Tag Archives: pediatric emergency medicine

How Doctors Use Ultrasound to Spot Dangerous Fluid After a Child Is Hurt

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When children are seriously hurt in accidents, doctors need to act fast. One of the biggest worries after a child is hurt in the belly area is internal bleeding (blood that collects deep inside where you can’t see it). This type of bleeding can be life-threatening but hard to detect just by looking at the child or doing a physical exam.

That’s where a tool called FAST, short for Focused Assessment with Sonography for Trauma, comes in. FAST is a type of ultrasound test used in emergency care to quickly look for problem areas inside the body. It’s safe, it doesn’t use radiation like X-rays or CT scans, and it gives doctors real-time pictures of what’s happening inside.

One important part of FAST is checking the pelvis, the lower part of the belly area, for what doctors call “free fluid.” In trauma patients, free fluid almost always means blood from an injury. The more fluid that’s there, the more likely that serious internal bleeding is happening. But not all fluid is easy to see or measure, especially when the amount is small. So how well can doctors actually estimate the amount of fluid when they look at the ultrasound screen?

How reliable are doctors when they make a quick judgment by eye, or gestalt, about fluid volume on a pelvic FAST exam in children? Can doctors consistently recognize when there’s enough fluid to be concerning versus when the fluid is minor and probably not dangerous.

  • Doctors who are trained in ultrasound do a good job of distinguishing between larger amounts of fluid and smaller amounts. In other words, experienced clinicians can reliably tell when the fluid is significant enough to warrant concern versus when there is just a little bit.
  • The challenge is with very small amounts of fluid. When the fluid is minimal, doctors are less consistent in their estimates. Small amounts of fluid can be subtle on ultrasound, and even experienced eyes may disagree about what they see.

Why This Matters for Children Hurt in Accidents

When a child arrives at the emergency department after an accident, time is of the essence. FAST exams are often done right at the bedside so that decisions about further care, like whether to get a CT scan or go straight to surgery, can be made quickly.

The fact that doctors trained in point-of-care ultrasound can reliably spot significant fluid means that FAST remains a valuable tool in pediatric trauma care. It helps teams identify children who may need urgent intervention without waiting for longer, more complicated tests.

At the same time, small volumes of fluid are harder to judge, which highlights the limits of quick visual estimation. In cases where only a little fluid shows up, doctors may need to be cautious and consider other clinical signs, or use additional imaging tools when possible.

Improving Ultrasound Use in Emergencies

Understanding the strengths and limits of physician judgment can help hospitals train their teams better and make more informed decisions about when to rely on FAST and when to follow up with more detailed imaging.

In a field where every second counts and where radiation exposure is a real concern, especially in children, having reliable, fast, bedside tools like FAST is a big advantage. Knowing how well those tools work in the hands of real doctors helps make pediatric trauma care safer and more effective.

Cynthia Owens, BA, is the Publications Coordinator for the American Institute of Ultrasound in Medicine (AIUM).

To read more about the FAST exam in pediatric patients, check out this article from the Journal of Ultrasound in Medicine (JUM):

A Potential Pitfall of Using Focused Assessment With Sonography for Trauma in Pediatric Trauma – Baer Ellington – 2019 – Journal of Ultrasound in Medicine – Wiley Online Library

The Future of Point-of-Care Ultrasound in Pediatric Emergency Medicine

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Pediatrics entices practitioners with its focus on treating illness in the youngest patients, for long-term outcomes of future growth and development. When I reflect on my own journey through Pediatrics and Pediatric Emergency Medicine, helping patients in real-time through providing the best quality care given limited information, drew me to Pediatric Emergency Medicine.

Lianne Profile FinalPediatric Emergency Medicine (PEM) focuses on providing acute care to patients from the newest newborns to teenagers. With this breadth of ages comes differing pathology, physiology, and of course differences in relative and absolute size. Integration of point-of-care ultrasound (POCUS) into PEM practice offers the clinician an added tool to provide the best possible care. Children are ideal patients for POCUS scanning as they often have slimmer body habitus, fewer comorbidities, and there is increasing interest in limiting ionizing radiation amongst all patients, especially the very young.

POCUS offers direct visualization for procedures such as endotracheal tube airway confirmation, central-line insertion, and intravenous and intraosseous access. Utilizing this clinical adjunct allows for accuracy in nerve block administration, reducing the volume used of local anesthetic and decreasing the need for systemic sedation. Visualizing fractures following reduction and assessing joints and soft tissue infections prior to decision of incision and drainage or aspiration can all be achieved using POCUS.

Because our patients vary in size, optimizing planning prior to starting procedures can help to maximize success. Risk in pediatric procedures is heightened due to variable sizing, risking too-deep insertion of needles and endotracheal tubes. Direct visualization helps to support the provider in making safe choices.

Beyond procedures, POCUS allows PEM providers to optimize resuscitation, through real-time monitoring of volume status, cardiac function, and pulmonary edema. Reassessment throughout resuscitation adds additional information to vital signs and end-organ markers as patients are treated.

As machines become increasingly accurate at more portable sizes, and as cloud storage is increasingly popular among organizations, the future of POCUS offers providers along the care-continuum the opportunity to share information and images. My hope for the future of acute POCUS would be to have pre-hospital POCUS, emergency POCUS, consultative radiology imaging, and follow-up POCUS imaging in community clinics on an integrated system allowing for shared images and progressive monitoring for long-standing conditions.

The future of POCUS is bright as innovation and technology disruption move ultrasound outside of the walls of the hospital, placing transducers in the hands of those at the bedside from the helicopter to the remote health clinic. For countries such as Canada, increased portability means increasing access for those populations most at risk of health inequity, those living in the far North and remote regions of my country, who have limited access to urban care. POCUS with added portability and technological integration can help improve access, and shared decision making between urban centers and remote regions with patient safety and privacy as a priority.

I’m excited to see where POCUS integration moves in the course of the rest of my medical career, as I look forward to being an advocate for access and clinical education in addition to being an expert that maintains clinical accountability, safety, and privacy. The promotion of these critical pillars will help determine the success of the POCUS-empowered clinical experience.

Do you use point-of-care ultrasound in pediatric practice? If so, how has it helped you? Is there another medical field you think should use ultrasound more? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Lianne McLean, MB BCh, BAO, FRCPC, is Assistant Professor at the University of Toronto; and Staff Physician and Chair of the Council of Informatics & Technology in the Division of Emergency Medicine at the Hospital for Sick Children in Toronto, Canada.