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dosing in children. The American College of Radiology, American Institute of Ultrasound in Medicine, and dozens of other organizations have worked to reduce unnecessary radiation exposure for diagnostic and interventional radiology pro- cedures, and as part of this effort interest in point-of-care ultrasound has increased. Aside from lowering radiation exposure, ultrasound can be beneficial in other ways as well. Pediatric patients who require invasive procedures and/or diag- nostic imaging where they must hold still can be especially challenging. Ultra- sound can be performed while the pediatric patient is held by parents or trusted caregivers, thus avoiding unnecessary restraints and/or sedation. Moreover, given that physicians need to communicate with parents or caregivers with regard to a pediatric patient’s illness, the visual instruction ultrasound provides can be used as a teaching tool to help illustrate pathophysiology. This bulk of this chapter will review the indications that are most specific to pediatrics. However, it is important to note that the most common pediat- ric indications are often the most common in adults as well. Many pediatric acute care providers see enormous benefit in the use of bedside ultrasound for skin and soft tissue applications such as differentiating cellulitis from abscess or evaluating foreign bodies (described in Chapters 11 and 16 ). Pelvic ultrasound to assess first trimester pregnancy complications may be a very common use in the pediatric emergency department as well (see Chapter 4) . A host of procedures benefit from ultrasound guidance: bladder catheteriza- tion, central and peripheral venous access, and arthrocentesis are just a few commonly encountered in the pediatric population (see Chapter 16 ). As ultrasound becomes incorporated into pediatric and pediatric critical care curriculums, whole textbooks will be devoted to pediatric applications. For this edition, a few specific pediatric applications most likely to be used in the acute setting will be reviewed – but stay tuned for more to come. Abdominal applications Appendicitis The ultrasound diagnosis of appendicitis was reviewed in Chapter 12 . The scanning technique and findings are essentially the same in adult and Diagnostic ultrasound 241 Pediatric ultrasound
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pediatric patients ( Figure 13.1 ). Given the growing body of evidence high- lighting concerns about radiation exposure in pediatric patients, and given the acceptable test characteristics of ultrasound for appendicitis, computed tomography (CT) should be reserved for those patients with non-diagnostic ultrasounds and high clinical suspicion for appendicitis. Figure 13.1 Appendicitis (A). 242 Diagnostic ultrasound Pediatric ultrasound
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Intussusception As mentioned in Chapter 12 , the role of ultrasound is well established in the evaluation of suspected intussusception, with published sensitivity and specificity rates of 98–100% and 88–100% respectively and general acceptance of ultrasound as a first-line diagnostic test [ 2 ]. Sonographically the intussus-
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