Purpose: To provide clinicians with an evidence-based overview of all topics related to ultrasound vascular access. Methods: An international evidence-based consensus provided definitions and recommendations.

The responses to oxidative stress induced by chronic exercise (8-wk treadmill running) or acute exercise (treadmill running to exhaustion) were investigated in the brain, liver, heart, kidney, and muscles of rats. Various biomarkers of oxidative stress were measured, namely, lipid peroxidation [malondialdehyde (MDA)], protein oxidation (protein carbonyl levels and glutamine synthetase activity), oxidative DNA damage (8-hydroxy-2'-deoxyguanosine), and endogenous antioxidants (ascorbic acid, alpha-tocopherol, glutathione, ubiquinone, ubiquinol, and cysteine). The predominant changes are in MDA, ascorbic acid, glutathione, cysteine, and cystine. The mitochondrial fraction of brain and liver showed oxidative changes as assayed by MDA similar to those of the tissue homogenate. Our results show that the responses of the brain to oxidative stress by acute or chronic exercise are quite different from those in the liver, heart, fast muscle, and slow muscle; oxidative stress by acute or chronic exercise elicits different responses depending on the organ tissue type and its endogenous antioxidant levels.

In a sample of pediatric ED patients with difficult access, ultrasound-guided intravenous cannulation required less overall time, fewer attempts, and fewer needle redirections than traditional approaches.

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.

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Background: Pediatric emergency medicine (PEM) physicians have variably incorporated point-of-care ultrasound (POCUS) into their practice. Prior guidelines describe the scope of POCUS practice for PEM physicians; however, consensus does not yet exist about which applications should be prioritized and taught as fundamental skills for PEM trainees. Members of the PEM POCUS Network (P2Network) conducted a consensusbuilding process to determine which applications to incorporate into PEM fellowship training.Methods: A multinational group of experts in PEM POCUS was recruited from the P2Network and greater PEM POCUS community if they met the following criteria: performed over 1,000 POCUS scans and had at least 3 years of experience teaching POCUS to PEM fellows, were a local academic POCUS leader, or completed a formal PEM POCUS fellowship. Experts rated 60 possible PEM POCUS applications for their importance to include as part of a PEM fellowship curriculum using a modified Delphi consensus-building technique.Results: In round 1, 66 of 92 (72%) participants responded to an e-mail survey of which 48 met expert criteria and completed the survey. Consensus was reached to include 18 items in a PEM fellowship curriculum and to exclude two items. The 40 remaining items and seven additional items were considered in round 2. Thirty-seven of 48 (77%) experts completed round 2 reaching consensus to include three more items and exclude five. The remaining 39 items did not reach consensus for inclusion or exclusion.Conclusion: Experts reached consensus on 21 core POCUS applications to include in PEM fellowship curricula. P oint-of-care ultrasound (POCUS) has been established in the practice of emergency medicine for over two decades. 1,2 More recently, its use has expanded into the practice of pediatric emergency medicine (PEM). 3 Most PEM fellowship programs now offer formal ultrasound training to their fellows and incorporate POCUS into the care of the pediatric patient. 4,5 In

Arrhythmias in children are less common than in adults but are increasing because of successful repair of congenital heart diseases. Supraventricular tachycardia is the most common symptomatic pediatric tachyarrhythmia. Atrial flutter and atrial fibrillation in children are attributed largely to structural heart disease. Bradycardia is defined as a heart rate less than the lower limit of normal for a child's age, and the most common cause is sinus bradycardia. Despite the infrequent occurrence of arrhythmias, it is crucial to expeditiously identify and treat certain rhythm abnormalities because they can lead to further decompensation.

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.