Author:  Julia Stiz, MSc, CRGS, CRCS

Reviewers: Mark Bromley, MD, FRCPC; Melanie Willimann, MD, FRCPC

 

 

By selecting the “Mark as Complete” button below, I acknowledge that:

• This activity is educational only.
• Completion does not grant certification, credentialing, privileging, or independent authorization to perform point-of-care ultrasound.
• I am responsible for practicing within my professional scope, training, local institutional policies, supervision requirements, and regulatory requirements.
• I will not rely on point-of-care ultrasound findings in isolation when making clinical decisions.
• Any clinical use of point-of-care ultrasound remains subject to local governance, quality assurance, documentation, and patient safety processes.

 

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References

1. Valley, V & Stahmer, S. Targeted Musculoarticular Sonography in the Detection of Joint Effusions. Academic Emergency Medicine. 2001. 8:361-367
2. Cruz, C et al. Point-of-care hip ultrasound in a pediatric emergency department. American Journal of Emergency Medicine. 2018. 36:1174-1177. https://doi.org/10.1016/j.ajem.2017.11.059
3. Kane, Balint, & Sturrock. Ultrasonography is superior to clinical examination in the detection and localization of knee joint effusion in rheumatoid arthritis. J Rheumatology. 2001; 30(5):966-971.
4. Zieger, M et al. Ultrasonography of hip joint effusions. Skeletal Radiology. 1987. 16:607-611
5. Tsung, J & Blaivas, M. Emergency Department Diagnosis of Pediatric Hip Effusion and Guided Arthrocentesis Using Point-of-Care Ultrasound. The Journal of Emergency Medicine. 2008. 35:393–399. doi:10.1016/j.jemermed.2007.10.054
6. Shavit, I et al. Sonography of the Hip Joint by the Emergency Physician: Its role in the evaluation of children presenting with acute limp. Pediatric Emergency Care. 2006. 22:570-573.
7. Vieira, R & Levy, J. Bedside Ultrasonography to Identify Hip Effusions in Pediatric Patients. Annals of Emergency Medicine. 2010. 55:284-289. doi:10.1016/j.annemergmed.2009.06.527
8. Adhikari & Blavais. Utility of bedside sonography to distinguish soft tissue abnormalities from joint effusions in the emergency department. J Ultrasound Med. 2010; 29(4):519-526.
9. Deanehan, J et al. Bedside Hip Ultrasonography in the Pediatric Emergency Department: A Tool to Guide Management in Patients Presenting with Limp. Pediatric Emergency Care. 2014. 30:285-287.
10. Alves, T et al. US of the Knee: Scanning Techniques, Pitfalls, and Pathologic Conditions. RadioGraphics. 2016. 36:1759-1775. https://doi.org/10.1148/rg.2016160019
11. Wiler, J et al. Comparison of Ultrasound-Guided and Standard Landmark Techniques for Knee Arthrocentesis. The Journal of Emergency Medicine. Vol 39. No 1. 2010. https://doi.org/10.1016/j.jemermed.2008.05.012
12. Wu, T et al. Ultrasound-guided versus landmark in knee arthrocentesis: A systematic review. Seminars in Arthritis and Rheumatism. 2016. http://dx.doi.org/10.1016/j.semarthrit.2015.10.011
13. Lueders, D, Smith, J, & Sellon, J. Ultrasound-Guided Knee Procedures. Physical Medicine Rehabilitation Clinics of North America. 2016. 27:631-648. http://dx.doi.org/10.1016/j.pmr.2016.04.010]
14. Daniels, J & Williams, D. Basics of musculoskeletal ultrasound. Springer. 2013.
15. Edsonoshare.com

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References

1. Grimberg et al. Diagnostic accuracy of sonography for pleural effusion: systematic review. Sao Paulo Med J (2010) 128;2: 90-95.

2. Asthon-Cleary, DT. Is thoracic ultrasound a viable alternative to conventional imaging in the critical care setting? BJA (2013) doi:10.1093/bja/aet076

3. Kurian et al. Comparison of Ultrasound and CT in the Evaluation of Pneumonia Complicated by Parapneumonic Effusion in Children. AJR (2009) DOI:10.2214/AJR.09.2791

4. Calder and Owens. Imaging of parapneumonic pleural effusions and empyema in children. Ped Rad (2009) DOI: 10.1007/s00247-008-1133-1

5. Volpicelli et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med (2012) DOI:10.1007/s00134-012-2513-4

6. Islam et al. The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee. J Ped Surg (2012) DOI: 10.1016/j.jpedsurg.2012.07.047

7. Peris et al. The Use of Point-of-Care Bedside Lung Ultrasound Significantly Reduces the Number of Radiographs and Computed Tomography Scans in Critically Ill Patients. Anesth&Analg (2010) DOI: 10.1213/ANE.0b013e3181e7cc42

8. Jones BP, Tay ET, Elikashvili I, Sanders JE, Paul AZ, Nelson BP, Spina LA, Tsung JW, Feasibility and Safety of Substituting Lung Ultrasound for Chest X-ray When Diagnosing Pneumonia in Children: A Randomized Controlled Trial, CHEST (2016), doi: 10.1016/j.chest.2016.02.643

Summary

• PoCUS is sensitive, and specific for the detection of pleural effusions.
• Position the probe in the posterior axillary line with the marker towards the head
• Identify the liver/spleen, diaphragm, vertebral bodies and lung
• The characteristic (positive) finding is a hypoechoic collection above the diaphragm with distinct borders and dynamic movement.
• Don’t forget to document your findings in the chart and save images for QA.

 

 

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References

1. Patel, G et al. Point-of-Care Cardiac Ultrasound (POCCUS) in the Pediatric Emergency Department. Clinical Pediatric Emergency Medicine. 2018. 19: 323-327. DOI: 10.1016/j.cpem.2018.12.009
2. Guevarra K, Greenstein Y. Ultrasonography in the Critical Care Unit. Curr Cardiol Rep. 2020;22(11):145. doi:10.1007/s11886-020-01393-z
3. Volpicelli G, Lamorte A, Tullio M, et al. Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department. Intensive Care Med. 2013;39(7):1290-1298. doi:10.1007/s00134-013-2919-7
4. Potter SK, Griksaitis MJ. The role of point-of-care ultrasound in pediatric acute respiratory distress syndrome: emerging evidence for its use. Ann Transl Med. 2019;7(19):507-507. doi:10.21037/atm.2019.07.76
5. Mojoli F, Bouhemad B, Mongodi S, Lichtenstein D. Lung Ultrasound for Critically Ill Patients. Am J Respir Crit Care Med. 2019;199(6):701-714. doi:10.1164/rccm.201802-0236CI
6. Longjohn M, Wan J. Point-of-Care Echocardiography by Pediatric Emergency Physicians. Pediatric Emergency Care. 2011;27(8).
7. Miller AF, Arichai P, Gravel CA, et al. Use of Cardiac Point-of-Care Ultrasound in the Pediatric Emergency Department. Pediatr Emer Care. 2022;38(1):e300-e305. doi:1097/pec.0000000000002271
8. Riera A, Weeks B, Emerson BL, Chen L. Evaluation of a Focused Cardiac Ultrasound Protocol in a Pediatric Emergency Department. Pediatr Emer Care. 2021;37(4):191-198. doi:1097/pec.0000000000001495
9. Spurney CF, Sable CA, Berger JT, Martin GR. Use of a hand-carried ultrasound device by critical care physicians for the diagnosis of pericardial effusions, decreased cardiac function, and left ventricular enlargement in pediatric patients. Journal of the American Society of Echocardiography. 2005;18(4):313-319. doi:1016/j.echo.2004.10.016
10. Conlon TW, Himebauch AS, Fitzgerald JC, et al. Implementation of a Pediatric Critical Care Focused Bedside Ultrasound Training Program in a Large Academic PICU*. Pediatric Critical Care Medicine. 2015;16(3):219-226. doi:1097/pcc.0000000000000340
11. Moore CL, Rose GA, Tayal VS, Sullivan DM, Arrowood JA, Kline JA. Determination of Left Ventricular Function by Emergency Physician Echocardiography of Hypotensive Patients. Academic Emergency Medicine. 2002;9(3):186-193. doi:1197/aemj.9.3.186
12. Vorel ES, Jacquemyn X, Cohen JS, Kutty S, Deanehan JK. Pediatric Reference Ranges and Test Characteristics of E-point Septal Separation as a Marker for Left Ventricular Dysfunction: A Retrospective Study. Pediatric Emergency Care. Published online April 14, 2025. doi:1097/pec.0000000000003393
13. Griffee MJ, Merkel MJ, Wei KS. The role of echocardiography in hemodynamic assessment of septic shock. Crit Care Clin. 2010;26(2):365-382, table of contents. doi:10.1016/j.ccc.2010.01.001
14. Watkins LA, Dial SP, Koenig SJ, Kurepa DN, Mayo PH. The Utility of Point-of-Care Ultrasound in the Pediatric Intensive Care Unit. J Intensive Care Med. Published online October 9, 2021:088506662110478. doi:10.1177/08850666211047824
15. Gaspar HA, Morhy SS. The Role of Focused Echocardiography in Pediatric Intensive Care: A Critical Appraisal. BioMed Research International. 2015;2015:1-7. doi:10.1155/2015/596451 de Boode WP, van der Lee R, et al. The role of Neonatologist Performed Echocardiography in the assessment and management of neonatal shock. Pediatr Res. 2018;84(S1):57-67. doi:10.1038/s41390-018-0081-1
16. Arnoldi S, Glau CL, Walker SB, et al. Integrating Focused Cardiac Ultrasound Into Pediatric Septic Shock Assessment*. Pediatric Critical Care Medicine. 2021;22(3):262-274. doi:10.1097/PCC.0000000000002658
17. Ranjit S, Aram G, Kissoon N, et al. Multimodal Monitoring for Hemodynamic Categorization and Management of Pediatric Septic Shock: A Pilot Observational Study*. Pediatric Critical Care Medicine. 2014;15(1):e17-e26. doi:10.1097/PCC.0b013e3182a5589c
18. Singh Y, Tissot C, Fraga MV, et al. International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Crit Care. 2020;24(1):65. doi:10.1186/s13054-020-2787-9
19. Lu JC, Riley A, Conlon T, et al. Recommendations for Cardiac Point-of-Care Ultrasound in Children: A Report from the American Society of Echocardiography. Journal of the American Society of Echocardiography. 2023;36(3):265-277. doi:1016/j.echo.2022.11.010 1.
20. Sengupta PP, Tajik AJ, Chandrasekaran K, Khandheria BK. Twist Mechanics of the Left Ventricle. JACC: Cardiovascular Imaging. 2008;1(3):366-376. doi:1016/j.jcmg.2008.02.006
21. Engle SJ, DiSessa TG, Perloff JK, et al. Mitral valve E point to ventricular septal separation in infants and children. The American Journal of Cardiology. 1983;52(8):1084-1087. doi:1016/0002-9149(83)90537-4
22. Tissot C, Singh Y, Sekarski N. Echocardiographic Evaluation of Ventricular Function—For the Neonatologist and Pediatric Intensivist. Front Pediatr. 2018;6. doi:3389/fped.2018.00079
23. Margossian R, Schwartz ML, Prakash A, Wruck L, Colan SD, Atz AM, et al. Comparison of echocardiographic and cardiac magnetic resonance imaging measurements of functional single ventricular volumes, mass, and ejection fraction (from the Pediatric Heart Network Fontan CrossSectional Study). Am J Cardiol (2009) 104(3):419–28. doi:10.1016/j. amjcard.2009.03.058 1.
24. Muniz RT, Mesquita ET, Souza Junior CV, Martins WDA. Pulmonary Ultrasound in Patients with Heart Failure – Systematic Review. Arquivos Brasileiros de Cardiologia. Published online 2018. doi:5935/abc.20180097
25. van Royen N, Jaffe C, Krumholz H, Johnson K, Lynch P, Natale D, Atkinson P, Deman P, Wackers F. Comparison and Reproducibility of Visual Echocardiographic and Quantitative Radionuclide Left Ventricular Ejection Fractions. American Journal of Cardiology. 1996;77.

Summary

• PoCUS is a rapid and focused tool for assessing cardiac function, offering more timely insights than the physical exam alone and providing useful preliminary information to guide further cardiology evaluation and management.
• PoCUS should be used as a rule-in tool, not a rule-out test, especially when clinical suspicion for LV dysfunction is high. A normal or unclear PoCUS exam does not exclude pathology and should not replace formal imaging when concern persists
• Multiple views = more confidence. Always assess LV systolic function from the standard windows (PLAX, PSAX, A4C, and subxiphoid 4-chamber) to ensure consistency and accuracy.
• An EPSS ≤ 7 mm is generally considered within normal limits, though values should always be interpreted in context and with consideration of the clinical picture.
• Be mindful of the limitations, both technical (e.g., foreshortening, off-axis views, poor acoustic windows) and interpretive (e.g., variability in qualitative and quantitative measures).