Paediatric ultrasound and point of care ultrasound — branching viva

Opening question

This febrile, grunting 8-month-old needs a bedside lung ultrasound to distinguish community-acquired pneumonia from bronchiolitis. Walk me through how you would choose the probe, set the image-quality controls, and run the scan, and tell me the artefact repertoire you would read at each zone. [1] [3]

Branch 1 — the BLUE protocol and the pneumonia sign

You have decided the scan can proceed. Describe the eight-zone scan, explain how the BLUE protocol interprets the A-line, B-line, sliding and lung-point patterns, and tell me exactly which sign confirms a pneumonia and why a chest radiograph may be unnecessary. [2] [3]

Branch 2 — the FAST in paediatric blunt abdominal trauma

Suppose instead a 6-year-old unstable victim of a high-speed crash arrives and the FAST shows free fluid in Morison's pouch. What is the next step, and what is the single most important limitation of the FAST in children that you must state to the examiner? Defend why a negative FAST never clears a child. [7]

Branch 3 — intussusception, pyloric stenosis, and difficult access

A 9-month-old with colicky screaming shows concentric rings of bowel wall on ultrasound, and a 4-week-old with projectile vomiting shows a thickened pylorus. Name both signs, give the pyloric measurement cut-offs, and tell me the caveat about those cut-offs. Then, for a dehydrated child with no palpable veins, defend ultrasound guidance using the EPIC trial. [9] [10]

Closing — focus-assessed cardiac ultrasound in shock

Finally, a child in undifferentiated shock is scanned. Tell me the four focused questions a cardiac point-of-care ultrasound is designed to answer, how the inferior vena cava read refines volume status, and why this scan never replaces the formal echocardiogram. [11]