Abstract
Background: Point of care echocardiography (POCE) provides real time haemodynamic information, crucial in the Emergency Department (ED) where decision-making is required to be both timely and correct in order to establish the most appropriate lifesaving therapy. This case series will discuss several scenarios where the use of POCE directly affected management of critically ill patients.
Aims: To demonstrate the appropriate use of POCE in the Paediatric Emergency Department (PED).
Methods: This is a descriptive study incorporating a series of 5 case reports. A five-part case series derived from tertiary level paediatric emergency departments on the island of Ireland.
Results:
Case 1: describes the use of POCE to confirm the absence or presence of regular organised contractions during pulse checks and to reduce time off the chest in paediatric cardiac arrest.
Case 2: describes the use of POCE to assess left ventricle function and to guide fluid resuscitation in paediatric sepsis.
Case 3: describes the use of POCE to clarify diagnosis of myocarditis in the setting of undifferentiated shock and thereafter to guide fluid management.
Case 4: describes the use of POCE to clarify diagnosis and to guide fluid management, differentiating low flow cardiac output from no-flow cardiac arrest, in an infant with septic emboli.
Case 5: describes the use of POCE in the setting of a new murmur in an unwell adolescent presenting with Transient Ischemic Attack (TIA). As well as the importance of repeat examination in an evolving clinical picture to clarify the diagnosis of an atrial mass and assist in directing on-going management.
Conclusion: It is knowing when and why to use POCE that ensures it is a tool that is used for the benefit of patient management and outcome. Point of care echocardiography is not a screening tool and must answer a clinical question based on the compilation of the presenting signs and symptoms.