Pediatric Cardiothoracic Point-of-Care Ultrasound: Part II

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 both diagnosis and treatment strategies. In the January 2019 issue, the authors focused on the uses and limitations of cardiac ultrasound in the acute setting. In this article, they discuss cardiac arrest, congenital abnormalities, pneumothorax, pleural effusion, and pneumonia.

— Ann M. Dietrich, MD, FAAP, FACEP, Editor

Introduction

When a child presents to the emergency department (ED) in obvious shock, it is helpful for providers to know the specific type of shock so they can guide management and direct interventions. A quick, focused echocardiogram can help differentiate types of shock and guide the use of fluids, vasopressors, and inotropes. Point-of-care ultrasound (POCUS) is becoming a frontline tool because it is easily accessible and enhances critical decision-making.

Pulmonary ultrasound is a rapidly growing field with POCUS in pediatrics, including additional applications. Traditionally, it was used to evaluate for pneumothorax and pleural effusions, but now, it is expanding to include pneumonia and beyond. (See Table 1.) While applications have continued to evolve, the current focused questions have remained simple and attainable: Is there a pleural effusion? Is there a pneumothorax? Are there pathologic B lines?

Table 1. Findings on Cardiothoracic Point-of-Care Ultrasound
Pathology	Images Required	Images Demonstrate
Pulmonary hypertension/pulmonary embolism/Eisenmenger syndrome	•Apical four chamber is most important, followed by parasternal short •IVC	•RV:LV ratio approaches 1:1 •D sign on parasternal short •McConnell’s sign •Dilated IVC
Pneumothorax	•Evaluation of more than three lung zones with linear probe	•Absent lung sliding •Lung point •Absence of lung pulse •Barcode sign on M-mode
Pneumonia	•Evaluation of more than three lung zones with curvilinear or phased array probe	•Unilateral B...