Knowledge guides

LG13: Acute care

Key presentations and conditions

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

More detailed conditions and presentations are presented as an appendix.

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Epidemiology, pathophysiology, and clinical sciences

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

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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.

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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 into care.

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Appendix

Advanced trainees will have knowledge of a variety of acute presentations and conditions across the scope of general paediatrics, including but not limited to those listed here.

Advanced trainees should be able to recognise conditions, and be familiar with initial stabilisation and resources / referral pathways for ongoing care.

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Common and key presentation types
  • Abdominal pain
  • Accidental ingestion / poisoning
  • Acute behavioural disturbance
  • Acute mental health presentations
  • Acute presentations in adolescents / young adults
  • Acute presentations in child with developmental disability
  • Acute presentations in neonate / young infant
  • Altered conscious state
  • Anaphylaxis and allergy
  • Back pain
  • Breathing difficulties, such as:
    • cough
    • stridor
    • wheeze
  • Cardiorespiratory arrest
  • Collapse
  • Constipation
  • Diarrhoea
  • Feeding difficulties
  • Fever
  • Fluid and electrolyte disturbance
  • Gait disturbance
  • Gynaecological conditions
  • Headache
  • Infection
  • Jaundice
  • Joint pain or swelling
  • Limp
  • Lymphadenopathy
  • Metabolic disorder
  • Neonatal resuscitation
  • Oncological presentations
  • Pain:
    • generalised
    • localised
  • Pallor
  • Penile and testicular conditions
  • Rashes
  • Recurrent unexplained presentations
  • Seizures
  • Seriously ill child
  • Seriously injured child
  • Shock
  • Slow growth
  • Substance use
  • Suspected child abuse and neglect
  • Vomiting
  • Weakness:
    • generalised
    • localised

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

Synthesise
  • recognise the clinical presentation
  • identify relevant epidemiology, pathophysiology, and clinical science
  • take a relevant clinical history
  • conduct an appropriate examination
  • establish a differential diagnosis
  • plan and arrange appropriate investigation
  • consider the impact of illness and disease on patients and families, and their quality of life
Manage
  • provide evidence-based management including use of medications
  • for less common or more complex presentations and conditions, the trainee must also seek expert opinions
  • 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
  • Basic toxicology
  • Clinical pharmacology
  • Pathophysiology of cardiovascular failure
  • Pathophysiology of coma
  • Pathophysiology of respiratory failure
  • Pathophysiology of shock
  • Physiology of acid–base and electrolyte disturbances
Investigations
  • Blood tests:
    • bacterial and viral PCR
    • biochemistry
    • culture and antimicrobial sensitivity
    • endocrinological
    • haematological
    • inflammatory markers
    • serology
  • Cerebral spinal fluid:
    • culture and antimicrobial sensitivity
    • microscopy
    • role for additional testing (autoimmune / metabolic)
  • Echocardiography
  • Radiology:
    • CT scan
    • MRI
    • plain x-rays
    • ultrasound
  • Site swabs and samples:
    • culture and antimicrobial sensitivity
    • microscopy
  • Urine:
    • biochemistry
    • culture and antimicrobial sensitivity
    • microscopy
    • toxicology screen
Clinical assessment
  • A – E assessment of the critically unwell child
  • Primary, seconday, and tertiary survey
Procedures
  • Airway stabilisation procedures
  • Indwelling catheter insertion
  • Intercostal catheter insertion
  • Intraosseous needle insertion
  • Intravenous cannulation
  • Lumbar puncture
  • Midline insertion
  • Nasogastric tube insertion
  • Needle thoracocentesis
  • Percutaneous long line
  • Point of care ultrasound (POCUS), including an understanding of its role in procedures and as a diagnostic aide
  • Suprapubic aspiration
  • Umbilical venous catheter insertion
  • Advanced paediatric life support algorithms
  • Basic principles of postoperative care for critically unwell surgical neonates, infants, children, or young people:
    • preoperative requirements for newborns, infants, children, or young people undergoing major surgery
    • risks of major surgery for newborns, infants, children, or young people with chronic disability and illness
  • Clinical handover and referral, including use of tools
  • Complications of in situ medical devices, such as:
    • central venous access devices
    • intrathecal baclofen pumps
    • ventriculoperitoneal shunt
  • Crisis resource management principles
  • Criteria for ICU admission, and recognition of differing resources in different clinical contexts
  • Critical incident debriefing principles
  • Drug management of infants or children for safe ETT paralysis and sedation
  • Fluid management
  • Inotropes – understand the indications and commencement in resuscitation
  • Local escalation and emergency procedures
  • Manual and mechanical ventilation
  • Medicolegal requirements for certifying death of a child
  • Neuroprotective measures
  • Non-invasive ventilation:
    • bilevel positive airway pressure (BiPAP)
    • continuous positive pressure ventilation (CPAP)
    • use of T-piece device (e.g., Neopuff)
  • Nutritional requirements of critically ill infants, children, or young people:
    • enteral feeding and parenteral nutrition
  • Oxygen delivery, including evidence-based use of humified high-flow oxygen
  • Procedural sedation, anxiety, and pain management:
    • non-pharmacological – child life therapist
    • pharmacological
  • Resuscitation calculators and emergency guidelines
  • Retrieval services:
    • receiving patients
    • referral and transfer
    • understanding of key issues for stabilisation
  • Use of modern ventilators, especially modes for neonatology and paediatrics in the work setting