UMEM Educational Pearls - By Julie Kurek

Title: Using Ultrasound Guidance for IV Placement in the Pediatric ED

Posted: 11/7/2025 by Julie Kurek, MD (Updated: 12/5/2025)
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A recent randomized control trial published in JAMA Pediatrics in January 2025 showed improvement in first attempt for IV access when using ultrasound in the pediatrics ED.

This trial was performed at a quaternary pediatric hospital in Australia with a total of 164 patients (ages 18 and younger). Median age of the patients was 24 months. There was computerized system that randomized patients into either getting an IV by standard procedure vs ultrasound-guided. Those placing the ultrasound-guided IV had extensive training. Overall, the first time success rate was higher in the ultrasound group with about 85.7% compared to 32.5% in the standard group.

Main point: US IV decreases the number of sticks a child has to experience for IV access with a higher first stick success rate. Consider US IV training in your Pediatric Emergency Department in the future. Also use ultrasound guidance with first attempt IV access for your chronically ill children or for very anxious parents.

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Title: Inhaled Corticosteroid Use in Pediatric Asthma Patients

Category: Pediatrics

Posted: 9/5/2025 by Julie Kurek, MD (Updated: 12/5/2025)
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Evidence shows the effectiveness of inhaled corticosteroids during pediatric asthma attacks.

A metanalysis from 2020 reviewed 7 different studies between 2009 to 2018 that included patients < 18 years. The studies compared the use of inhaled corticosteroids to placebo, inhaled corticosteroids compared to systemic corticosteroids, and inhaled corticosteroids in addition to systemic corticosteroids. Please note that in the studies children were still being treated with albuterol.

The results showed:

-Inhaled corticosteroids would significantly reduce the hospital admission rate when compared to placebo (by about 83%).

-Inhaled corticosteroids reduced hospital admission rates when compared to systemic steroids only (by 27%) for mild to moderate asthma.

-When combining systemic steroids with inhaled corticosteroids, the hospital admission rate would be reduced by 25% compared to using only systemic steroids for moderate to severe asthma attacks.

Bottom line: Consider administering inhaled corticosteroids in pediatric asthma patients.