1. Applications of Bedside Ultrasonography Jay Pershad, MD, FAAP Le Bonheur Children’s Medical Center Pediatric Emergency & Sedation Specialists, PC

2. Urinary Bladder: Indications Enhance Success Rate of Bladder Enhance Success Rate of Bladder Catheterization Catheterization Suprapubic Aspiration Suprapubic Aspiration Suspected Obstructive Uropathy Suspected Obstructive Uropathy

3. Bladder: Technical Aspects 2.5-5 MHz 2.5-5 MHz Curvilinear Abdominal Probe Curvilinear Abdominal Probe Transverse Scanning Plane Transverse Scanning Plane 22G 1.5” needle for SPA 22G 1.5” needle for SPA US Assisted or US Guided US Assisted or US Guided

4. Soft Tissue Abscess: Indications Indications Abscess versus Cellulitis Abscess versus Cellulitis Abscess versus Lymphadenitis Abscess versus Lymphadenitis

5. Abscess: Technical Aspects 5-10 MHz 5-10 MHz Linear Array Probe Linear Array Probe Liberal use of Gel Liberal use of Gel Compare “Normal” Side Compare “Normal” Side Scan in > 2 Orthogonal Planes Scan in > 2 Orthogonal Planes “Acoustic Standoffs” “Acoustic Standoffs” THI Mode THI Mode

6. Abscess Vs. Cellulitis Hypoechoic cavity c relatively Hypoechoic cavity c relatively hyperechoic rim hyperechoic rim Posterior acoustic enhancement Posterior acoustic enhancement Absence of Doppler flow Absence of Doppler flow

7. Abscess Vs. Lymphadenitis Cortex – hypo echoic & Medulla – hyper Cortex – hypo echoic & Medulla – hyper echoic echoic Normal echo-density of surrounding Normal echo-density of surrounding tissues tissues Smooth walled Smooth walled Multiple Multiple Doppler flow + Doppler flow +

8. Soft Tissue Foreign Body Detection: Indications Detection: Indications Radiolucent FB (e.g. Wood, Plastic) Radiolucent FB (e.g. Wood, Plastic) Real Time Localization & Removal Real Time Localization & Removal

9. FB Detection: Technical Aspects Aspects 6-12 MHz, Linear 6-12 MHz, Linear Multiple Scanning Planes Multiple Scanning Planes SQ Tissue in Palms & Soles Can Obscure or SQ Tissue in Palms & Soles Can Obscure or Mimic FB Mimic FB Hyperechoic focus with Shadowing Hyperechoic focus with Shadowing “Acoustic Standoff” “Acoustic Standoff” Operator Dependant Operator Dependant

10. FB Detection: Pitfalls “Negative Examination” “Negative Examination” False Positives in Palms & Soles False Positives in Palms & Soles Multiple FB (Wood Splinters) Multiple FB (Wood Splinters) Inaccessible Areas Inaccessible Areas