A 10-year-old boy enters the pediatric emergency room with shortness of breath. Immediately he is admitted, and workup begins. His attending physician conducts imaging during the child’s exam using point-of-care ultrasound (POCUS). Imaging results reveal a hemodynamically compromising pericardial effusion. The patient was mobilized to the PICU and received definitive care without any unnecessary delays.
A lightbulb went off for Dr. Dan Park, a second-year Penn fellow at the time of the patient’s admission. This event turned him into a disciple of POCUS usage in pediatric emergency care. What became clear to him from this experience was, “The ability to provide an accurate and timely diagnosis while saving a 10-year-old’s life is nothing short of a win-win,” Dr. Park explains.
The diagnosis was made swiftly during the initial examination, and because of what imaging unveiled, there were zero delays in providing the patient the care he needed before he could become unstable. POCUS became the life-saving element in this case.
Our 10-year-old patient isn’t alone in experiencing the life-preserving power of POCUS. It is what the pocket size device has become known for, helping to make life-saving diagnoses expeditiously. Due to its contributions in enhancing the diagnostic and patient care experience, attention has been given to POCUS application in the emergency and critical care settings and centered on focused cardiac examination, particularly within pediatrics.
Even with heroic stories such as the case about our 10-year-old star, the use of cardiac POCUS is still underutilized in the pediatric patient population. The presumption is that the overall incidence of acquired cardiac pathology in pediatric populations is low compared with adult patients. Although this may be true, it is difficult not to acknowledge how the immediacy in identifying cardiac pathology in children plays a significant role in saving a life.
The literature on focused cardiac POCUS in pediatric patients is limited. But, let’s review one that does provide substantial findings. This study is presented in The Ultrasound Journal, conducted with 70 pediatric emergency department patients, producing results that evidenced “the overall sensitivity and specificity of cardiac POCUS in detecting diminished LV function, pericardial effusions, and abnormal IVC collapsibility, when compared with comprehensive echocardiogram was 95% (95% CI 82–99%) and 83% (95% CI 64–93%), respectively.”
One specific case highlighted in the study involved a 12-year-old male. He was being treated for pneumonia and showing no improvement after seven days of admission. He developed severe chest pain, shortness of breath, and diaphoresis that was progressively worsening. Physicians attempted a lung ultrasound to evaluate the previously diagnosed pneumonia’s progression. However, a sizable anechoic structure obliterated the normal lung artifacts.
Next, a Pediatric Emergency Medicine fellow with extensive POCUS training performed a focused cardiac POCUS exam, revealing a large circumferential pericardial effusion. The diagnosis of cardiac tamponade was then made from the findings. An ultrasound-guided pericardiocentesis conducted by a pediatric cardiologist yielded one liter of serosanguinous fluid.
In both cases presented, cardiac POCUS complemented the clinical examinations. In one case, time was of the essence, and the application of POCUS initiated quick decisions and prompted actions that needed to be taken immediately. In our second case, results were unreliable, and no further diagnosis could be made. POCUS was used to augment the examinations previously performed to provide accurate and valid results.
There remains a great potential to study cardiac POCUS utilization in pediatric patients. The study’s conclusive sentiment summarizes well the next steps available in pediatric cardiology:
“The use of focused cardiac POCUS for suspected pericardial effusions, tamponade, and mediastinal masses presents an opportunity for pediatric emergency medicine, cardiology, and critical care services to collaborate and establish best practices for these, at times, elusive diagnosis.”
May we emphasize the need for the medical community to collaborate and work together to create best practices that lend to even greater care and more phenomenal outcomes. Here at the POCUS Certification Academy™, we have created a platform for doing so. Join the POCUS community and help amplify this movement to strengthen pediatric care and all specialties across our world of medicine.