Ultrasound for Pediatric Shock

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September 10, 2015 by dailybolusoflr

By: Debra Ravert, MD

Common causes of pediatric shock

        Hypovolemia secondary to gastroenteritis
        Hemorrhage
        Sepsis
Benefits of ultrasound

        Can limit radiation exposure
        Limitations in history and exam can lead to treatment delays; ultrasound is a method to mitigate this factor
Modified RUSH exam for pediatrics

Proposed in Pediatric Emergency Care (2015)

Four components
  • Heart
  • IVC
  • Intraperitoneal
  • Lungs/pleura

Heart

Goals
        Assess LV function
        Assess for pericardial effusion
View options
        Subxiphoid

        Parasternal Long

Park, Daniel; Presley, Bradley; Cook, Thomas; Hayden, Geoffrey. Point-of-Care Ultrasound for Pediatric Shock. Pediatr Emer Care. 2015; 31: 591–601.

Park, Daniel; Presley, Bradley; Cook, Thomas; Hayden, Geoffrey. Point-of-Care Ultrasound for Pediatric Shock. Pediatr Emer Care. 2015; 31: 591–601.

IVC
Options for assessment:
  • Transverse – measure
  • Longitudinal – assess collapsibility
Park, Daniel; Presley, Bradley; Cook, Thomas; Hayden, Geoffrey. Point-of-Care Ultrasound for Pediatric Shock. Pediatr Emer Care. 2015; 31: 591–601.
Intraperitoneal

Highest yield in children:
  • RUQ
  • Pelvis

Park, Daniel; Presley, Bradley; Cook, Thomas; Hayden, Geoffrey. Point-of-Care Ultrasound for Pediatric Shock. Pediatr Emer Care. 2015; 31: 591–601.

Lungs/pleura

Ultrasound useful for:

  • Pneumothorax
  • Pulmonary edema
  • Pleural effusions

Park, Daniel; Presley, Bradley; Cook, Thomas; Hayden, Geoffrey. Point-of-Care Ultrasound for Pediatric Shock. Pediatr Emer Care. 2015; 31: 591–601.

References:
  1. Acker, Shannon N. et al. Pediatric specific shock index accurately identifies severely injured children. Journal of Pediatric Surgery; 2014; 50: 331-334.
  2. Park, Daniel; Presley, Bradley; Cook, Thomas; Hayden, Geoffrey. Point-of-Care Ultrasound for Pediatric Shock. Pediatr Emer Care. 2015; 31: 591–601.
  3. Perera, Phillips et al. The RUSH Exam: Rapid Ultrasound in SHock in the Evaluation of the Critically Ill. Emergency Medicine Clinics of North America; 2010;    28:   29-56.
  4. Rezaie, Salim. RUSH protocol: Rapid Ultrasound for Shock and Hypotension. Academic Life in Emergency Medicine; 2013; http://www.aliem.com/rush-protocol-rapid-ultrasound-for-shock-and-hypotension.

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