Curriculum standards

Knowledge guides

LG15: Acute injury

Key presentations and conditions

Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.

View

Epidemiology, pathophysiology, and clinical sciences

Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.

View

Investigations, procedures, and clinical assessment tools

Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.

Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.

View

Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.

View

Environmental injury

Barotrauma
Bites and stings:
- animal
- human
- insect
- marine
- reptile
Burns:
- chemical
- contact
- lightning injury
- radiation injury
- scalds
- smoke inhalation
- sunburn
Cold injury:
- peripheral cold injuries
- systemic hypothermia
Decompression illness
Drowning
Environmental and burns, including:
- environmental exposures:
  - hyperthermia
  - hypothermia
Heat injury
Radiation
Toxic marine ingestions

General types of injury

Burns
Internal
Laceration
Non-accidental
Orthopaedic
Toxic

Injuries by region

Abdominal injury:
- hepatic
- hollow viscus
- kidney
- pancreatic
- splenic
Back injury:
- ligamentous injuries
- musculoskeletal back pain
- spinal cord injuries
- spinal fractures
Chest injury:
- flail chest:
  - fractured ribs
  - fractured sternum
  - injury of great vessels
- haemothorax
- penetrating thoracic injury:
  - myocardial contusion
  - pericardial tamponade
- pneumothorax
- pulmonary contusion
- traumatic asphyxia:
  - diaphragmatic eventration
  - tracheobronchial rupture
Face injury:
- burns
- dental
- ear
- eye, including:
  - foreign bodies
- facial fractures
- jaw dislocation
- lacerations
- nose
Genitourinary or pelvic injury:
- bladder rupture:
  - pelvic fracture
  - straddle injuries
- penetrating genitourinary trauma
- penile / perineal / vaginal injury
- sexual assault
- testicular trauma
- ureteric:
  - urethral
Hand injury:
- amputation
- crush injury
- cutaneous foreign bodies
- lacerations / skin injury:
  - contaminated
  - cutaneous foreign body
  - deep lacerations
  - degloving
  - marine wounds, including:
    - coral
  - non-venomous bites
  - puncture wounds
  - superficial lacerations
- nail and nail bed
- nerve
- pressure injection injury:
  - animal bites
  - fractures
  - penetrating injuries
  - tendon
Head injury:
- concussion
- diffuse axonal injury
- extra-axial
- haematomas
- intracerebral
- intracranial
- minor head injuries
- non-accidental
- penetrating head injury
- post-concussive syndrome
- skull fractures
Neck and spinal injury:
- fractures
- nerve injury
- spinal cord injury without radiologic abnormality
- spinal cord syndromes
- vascular injury

Orthopaedic injury

Dislocations:
- acromioclavicular joint
- ankle
- elbow, including:
  - pulled elbow
- hip
- jaw
- knee
- patella
- phalanges, including:
  - hand
  - foot
- shoulder
Ligamentous / Soft tissue injury:
- ankle
- apophysitis / osteochondrosis
- compartment syndrome
- elbow
- foot
- hand, such as:
  - trigger finger
- knee
- Lisfranc
- muscular sprain
- shoulder
- tendinopathies
Lower limb fracture:
- avulsion fracture of fifth metatarsal
- distal tibia, including:
  - epiphyseal-metaphyseal
- femoral neck and shaft
- fibula
- metatarsal
- midshaft and proximal tibia
- patella
- phalangeal
- slipped upper femoral epiphysis
- tarsal, including:
  - calcaneus
  - talus
- tibial plateau – tibial spine
- toddler’s fracture
Pelvic fractures:
- avulsion fractures
- superior iliac spine:
  - anterior
  - inferior
- ischial tuberosity
- pelvic rim fractures
Spinal injuries:
- ligamentous and soft tissue injuries
- spinal cord injury without radiologic abnormality
- spinal cord syndromes
- vertebral fracture and dislocation
Upper limb fracture:
- carpal
- clavicle
- distal radius and ulna, including:
  - epiphyseal-metaphyseal
- Galeazzi and Monteggia fractures
- lateral and medial humeral condyles
- metacarpal
- midshaft:
  - humerus
  - radius
  - ulna
- phalangeal
- proximal ulna
- radial head and neck
- scapular
- supracondylar:
  - grading
  - occult
- upper humerus, including:
  - epiphyseal-metaphyseal

For each presentation and condition, Advanced Trainees will know how to:

Synthesise

recognise the clinical presentation
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a comprehensive clinical history
conduct an appropriate examination
establish a differential diagnosis
plan and arrange appropriate investigations
consider the impact of illness and disease on patients and their quality of life when developing a management plan

Manage

provide evidence-based management
prescribe therapies tailored to patients’ needs and conditions
recognise potential complications of disease and its management, and initiate preventative strategies
involve multidisciplinary teams

Consider other factors

identify individual and social factors and the impact of these on diagnosis and management

Age- and anatomy-related normal physiology of injured area:
- abdominal or pelvic
- chest
- facial
- genitourinary
- hand
- head
- neck
- orthopaedic
- soft tissue
- spinal
Signs of severity and patterns of decompensation
Toxic injury:
- antidotes for common poisons
- epidemiology of poisoning
- pharmacological techniques for drug removal
- toxicology and drug testing and screening methods

Clinical assessment tools

Burns

Burn depths categorisation

Head

Evaluate degrees of head injury – scalp lacerations
Level of consciousness

Facial

Eye examination, including:
- slit lamp

Toxic

Assess need for and administer activated charcoal
Drug testing and screening
Patient decontamination for chemical agents

Investigations

Investigations – general

CT
MRI
Pathology, including blood tests in trauma, including:
- chemistry
- cross-match
- full blood count
- lipase
Ultrasound
Urine testing, including:
- BHcG (when indicated)
X-rays

Burns

Burn nomogram

Chest injury

Investigations for inhaled foreign bodies
Ultrasound

Facial injury

Orthopantomogram

Head injury

CT
MRI
Radiological investigations, such as:
- fundoscopy

Vascular injury

Angiography
Doppler ultrasound
Sonography

Procedures

Burns

Dressing selection and application
Escharotomy
Fluid resuscitation

Chest injury

Intercostal drain insertion
Percutaneous needle thoracostomy
Pericardiocentesis

Facial injury

Anterior nasal pack
Facial burns:
- dressing for superficial and partial thickness burns
- refer higher degree burns
Foreign body removal:
- ear
- eye:
  - conjunctival
  - corneal
- nose
Irrigate conjunctival and corneal eye burns
Reduce temporomandibular joint dislocation
Reimplant secondary tooth
Repair lacerations:
- sutures
- tissue adhesives

General

Procedural sedation:
- contraindications and indications
- options for procedural sedation in the emergency department

Genitourinary or pelvic injury

Foreign body investigation and removal
Stabilise pelvic fracture

Hand injury

Digital nerve block
Ring removal
Splinting:
- interphalangeal joint dislocation
- metacarpal fracture
- metacarpophalangeal joint dislocation
- phalangeal fracture

Head injury

Laceration repair:
- glue
- staples
- sutures
Management of raised intracranial pressure, including:
- neuroprotective measures
Neurosurgical time-critical intervention, including:
- burr holes

Lacerations

Amputated area management
Fishhook removal
Foreign body removal
Wound:
- anaesthesia administering
- cleanse and debride
- dressing

Orthopaedic

Casting
Nerve blocks:
- fascia iliaca / femoral block with ultrasound guidance
Reduction of:
- dislocations, with and without compromise
- fractures, with and without compromise
Soft tissue injury
Splinting:
- limb fractures:
  - lower
  - upper

Spinal injury

Log roll
Spinal immobilisation

Toxic injury

Decontamination
Gastrointestinal (GI)
Skin
Whole bowel irrigation

Acute treatment of injuries and trauma
Aeromedical:
- safety considerations
- transfer
Expected clinical course and outcome
First aid procedures
HAZMAT principles
Indications and contraindications of varying routes of analgesia:
- gaseous
- intranasal
- intravenous
- local anaesthesia:
  - blocks
  - topical
- oral analgesia
Non-pharmacological treatment options:
- dexmedetomidine
- distraction
- ketamine:
  - intramuscular
  - intravenous
- nitrous oxide
- oral agents, such as:
  - clonidine
  - midazolam
- splints
Pharmacological treatment options for analgesia
Preparation and delivery of discharge instructions
Referral to:
- other relevant specialists
- radiologist
Rehabilitation, including:
- acute
Techniques, utility, and limitations of focused ultrasound in guiding paediatric procedures