KINDERÄRZTE.SCHWEIZ 2/2020

21 02 / 2020 FORTB I LDUNG: THEMENHEFTTE I L K I N D E R Ä R Z T E . SCHWEIZ P ediatric emergency physicians have recently adopted point-of-care ultrasonography (POCUS) as an adjunct to reach the correct diagnosis, monitor health conditions, or guide procedures. POCUS is now considered as an ex- tension of the physical exam which can improve clinical findings [1]. According to Snelling et al., POCUS offers the additional advantage of allowing visualization, rather than just auscultation of internal structures [2]. It also provides a rapid answer to clinicians to a targeted clinical question and can be repeated serially to map an evolving clinical picture [3]. The use of POCUS by pediatric emer- gency physicians is a way to expedite and improve pati- ents’ care by reducing time to arrive at a diagnosis and of definitive treatment. Especially in case of life-threatening conditions, POCUS has shown patients’ management improvement thanks to prompt pathologies’ recogni- tion and treatment [4]. Moreover, POCUS is advanta- geous in settings where no comprehensive pediatric radiology services are available 24/7. In Pediatric Emergency Medicine (PEM), POCUS indica- tions are numerous, including clinical and procedural scenarios. To date, in Switzerland, no formal specific program exists, however the main applications are sum- marized in SIWF/ISFM‘s Pediatric Learning Objectives [5]. Table 1 illustrates an overview of the wide variety of pos- sible clinical and procedural applications in PEM. Indications being varied, their practicality and efficacy dif- fer [3, 6]. In PEM, POCUS is mainly used for lungs, soft tissue or trauma assessment, as well as vascular access. Lung ultrasound is particularly promising in the exami- nation of children, it being more accurate compared to standard chest X-ray for pneumonia [2]. Other useful applications include, for instance, diagnosis of a hip effusion in case of limping; measurement of op- tic nerve sheath diameter or optic disk elevation to detect increased intracranial pressure in a patient with head- aches. In case of shock, evaluation of global cardiac func- tion, inferior vena cava filling and lung ”wetness“can guide resuscitation [2]. The learning curve of POCUS users is steep and requires practice, as well as supervision in order to reach the ap- propriate level of expertise to perform and interpret the images correctly, as well as to integrate them adequate- ly in the clinical picture [7, 8]. According to Snelling et al., POCUS is a revolutionary tool challenging the traditional approach of children‘s assess- ment in the Emergency Department [2]. The evidence supporting POCUS as an adjunct to the clinical effective- ness of PEM physicians is growing. To safeguard proce- dures, it has become standard practice already. Even if, for diagnostic assessments, the benefits of its routine use still have to be further validated, POCUS should definite- ly in the near future play an important role as an adjunct to improve patient outcomes [6]. ■ DR MED. AUDE TONSON LA TOUR SPECIALIST IN PEDIATRICS FMH, SPECIALIST IN PEDIATRIC EMERGENCY MEDICINE, PEDIATRIC DEPARTMENT, HÔPITAL DE LA TOUR, MEYRIN Korrespondenzadresse: aude.tonson-la-tour@latour.ch DR MED. MAGALI GAUTHEY SPECIALIST IN PEDIATRICS FMH, SPECIALIST IN PEDIATRIC EMERGENCY MEDICINE, PEDIATRIC DEPARTMENT, HÔPITAL DE LA TOUR, MEYRIN Korrespondenzadresse: magali.gauthey@latour.ch POCUS in Pediatric Emergency Medicine REFERENCES 1. Jauhar, S., The demise of the physical exam . N Engl J Med, 2006. 354 (6): p. 548–51. 2. Snelling, P.J. and M. Tessaro, Paediatric emergency medicine point- of-care ultrasound: Fundamental or fad? Emerg Med Australas, 2017. 29 (5): p. 486–489. 3. O’Brien, A.J. and R.M. Brady, Point-of-care ultrasound in paediatric emergency medicine . J Paediatr Child Health, 2016. 52 (2): p. 174–80. 4. Tayal, V.S., et al., FAST (focused assessment with sonography in trau- ma) accurate for cardiac and intraperitoneal injury in penetrating an- terior chest trauma . J Ultrasound Med, 2004. 23 (4): p. 467–72. 5. http://www.svupp/assets/downloads/uploads/anhang-2.pdf. 6. Marin, J.R., et al., Pediatric emergency medicine point-of-care ultra- sound: summary of the evidence . Crit Ultrasound J, 2016. 8 (1): p. 16. 7. Cantisani, V., et al., EFSUMB statement on medical student education in ultrasound [short version] . Ultraschall Med, 2016. 37 (1): p. 100–2. 8. Sonja Fontana, R.S., Point-of-Care Ultrasound in Pediatrics: Are we ready? Paediatrica, 2019. eFAST (extended Focused Assessment with Sonography in Trauma) Intraperitoneal free fluid (hemoperitoneum) Pleural and pericardial effusion Pneumothorax Lung Pleural effusion, pneumonia, pneumothorax Cardiac Global cardiac function, cardiac tamponade IVC Fluid status Abdominal Intussusception Appendicitis Intestinal malrotation Spleno/hepatomegaly Constipation Pyloric stenosis Cholecystitis Bowel obstruction Musculoskeletal Fractures Muscle and ligamental injuries Hip effusion Soft tissues Abscess, adenopathy, cellulitis, foreign body Kidney/bladder Hydronephrosis, urinary retention, pre-catheterisation volume Testicle Testicular torsion CNS Optic disk elevation/ Optic nerve sheath diameter, hydrocephaly Procedural Vascular access, regional anesthesia, lumbar puncture, abscess drainage, foreign body removal, fracture reduction, joint aspiration, pleurocentesis Table 1.