Curriculum standards

Knowledge guides

LG13: Foundations of paediatric emergency medicine

Epidemiology, pathophysiology, and clinical sciences

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

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 tinterpret the reported results of each investigation or procedure.

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

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Important specific issues

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

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Anatomy and physiology, including normal and abnormal ranges and development
Basic sciences, epidemiology, and pathophysiology of critical paediatric illness and injury, including:
- diagnosis
- evidence-based management
- pharmacology
- treatment
High-risk clinical features and comorbidities
Patterns of clinical and physiological decompensation
Pharmacological and non-pharmacological pain relief
Pharmacology of pain relieving and sedative agents, such as:
- analgesics, including:
  - nitrous oxide
- general anaesthetics, including:
  - sedatives
- local anaesthetics
Physiological and clinical responses to pain
Stabilisation and emergency treatment in critical illness or injury

Clinical assessment tools

Comparative pain scale
Local / Statewide / National clinical assessment tools, including, but not limited to:
- anaphylaxis
- asthma
- bronchiolitis
- burns
- cervical spine injury
- diabetic ketoacidosis
- gastroenteritis
- head injury
- hydration status
- sepsis
- stroke
Oximetry and capnography tmonitor intubated patients
Resuscitation and critical care structured assessment

Investigations

Biochemical:
- blood gases
- endocrinological:
  - blood glucose level
  - ketones
- inflammatory markers
- stool:
  - faecal calprotectin
- urine
ECG
Haematological:
- full blood count
- transfusion sample
Metabolic:
- hypoglycaemia screen
- metabolic screening tests
- newborn blood spot screening
- urine screen:
  - drug
  - metabolic
Microbiological:
- antimicrobial sensitivity, culture, and microscopy
- blood tests, such as:
  - bacterial
  - viral polymerase chain reaction (PCR)
- cerebral spinal fluid
- serology
- skin / fluid swabs:
  - antimicrobial sensitivity and culture
  - bacterial and viral PCR
  - microscopy
- stool:
  - culture and antimicrobial sensitivity
  - cysts, ova, and parasites
- urine:
  - antimicrobial sensitivity and culture
Patient monitoring
Radiological:
- CT
- MRI
- ultrasound – including point of care ultrasound
- x-ray

Procedures

Advanced airway support, including difficult airways:
- intercostal catheters
- intubation and rapid sequence inductions
- laryngeal mask use
- nasotracheal intubation
- needle cricothyroidotomy
- orotracheal
- percutaneous needle thoracocentesis
- surgical airways
Advanced life support:
- cardioversion for arrhythmia
- defibrillation
- fluid resuscitation
- pericardiocentesis
- pharmacology, including:
  - antiarrhythmics
  - inotropes
  - vasodilators
Analgesia and sedation procedures:
- general anaesthetic administration, including:
  - inhalation analgesics
  - sedation:
    - benzodiazepine – with or without fentanyl
    - choral hydrate
    - dexmedetomidine
    - ketamine
    - nitrous oxide
    - propofol
- immobilisation techniques, including splinting
- nerve blocks:
  - Bier block
  - digital nerve block
  - fascia iliaca compartment block
  - femoral nerve block
  - other nerve blocks
Foreign body removal, from:
- ear
- eye
- mouth
- nose
- skin
- soft tissue
Lumbar puncture
Practical trauma procedures:
- airway management, including:
  - bag and mask ventilation
  - circulation management
  - endotracheal intubation
  - manoeuvres and adjuncts
  - mechanical ventilation
  - oxygen delivery systems
  - ventilation:
    - invasive
    - non-invasive
Temperature homeostasis
Ultrasound guided procedures, including, but not limited to:
- cannulation
- fracture manipulation
Vascular procedures:
- arterial:
  - cannulation
  - puncture
- cardiac pacing
- vascular access:
  - central
  - intraosseous

Child protection
Emergency Medical System (EMS), including communicating with pre-hospital providers
Management of mental health / behaviours of concern in the emergency department
Neurodiversity
Reducing overuse of investigations and treatments
Understand the techniques, utility, and limitations of focused ultrasound in guiding paediatric procedures

Disasters involving children

Considerations of disaster site management:
- equipment and supplies
- field hospitals
- media management
- roles and responsibilities
- transport
Disaster preparation – planning and training
Emergency department resources required to receive victims of a disaster:
- equipment
- personnel
Essential information that must be communicated following a disaster
Management of collegial, nursing, and transport staff
Methods of disaster site triage and on-site treatment
Occupational health and safety risks
Potential medical issues:
- mental health
- public health
Regional, state, and national governments’ responsibilities following disasters

Manage the death of a child

Criteria for:
- coronial investigation
- determining death
Grieving process
Organ donation requirements
Religious and cultural attitudes to death
Staff support, and organisations to assist mourning families

Retrieval and/or transfer

Inter-hospital transfer:
- handover protocol
- risk factors
- transfer:
  - disposition
  - method
- transfer of responsibilities
Intra-hospital transfer:
- clinical handover
- handover protocol
- monitoring devices
- risk factors
Retrieval medicine

Risk management

Australasian triage scale indicators
Clinical risk management processes, including:
- complaint and incident report management
- consent
- consultation
- documentation
- quality assurance
Medical advice that may be provided by telephone triage
Risk components of an emergency medical department