Pediatric emergency medicine trisk 4528 4528
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PARACENTESIS AND PERICARDIOCENTESIS
The need for these procedures is uncommon in pediatrics, but ultrasound can be
helpful in identifying the location of fluid and in avoiding injury to solid organs.
A phased array or curvilinear probe should be used for identifying fluid and for
dynamic ultrasound guidance. For paracentesis, the transducer should be placed
in different parts of the abdomen in order to identify the deepest pocket of fluid.
For pericardiocentesis, a small footprint probe will allow better visualization
between the ribs. Sonographic guidance allows a transthoracic approach rather
than the subxyphoid approach, which reduces the risk of injury to the liver.
EVALUATION OF JOINTS
Ultrasound can help with the detection or exclusion of joint effusion and can also
be used to guide arthrocentesis. The high-frequency linear probe is used.
Evaluation of the hip is discussed above. Ultrasound has also been used for the
knee, elbow, and shoulder.
NERVE BLOCKS
Nerve blocks may obviate the need for sedation for painful procedures, and may
decrease the amount of locally injected anesthetic. Ultrasound guidance for nerve
blocks can help prevent accidental puncture of neighboring vasculature and can
direct the needle tip to within close proximity of the desired nerve structures. A
linear high-frequency probe should be used. Ultrasound has been used to assist
with nerve blocks for the femoral nerve and the nerves of the forearm.
