Pediatric emergency medicine trisk 355

hydrocephalus
Chest CT scan
Intra/extrathoracic
anomaly, mass,
abscess, diaphragmatic
hernia
Abdomen CT scan
Obstruction, mass,
appendicitis
Pulmonary and cardiac US Pleural or pericardial
effusion, tamponade
Electrocardiogram
Cardiac anomaly, failure,
pericarditis
Echocardiogram
Structural, functional
cardiac abnormality
Thoracentesis,
Infection, inflammation,
pericardiocentesis
oncologic process
cytology, biochemical, cx
involving chest, heart,
lymphatics
Barium swallow
Tracheoesophageal
fistula, vascular ring,
reflux
Pulmonary function tests
Central or peripheral
nervous system

depression of chest
wall function,
respiratory system
disease
Electromyography
Central respiratory drive
depressed,
neuromuscular disease

Chest angiography

Vascular anomaly, PE

Also therapeutic
Consider US guidance

Measures lung
volume, flow,
compliance

Measures muscle
activity generated
by neural outflow
from respiratory
centers
If concern PE,
consider extremity
US to evaluate for
DVT

ABG, arterial blood gas; CBC count, complete blood cell count; cx, culture; CSF, cerebrospinal fluid; EBV,
Epstein–Barr virus; BUN, blood urea nitrogen; CR, creatinine; Ca, calcium; PO4 , phosphate; Mg,
magnesium; LFTs, liver function tests; TFTs, thyroid function tests; PT, prothrombin time; PTT, partial
thromboplastin time; IFA, immunofluorescence assay; TB, tuberculosis; AP, anteroposterior; CT, computed
tomography.


TABLE 71.10
ULTRASOUND FOR EVALUATION AND TREATMENT OF
RESPIRATORY DISTRESS a


Examination
diagnosis
Thoracic
Pneumothorax

Pleural effusion,
hemothorax

Pneumonia

Probe, position

Key diagnostic
findings

Therapeutic
indications

High-frequency
Absence of lung
Thoracentesis,
probe
sliding
thoracotomy
(“barcode sign”
Anterior chest
in M-mode) with
midclavicular
lung point
and anterior
confirms
axillary line
pneumothorax
Marker to patient’s
Normal lung
head
sliding
(“seashore sign”
in M-mode) with
the presence of
the comet tail
artifact rules out
pneumothorax
Low-frequency
Anechoic fluid
Thoracentesis,
probe

overlying the
thoracotomy
lung
RUQ, LUQ (FAST
parenchyma,
views)
typically in the
High- or lowposterior/inferior
frequency probe
region
Anterior, lateral,
Fibrin strands,
and posterior
debris,
lung zones
loculations
Marker to patient’s
suggest
head
empyema
High- or lowLung hepatization,
frequency probe
air
bronchograms
Anterior, lateral,
(which can be
and posterior
also be seen
lung zones
with atelectasis)