Curriculum standards
Curriculum standards
Completion requirements
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Advanced Training in Paediatric Emergency Medicine
Knowledge guides
LG15: Acute injury
Key presentations and conditions
Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
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 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.
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.
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
- environmental exposures:
- 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
- flail chest:
- 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
- bladder rupture:
- 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
- limb fractures:
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