PEM POCUS Series: Intussusception

Read this tutorial on the use of point of care ultrasonography (POCUS) for pediatric intussusception. Then test your skills on the ALiEMU course page to receive your PEM POCUS badge worth 2 hours of ALiEMU course credit.   PATIENT CASE Johnny is a 2-year-old boy who comes into the emergency department for abdominal pain for the last day. His parents are concerned that he has been having intermittent abdominal pain and has seemed very tired all day. Parents deny bloody stool. On arrival, his vital signs are: Vital Sign Finding Temperature 36.9C Heart rate 110 bpm Blood pressure 97/50 Respiratory rate 22 Oxygen saturation (room air) 99% He is tired appearing, and his abdominal exam is soft but diffusely tender. Given his intermittent abdominal pain, you decide to perform an intussusception point of care ultrasound (POCUS) exam. ULTRASOUND TECHNIQUE Intussusception is when one part of the bowel telescopes, or gets stuck, in another part of the bowel. Typically intussusception refers to ileocolic intussusception where the ileum becomes stuck in the colon. To perform the ultrasound, start in the right lower quadrant and trace the colon. See below for a step-by-step technique. Technique The patient should be positioned supine. To aid in comforting the child, the child can be positioned supine in the parent’s lap while undergoing the scan. Having the parent or another provider offer a toy, book, or phone/tablet to distract the child during the scan can also help ease anxiety. Begin in the right lower quadrant (RLQ), using a high frequency linear probe with the probe marker to patient’s right. First, identify the anatomical landmarks in the RLQ (see ultrasound images below): Psoas muscle (green) laterally Right iliac vessels (blue) Abdominal muscles (red) Bladder (yellow) medially … Continue reading PEM POCUS Series: Intussusception