Applications of Bedside Ultrasonography

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Applications of BedsideUltrasonography

• Jay Pershad, MD, FAAPLe Bonheur Childrens
  Medical CenterPediatric Emergency Sedation
  Specialists, PC

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Urinary Bladder Indications

• Enhance Success Rate of Bladder
• Catheterization
• Suprapubic Aspiration
• Suspected Obstructive Uropathy

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Bladder Technical Aspects

• 2.5-5 MHz
• Curvilinear Abdominal Probe
• Transverse Scanning Plane
• 22G 1.5 needle for SPA
• US Assisted or US Guided

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Soft Tissue Abscess

• Indications
• Abscess versus Cellulitis
• Abscess versus Lymphadenitis

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Abscess Technical Aspects

• 5-10 MHz
• Linear Array Probe
• Liberal use of Gel
• Compare Normal Side
• Scan in gt 2 Orthogonal Planes
• Acoustic Standoffs
• THI Mode

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Abscess Vs. Cellulitis

• Hypoechoic cavity c relatively
• hyperechoic rim
• Posterior acoustic enhancement
• Absence of Doppler flow

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Abscess Vs. Lymphadenitis

• Cortex hypo echoic Medulla hyper
• echoic
• Normal echo-density of surrounding
• tissues
• Smooth walled
• Multiple
• Doppler flow

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Soft Tissue Foreign Body

• Detection Indications
• Radiolucent FB (e.g. Wood, Plastic)
• Real Time Localization Removal

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FB Detection Technical

• Aspects
• 6-12 MHz, Linear
• Multiple Scanning Planes
• SQ Tissue in Palms Soles Can Obscure or
• Mimic FB
• Hyperechoic focus with Shadowing
• Acoustic Standoff
• Operator Dependant

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FB Detection Pitfalls

• Negative Examination
• False Positives in Palms Soles
• Multiple FB (Wood Splinters)
• Inaccessible Areas