotensive, and somnolent. He appears pale, with a prolonged capillary refill. A point-of-care ultrasound (POCUS) demonstrates a hyperdynamic heart with a collapsed inferior vena cava (IVC), consistent with hypovolemic shock. He is given fluid boluses with improvement in his mental status and vital signs and is admitted for severe dehydration.
Being pulled into a room to find a child in obvious shock is quite nerve-racking. Knowing the specific type of shock helps guide management and can alter the care of the patient drastically. A quick, focused echocardiogram can help differentiate the type of shock, as well as help guide the use of fluids, vasopressors, and inotropes. More and more providers are finding POCUS to be a frontline tool. It is easily accessible and enhances critical decision-making.1,2
Cardiac Ultrasound
In the world of POCUS, the cardiac ultrasound can be among the most intimidating. It is a dynamic ultrasound, with what seem to be endless views, Dopplers, and calculations. Pediatric echocardiography seems more daunting, with even more complicated anatomy.
The most important aspects of a bedside ultrasound of the heart can be evaluated easily. An emergency department 2016 critical care...