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    990617 EUS教學 (12) 急診超音波在兒科急症之應用

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    juice119
    This document discusses the use of emergency ultrasound in pediatric emergencies. It provides examples of how ultrasound can be used to diagnose conditions like intussusception, appendicitis, abdominal trauma, hydration status, cholecystitis and others. It also discusses new applications like using ultrasound to guide procedures, evaluate fractures and infections at the bedside. Overall it promotes ultrasound as a valuable tool for pediatric emergency diagnosis and management.

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    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    990617 EUS教學 (12) 急診超音波在兒科急症之應用

    Uploaded by

    juice119
    480 views67 pages
    This document discusses the use of emergency ultrasound in pediatric emergencies. It provides examples of how ultrasound can be used to diagnose conditions like intussusception, appendicitis, abdominal trauma, hydration status, cholecystitis and others. It also discusses new applications like using ultrasound to guide procedures, evaluate fractures and infections at the bedside. Overall it promotes ultrasound as a valuable tool for pediatric emergency diagnosis and management.

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    990617_EUS教學(12)急診超音波在兒科急症之應用

    Original Title

    990617_EUS教學(12)急診超音波在兒科急症之應用

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    This document discusses the use of emergency ultrasound in pediatric emergencies. It provides examples of how ultrasound can be used to diagnose conditions like intussusception, appendicitis, abdominal trauma, hydration status, cholecystitis and others. It also discusses new applications like using ultrasound to guide procedures, evaluate fractures and infections at the bedside. Overall it promotes ultrasound as a valuable tool for pediatric emergency diagnosis and management.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    480 views67 pages

    990617 EUS教學 (12) 急診超音波在兒科急症之應用

    Uploaded by

    juice119
    This document discusses the use of emergency ultrasound in pediatric emergencies. It provides examples of how ultrasound can be used to diagnose conditions like intussusception, appendicitis, abdominal trauma, hydration status, cholecystitis and others. It also discusses new applications like using ultrasound to guide procedures, evaluate fractures and infections at the bedside. Overall it promotes ultrasound as a valuable tool for pediatric emergency diagnosis and management.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    of 67

    Emergency Ultrasound (EUS)(12)

    Clinical application
    Trauma
    Intussusception
    Appendicitis
    Hypertrophic stenosis
    Procedure
    Acute abdomen
    Pediatric trauma management algorithm
    Dependent compartment
    FAST transducer placement
    FAST
    Normal RUQ View Normal LUQ View
    FAST
    Normal Subxiphoid View Normal Pelvic View
    E-FAST
    Doppler lung sliding M mode - seashore sign
    RUQ hemoperitoneum
    Hemoperitoneum
    Pericardial fluid
    Hemo-Pneumothorax
    Pediatric FAST & elevated liver transaminases:
    an effective screening tool in BAT

    Journal of Surgical Research 2009;157: 103107


    IVC/Ao ratio as an objective tool in
    assessment for dehydrated children

    Acad Emerg Med 2007; 14:841845


    IVC/Ao ratio as an objective tool in
    assessment for dehydrated children

    AUC: 0.91

    Acad Emerg Med 2007; 14:841845


    Sonographic inferior vena cava/aorta diameter index:
    a new approach to the body fluid status assessment

    IVC/Ao = 0.59

    IVC/Ao = 1.02
    Reference value for 20-30 years
    IVC/Ao index: 1.2 2 SD for SD = 0.17
    AJEM2008;26:320325
    Sonographic inferior vena cava/aorta diameter index:
    a new approach to the body fluid status assessment
    Normal appendix
    Graded-compression US
    Nocompressible
    Diameter > 6mm

    Appendicolith
    Pericecal or
    periappendiceal fluid
    Enlarged mesenteric
    LN
    Appendicitis
    Appendicitis
    Intussuception
    Pseudokidney sign Donut sign
    Intussusception
    Peak: 5-10 months, up to 3 years
    s/s:
    Cramping abdominal pain
    Irritability
    Vomiting
    Bloody stool
    Intussusception
    Intussusception
    Doughnut sign
    Ileoileal intussuscuption (6 m/o infant)

    SBI
    2-3-cm sized, short,
    doughnut-like lesion
    Left abdomen or
    paraumbilical region

    Tiao MM, et al. AEM 2001;8:368-373


    Crescent-in-doughnut sign
    Ileoileal intussuscuption (7 y/o boy)

    mesentery

    Tiao MM, et al. AEM 2001;8:368-373


    Multiple-concentric-rings sign
    ideopathic jejunojejunal intussuscuption (4 y/o boy)

    Tiao MM, et al. AEM 2001;8:368-373


    Ileocolic intussusception
    Crescent-in-doughnut sign Target (multiple concentric rings) sign

    Sandwich (pseudokidney sign) Hay-fork sign


    Small-bowel intussusception

    Double target sign Pseudokidney sign Double target sign


    US-guided hydrostatic reduction
    Post-reduction-doughnut sign
    Edematous ileocecal valve

    Ko HS, et al. European Radiology (2007)


    Triple-circle appearance
    (Double intussusception)
    Bladder Imaging

    Bladder diameter 2cm urine 2.5 cm3


    US can improve urine collection

    AJEM 2008; 26:1823


    Mimickers of appendicitis
    Mesenteric adenitis

    8-year-old girl
    RLQ pain
    Fever
    Crohns disease

    13-year-old boy
    RLQ pain
    Fever

    Thickened terminal ileum


    Sonography of the acute
    abdomen in the pediatirc patient
    Necrotizing enterocolitis
    Small bowel obstruction
    Malrotation
    Midgut Volvulus
    Whirlpool Sign
    Inguinal hernia

    Normal testes with hydrocele


    Acalculous cholecystitis
    Gallstones
    Point-of-care ultrasound diagnosis of
    pediatric cholecystitis in the ED

    Wall: 3mm; CBD: 3mm AJEM 2010;28: 338342


    Pyelonephrosis
    Acute pancreatitis
    Mesenteric adenitis
    Hemorrhagic ovarian cyst
    Ovarian torsion
    Constipation
    Pylorus
    Hypertrophic pyloric stenosis

    Antral nipple sign

    MWT > 3mm


    Muscle Wall Thickeness
    Referred pain
    New applications
    Bedside Limited Echocardiography by the EP Is
    Accurate During Evaluation of the Critically Ill Patient

    Pediatrics 2004;114:e667e671.
    Positioning for Lumbar Puncture in Children
    Evaluated by Bedside Ultrasound

    Pediatrics 2010;125:e1149e1153
    Use of bedside ultrasonography for endotracheal
    tube placement in pediatric patients

    Pediatrics 2007;120;1297-1303
    Bedside ultrasonography to identify
    hip effusions in pediatric patients

    Ann Emerg Med. 2010;55:284-289


    The Utility of Bedside Ultrasonography in Identifying
    Fractures and Guiding Fracture Reduction in Children

    Pediatr Emer Care 2009;25: 221Y225


    The Utility of Bedside Ultrasonography in Identifying
    Fractures and Guiding Fracture Reduction in Children

    Pediatr Emer Care 2009;25: 221Y225


    Bedside US changed management of
    pediatric soft tissue infection

    Management changed: 11/50 The Journal of Emergency Medicine, 2009


    Optic nerve sheath diameter
    ONSD
    3mm behind the globe
    Adult: 5mm
    Child
    > 1 y/o : 4.5mm
    < 1 y/o 4.0mm

    Br. J. Ophthalmol. 2002;86;1109-1113


    The sensitivity and specificity of bedside sonographic
    measurement of ONSD is inadequate children with
    suspected IICP

    Ann Emerg Med. 2009;53:785-791


    Ultrasound allows physicians to
    visualize peripheral veins of young
    children in the ED

    WestJEM. 2008;9:219-224

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