The utility of point-of-care ultrasound is well supported by the medical literature. Consequently, pediatric emergency medicine providers have embraced this technology in everyday practice. Recently, the American Academy of Pediatrics published a policy statement endorsing the use of point-of-care ultrasound by pediatric emergency medicine providers.  To date, there is no standard guideline for the practice of point-of-care ultrasound for this specialty. This document serves as an initial step in the detailed “how to” and description of individual point-of-care ultrasound examinations.  Pediatric emergency medicine providers should refer to this paper as reference for published research, objectives for learners, and standardized reporting guidelines.

The importance of point-of-care emergency ultrasound (EUS) to the practice of emergency medicine (EM) is well established, and mounting research continues to demonstrate how EUS can benefit pediatric emergency department (ED) patients. As members of the EM community, pediatric EM (PEM) physicians should understand the potential value of EUS and seek opportunities to incorporate EUS into their daily practice. Currently, EUS education and training is at an early developmental stage for PEM fellows and varies greatly between programs. The goal of this article is to provide consensus education guidelines and to describe a sample curriculum that can be used by PEM fellowship programs when developing or revising their US training curricula. The authors recognize that programs may be at different stages of EUS development and will consequently need to tailor curricula to individual institutional needs and capabilities. This guideline was developed through a collaborative process between EUS educators and members of the American Academy of Pediatrics Section of EM Fellowship Directors Subcommittee. The guideline includes the following topics: important considerations regarding EUS in PEM, PEM US program framework, PEM US curriculum, PEM US education program, and competency assessment.ACADEMIC EMERGENCY MEDICINE 2013; 20:300-306 © 2013 by the Society for Academic Emergency Medicine E mergency ultrasound (EUS) refers to point-ofcare US performed and interpreted at the patient's bedside by the treating physician to facilitate patient care in the emergency department (ED). Emergency physicians (EPs) use EUS for the resuscitation of critically ill patients, the diagnosis of patients with specific signs or symptoms, monitoring patients with rapidly changing clinical conditions, and the guidance of invasive procedures. The importance of EUS to the daily practice of EPs is underscored in policy statements published by the American College of Emergency Physicians (ACEP). The most recent ACEP policy statement includes comprehensive guidelines for the use of EUS in emergency medicine (EM) and summarizes recommendations for EUS training for EM residents.1 The training recommendations in this guideline mirror education guidelines delineated in consensus recommendations from the 2008 Council of Emergency Medicine Residency Directors' conference. 2The use of EUS by pediatric emergency medicine (PEM) physicians is expanding rapidly, and PEM-specific applications are increasingly being described and studied.3-5 EUS is listed in the American Board of Pediatrics core content guidelines for PEM fellowship training, and questions related to EUS appear on the subspecialty certification examination for PEM. In a recent survey of PEM fellowship directors, 95% of PEM programs endorse the use of EUS in their EDs.6 Still, no specific guidelines exist for the training of PEM fellows, and consequently, education varies greatly. The number of programs offering US education to their PEM fellows has increased significantly over the past 4 year...

Point-of-care ultrasonography is increasingly being used to facilitate accurate and timely diagnoses and to guide procedures. It is important for pediatric emergency physicians caring for patients in the emergency department to receive adequate and continued point-of-care ultrasonography training for those indications used in their practice setting. Emergency departments should have credentialing and quality assurance programs. Pediatric emergency medicine fellowships should provide appropriate training to physician trainees. Hospitals should provide privileges to physicians who demonstrate competency in point-of-care ultrasonography. Ongoing research will provide the necessary measures to define the optimal training and competency assessment standards. Requirements for credentialing and hospital privileges will vary and will be specific to individual departments and hospitals. As more physicians are trained and more research is completed, there should be one national standard for credentialing and privileging in point-of-care ultrasonography for pediatric emergency physicians.

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. Overnight shift in the pediatric emergency department. In 1 room, the fellow is attempting to place a central venous catheter in a 5-year-old boy with presumed septic shock but has been unable to locate the femoral vein with her finder needle. In the next room lies a 7-year-old trauma patient. He is tachycardic with poor perfusion and abrasions on his chest. The team calls for a portable chest radiograph and begins a secondary survey. The resident taps your shoulder. "Can I present a patient?" He describes a 15-year-old girl with lupus complaining of chest pain who is ill appearing, tachycardic, and short of breath. "I ordered labs and chest radiograph."July 1, 2012. Overnight shift in the pediatric emergency department. In 1 room, the fellow is attempting to place a central venous catheter in a 5-year-old boy with presumed septic shock. Using bedside ultrasound, she makes adjustments with her finder needle until she sees it enter the femoral vein. In the next room lies a 7-year-old trauma patient. He is tachycardic with poor perfusion and abrasions on his chest. The team performs an extended focused assessment with sonography for trauma examination, which reveals free fluid in Morison' s pouch and no pneumothorax. A computed tomography scan of the abdomen is prioritized, and type O negative blood is ordered. The resident taps your shoulder. "Can I present a patient?" He describes a 15-year-old girl with lupus complaining of chest pain who is ill appearing, tachycardic, and short of breath. "I did a bedside ultrasound, and she has a pericardial effusion."In 2002, many pediatricians, including the authors, viewed point-of-care ultrasound as a tool used primarily by "general" emergency physicians, cardiologists, and obstetricians. The relevance to our pediatric patients seemed uncertain. Ten years later, the advantages that pointof-care ultrasound offers to those caring for ill, injured, and diagnostically challenging children are difficult to ignore. Although point-of-care ultrasound is relatively new to pediatrics, it is growing rapidly in subspecialty fields such as pediatric emergency medicine, critical care, and neonatology.1-3 The use of point-of-care ultrasound to guide invasive procedures, quickly focus the evaluation of critically ill patients, and reduce exposure to ionizing radiation are some of the factors driving the adoption of bedside ultrasound by pediatric physicians caring for the sickest and most complex pediatric patients.Still, pediatricians who finished training more than a decade ago likely did not receive instruction in point-of-care ultrasound because the relevance to general pediatric patients had not yet been demonstrated. What does point-of-care ultrasound afford pediatrics today? We believe AUTHORS:

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