Hot Tip-How to Find the Optimal Imaging Angle to Look at the Pleura in a Pediatric Patient

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Hot Tip-How to Find the Optimal Imaging Angle to Look at the Pleura in a Pediatric Patient

Hot Tip-How to Find the Optimal Imaging Angle to Look at the Pleura in a Pediatric Patient. Gulfcoast Ultrasound Instructor Bret Nelson, MD, RDMS, FACEP, demonstrates how to find the optimal imaging angle to look at the pleura. Learn how to find the Optimal Imaging Angle to Look at the Pleura in a Pediatric Patient as well as many other tips and tricks in the Pediatric Emergency & Critical Care Ultrasound Course (August 21-22, 2017)Pediatric Emergency & Critical Care Ultrasound Course (August 21-22, 2017) is taught by leading Pediatirc Ultrasound experts. The Pediatric Emergency & Critical Care Ultrasound Course provides lectures and extensive hands-on scanning with live pediatric models.

  • Instruction by Leading Pediatric Ultrasound Experts
  • 3:1 Participant/Instructor Ratio for Maximum Hands on Scanning
  • Follows ACEP and WINFOCUS Ultrasound Guidelines
  • Increase Diagnostic Skills & Scanning Proficiency
  • Log of 30+ Pediatric Ultrasound Examinations
  • Free Pre-Course Webinar on Imaging Fundamentals

Topics:

  • E-FAST
  • Pediatric Urinary Tract, GI Applications
  • Pediatric Abdominal Case Studies
  • Head and Neck
  • Soft-Tissue & MSK Applications
  • Scrotal Ultrasound
  • Advanced Thoracic Applications
  • Lung Imaging, Trachea
  • BLUE/FALLS Protocol
  • Ultrasound Guided Procedures
  • Vascular Access
  • Lumbar Puncture
  • Focused Cardiac Assessment of the Pediatric Patient
  • Shock & Hypotension: RUSH Protocol
  • How to Start an Ultrasound Program
  • Deep Vein Thrombosis

 

 

OBJECTIVES:

  1. Increase the participant’s knowledge to better perform and/or interpret pediatric emergency and critical care ultrasound examinations.
  2. State the basic fundamentals of ultrasound physics and demonstrate appropriate optimization of system controls.
  3. Identify normal imaging characteristics of the pediatric urinary tract and recognize commonly seen pathology associated with renal disease and the GI tract in infants and children.
  4. Demonstrate protocols for evaluation of the trauma patient (FAST).
  5. Demonstrate ultrasound protocols for evaluation of pneumothorax, pneumonia and endotracheal tube placement.
  6. List the benefits of Ultrasound-Guided Procedures such as vascular access and lumbar puncture.
  7. Perform a focused cardiac ultrasound examination on a pediatric patient.
  8. List the benefits of soft-tissue and MSK ultrasound in the pediatric patient.
  9. Perform testicular ultrasound and recognize commonly seen abnormalities (optional session).
  10. Increase confidence to incorporate protocols, techniques & interpretation criteria to improve diagnostic/treatment accuracy.

CREDITS:

16 AMA PRA Category 1 Credit(s)
Approved for 16 MOC point(s)
16 hour(s) of ACEP Category 1 Credit

Registration is quick, affordable and easy for the Pediatric Emergency & Critical Care Ultrasound Course.

Click or Call to learn more about the Pediatric Emergency & Critical Care Ultrasound Course | 727.363.4500

FACULTY:

Stephanie Doniger, MD, RDMS, FAAP, FACEP
Director of Emergency Ultrasound
Attending Physician: Pediatric Emergency Medicine
Children’s Hospital & Research Center
Oakland, CA
No relevant financial relationship(s) exist.
Bret P. Nelson, MD, RDMS, FACEP
Director, Emergency Medicine Residency Program
Department of Emergency Medicine
Mount Sinai School of Medicine
No relevant financial relationships exist.

NEWS FLASH! North Dakota, Oregon, and New Mexico are the First Three States Requiring Sonographers to be Registered by an Organization!

NEWS FLASH !

North Dakota, Oregon, and New Mexico are the First Three Statesregistered sonographers Requiring Sonographers to be Registered by an Organization!

April 2, 2015

North Dakota has now become the 3rd State in the country (the two others being Oregon and New Mexico) to pass a law requiring Sonographers to be licensed by the state. Credentialing through nationally recognized agencies such as the ARDMS and CCI will be acceptable forms of documentation.

For the complete bill, see:
http://www.legis.nd.gov/assembly/64-2015/documents/15-8161-01000.pdf?20150128135731

Prepare for the registry board exams with Registry Reviews by Gulfcoast Ultrasound Institute’s Registry Reviews Week!

Confidence. Competence. Proven Results.

 

Point-of-Care Ultrasound is More Accurate than the Stethoscope in Diagnosing Pneumonia in Children

Point-of-Care Ultrasound is More Accurate than the Stethoscope in Diagnosing Pneumonia in Children

The new study from Mount Sinai was published in the online edition of Archives of Pediatrics & Adolescent Medicine.

by Jim Tsung
December 10, 2012 /Press Release/  

Point-of-care ultrasound is more accurate than the traditional method of auscultation by stethoscope in diagnosing pneumonia in children and young adults, and can even detect small pneumonias that a chest x-ray may miss, a Mount Sinai researcher reports in an article titled, “Prospective Evaluation of Point-of-Care Ultrasonography for the Diagnosis of Pneumonia in Children and Young Adults” in the online edition of Archives of Pediatrics & Adolescent Medicine published December 10, 2012.

These findings have important public health implications, especially in the developing world, as pneumonia is the leading cause of death in children worldwide. Pneumonia kills an estimated 1.2 million children under the age of five years every year – more than AIDS, malaria and tuberculosis combined.

“The World Health Organization has estimated as many as three-quarters of the world’s population, especially in the developing world, does not have access to any diagnostic imaging, such as chest x-ray, to detect pneumonia,” said senior author James Tsung, MD, MPH, Associate Professor of Emergency Medicine and Pediatrics at Mount Sinai School of Medicine. “Many children treated with antibiotics may only have a viral infection– not pneumonia. Portable ultrasound machines can provide a more accurate diagnosis of pneumonia than a stethoscope.”

Dr. Tsung of Mount Sinai, along with collaborators Vaishali Shah, MD of the Children’s Hospital at Montefiore and Michael G. Tunik, MD of Bellevue Hospital Center/NYU School of Medicine, studied 200 patients from birth to 21 years of age who were presented to the emergency department with suspected community acquired pneumonia at Bellevue Hospital Center from 2008-2010. The criteria for inclusion were patients requiring a chest x-ray for evaluation. Sonologists, clinicians who perform and interpret ultrasonography, were given one hour of focused training prior to the start of the study on the use the ultrasonography to diagnose pneumonia.

Researchers found point-of-care ultrasound to be highly specific (97 percent) for diagnosing pneumonia, with sensitivity as high as 92 percent that can be achieved with training and experience.  The accuracy for diagnosing pneumonia with the stethoscope was lower: specificity ranged from 77-83 percent, and sensitivity at 24 percent.

Further analysis of the data at Mount Sinai Medical Center revealed that ultrasound was able to identify pneumonia too small (less than 1 centimeter) for a chest x-ray to detect in 12 out of 48 patients with confirmed pneumonia.

Dr. Tsung and colleagues noted that diagnosing pneumonia with a stethoscope can be more difficult when a patient is wheezing or has co-existing diseases like asthma or bronchiolitis.  This is not a problem for ultrasound.

Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli. The alveoli fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake.

References:

About The Mount Sinai Medical Center

Mount Sinai HospitalThe Mount Sinai Medical Center encompasses both The Mount Sinai Hospital and Mount Sinai School of Medicine. Established in 1968, Mount Sinai School of Medicine is one of the leading medical schools in the United States. The Medical School is noted for innovation in education, biomedical research, clinical care delivery, and local and global community service. It has more than 3,400 faculty in 32 departments and 14 research institutes, and ranks among the top 20 medical schools both in National Institutes of Health (NIH) funding and by U.S. News & World Report.

The Mount Sinai Hospital, founded in 1852, is a 1,171-bed tertiary- and quaternary-care teaching facility and one of the nation’s oldest, largest and most-respected voluntary hospitals. In 2012, U.S. News & World Report ranked The Mount Sinai Hospital 14th on its elite Honor Roll of the nation’s top hospitals based on reputation, safety, and other patient-care factors. Of the top 20 hospitals in the United States, Mount Sinai is one of 12 integrated academic medical centers whose medical school ranks among the top 20 in NIH funding and by  U.S. News & World Report and whose hospital is on the U.S. News & World Report Honor Roll.  Nearly 60,000 people were treated at Mount Sinai as inpatients last year, and approximately 560,000 outpatient visits took place.

For more information, visit http://www.mountsinai.org.
Find Mount Sinai on:
Facebook: http://www.facebook.com/mountsinainyc
Twitter @mountsinainyc @multiscalebio
YouTube: http://www.youtube.com/mountsinainy

Accuracy of point-of-care ultrasonography for diagnosis of elbow fractures in children

Accuracy of point-of-care ultrasonography for diagnosis of elbow fractures in children.

Rabiner JE, Khine H, Avner JR, Friedman LM, Tsung JW.

Source

Department of Pediatrics, Division of Pediatric Emergency Medicine, Children’s Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY, USA. jrabiner@montefiore.org

Abstract

STUDY OBJECTIVE:

We determine the test performance characteristics for point-of-care ultrasonography performed by pediatric emergency physicians compared with radiographic diagnosis of elbow fractures and compare interobserver agreement between enrolling physicians and an experienced pediatric emergency medicine sonologist.

METHODS:

This was a prospective study of children aged up to 21 years and presenting to the emergency department (ED) with elbow injuries requiring radiographs. Before obtaining radiographs, pediatric emergency physicians performed focused elbow ultrasonography. An ultrasonographic result positive for fracture at the elbow was defined as the pediatric emergency physician’s determination of an elevated posterior fat pad or lipohemarthrosis of the posterior fat pad. All patients received an elbow radiograph in the ED and clinical follow-up. The criterion standard for fracture was fracture on initial or follow-up radiographs.

RESULTS:

One hundred thirty patients with a mean age of 7.5 years were enrolled by 26 sonologists. Forty-three (33%) patients had a radiograph result positive for fracture. A positive elbow ultrasonographic result had a sensitivity of 98% (95% confidence interval [CI] 88% to 100%), specificity of 70% (95% CI 60% to 79%), positive likelihood ratio of 3.3 (95% CI 2.4 to 4.5), and negative likelihood ratio of 0.03 (95% CI 0.01 to 0.23) for fracture. The interobserver agreement (κ) was 0.77. The use of elbow ultrasonography would reduce radiographs in 48% of patients but would miss 1 fracture.

CONCLUSION:

Point-of-care ultrasonography is highly sensitive for elbow fractures, and a negative ultrasonographic result may reduce the need for radiographs in children with elbow injuries. Elbow ultrasonography may be useful in settings in which radiography is not readily accessible or is time consuming to obtain.

Copyright © 2012. Published by Mosby, Inc

Reference:  http://www.ncbi.nlm.nih.gov/pubmed/23142008

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