Curriculum standards
Curriculum standards
Completion requirements
View
Advanced Training in Paediatric Emergency Medicine
Knowledge guides
LG14: Acute illness
Key presentations and conditions
Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Less common or more complex presentations and conditions
Advanced Trainees will understand these presentations and conditions.
Advanced Trainees will understand the resources that should be used to help manage patients with 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.
Presentations
- Abdominal:
- distension
- mass
- pain
- Acute scrotum
- Altered level of consciousness
- Anaphylaxis
- Angioedema
- Bites:
- snake
- spider
- Anorexia
- Apnoea / Irregular breathing
- Ataxia
- Bleeding
- Bruising
- Chest pain
- Chronic illness
- Chronic pain
- Collapse
- Complications of immunisation
- Constipation
- Cough
- Cyanosis
- Dehydration
- Developmental:
- abnormalities
- delay
- syndromes
- regression
- Diarrhoea
- Difficulty swallowing / Drooling
- Dysuria
- Ear discharge
- Electrolyte abnormalities
- Emergency contraception
- Epistaxis
- Erythrodermas and skin failure
- Facial swelling
- Fever, including:
- in the returned traveller
- Focal neurological deficit
- Foreign body:
- ingestion
- inhalation
- Goitre
- Haematemesis
- Haemoptysis
- Seizures
- Hair problems
- Headache
- Haematuria / Change in urine
- Hernia
- Hyperpigmentation
- Hypertension
- Hyperthermia
- Hypoglycaemia
- Hypothermia
- Inborn errors of metabolism
- Infections in immunocompromised children
- Insulin pump failure
- Intoxication from alcohol or drugs of abuse
- Jaundice
- Joint:
- stiffness
- swelling
- Lethargy
- Limp
- Lumps and bumps
- Lymphadenopathy
- Movement disorders
- Nail problems
- Oedema
- Organomegaly
- Paediatric resuscitation
- Pain, such as:
- ear
- joint
- pelvic
- Palpitations
- Photosensitivity
- Polydipsia
- Polyuria
- Poisoning and overdose
- Poor:
- dentition
- feeding
- Poor or abnormal growth
- Post-tonsillectomy haemorrhage
- Problems of the penis and foreskin, acute
- Precocious puberty
- Rash, such as:
- eczematous
- neonatal
- non-blanching
- papular
- papulosuamous
- pustular
- vesiculobullous
- Rectal bleeding
- Recurrent / Severe infection
- Reduced urine output
- Respiratory distress
- Rhinitis
- Seizures
- Sexual assault
- Shock
- Sore throat
- Stomatitis
- Stridor and noisy breathing
- Swelling / Protrusion of the ear
- Syncope
- Tooth pain / swelling
- Ulceration
- Unsettled baby
- Urinary retention
- Urticaria
- Vaginal:
- bleeding
- discharge
- Vascular malformations
- Vomiting
- Weakness
- Weight loss
- Wheezing
Conditions
Cardiovascular
- Cardiac murmurs
- Coarctation of the aorta
- Hypertrophic obstructive cardiomyopathy (HOCM)
- Myocarditis
- Palpitations
- Pericarditis
- Supraventricular tachycardia
- Syncope and causes, including, but not limited to:
- breath-holding spells
- tetralogy of Fallot
- vasovagal syncope
- ventricular tachycardia
Dental
- Abscess
- Caries
Dermatological
- Bacterial skin infections
- Dermatitis
- Eczema, including eczema herpeticum
- Erythema multiforme
- Henoch–Schönlein purpura
- Impetigo
- Kawasaki disease
- Petechiae
- Purpura
- Scabies
- Skin changes associated with bacterial infections, such as:
- rheumatic fever
- scarlet fever
- staphylococcal scalded skin syndrome (SSSS)
- Skin changes associated with immunological conditions, such as:
- Kawasaki disease
- Stevens–Johnson syndrome
- Toxic shock
- Urticaria
- Viral exanthems, including warts
- Viral rashes, including:
- measles
- non-specific
Developmental and congenital
- Attention deficit hyperactivity disorder (ADHD)
- Autism spectrum disorder
- Spina bifida
- Trisomy 21
Ear, nose, and throat
- Mouth ulcers:
- bacterial
- viral
- Otitis:
- externa
- media
- Quinsy
- Sinusitis
- Tonsillitis
Endocrinological
- Adrenal:
- crisis
- gland disorders
- Diabetes mellitus:
- type 1
- type 2
- Diabetic ketoacidosis
- Hypoglycaemia
- Insulin pump failure
- Polydipsia
- Polyuria
Gastrointestinal
- Appendicitis
- Bilious vomiting
- Bowel obstruction
- Cholecystitis
- Constipation
- Gastroenteritis
- Haematemesis
- Hernia:
- incarcerated
- irreducible
- Hirschsprung disease
- Infectious diseases
- Inflammatory bowel diseases
- Ingested foreign body
- Intussusception
- Jaundice
- Malrotation or volvulus
- Pancreatitis
- Pyloric stenosis
- Umbilicus disorders
General
- Dehydration
- Shock
Haematological and oncological
- Anaemia
- Haemorrhage and haemorrhagic shock
- Haemorrhagic and thrombotic disease
- Idiopathic thrombocytopenic purpura (ITP)
- Leukaemia
- Lymphoma
- Neutropoenia and sepsis
- Pancytopenia
- Solid organ tumours
- Thrombocytopaenia
- Allergies
- Anaphylaxis
- Bacterial tracheitis
- Kawasaki disease
- Rheumatic fever, acute
- Sepsis
- Vesicoureteral reflux
- Hypoglycaemia
- Limp, acute
- Osteomyelitis
- Parathyroid disorders
- Perthes disease
- Septic arthritis
- Slipped upper femoral epiphysis
- Thyrotoxicosis
- Transient synovitis
Neonatal
- Jaundice
- Neonatal acne
Neurological
- Bell’s palsy
- Cerebral palsy
- Encephalitis
- Facial weakness
- Intracranial neoplasms
- Meningitis
- Migraines
- Raised intracranial pressure
- Seizures and movement disorders
Renal
- Glomerulonephritis
- Henoch–Schönlein purpura
Respiratory
- Asthma
- Bronchiolitis
- Croup
- Empyema
- Laryngomalacia and tracheomalacia
- Lower respiratory tract infection
- Lung abscess
- Neonatal apnoea
- Pertussis
- Pleural effusion
- Pneumonia and its complications
- Pneumothorax
- Respiratory distress
- Stridor
- Upper respiratory tract infection
Toxicological
- Alcohol intoxication
- Antidepressant and antipsychotic overdose
- Clonidine overdose
- Paracetamol overdose
Urological
- Acute idiopathic scrotal oedema
- Phimosis
- Urinary retention
- Urine infections
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
Presentations
- Exposure to toxic gases
- Marine envenomation
- Poisonous fungi / plant ingestion and exposure
Conditions
Cardiovascular
- Acute coronary syndrome
- Anomalous left coronary artery
- Aortic stenosis
- Arrhythmogenic right ventricular cardiomyopathy
- Atrial septal defect (ASD)
- Atrioventricular (AV) blocks
- Brugada syndrome
- Cardiac transplantation
- Coronary aneurysms, with Kawasaki disease
- Ebstein anomaly
- Endocarditis
- Heart failure
- Hypertensive emergencies
- Patent ductus arteriosus (PDA)
- Prolonged QT interval
- Pulmonary:
- atresia / stenosis
- hypertension
- Rheumatic heart disease
- Single ventricle physiology (hypoplastic left / right heart)
- Sinus node dysfunction
- Total anomalous pulmonary venous return
- Transposition of the great arteries
- Tricuspid atresia
- Truncus arteriosus
- Ventricular septal defect (VSD)
- Wolff–Parkinson–White syndrome
Dermatological
- Bullous disease
- Haemangiomas
Developmental and congenital
- CHARGE syndrome
- Developmental delay and regression
- Foetal alcohol syndrome
- Fragile X syndrome
- Muscular dystrophy
- VACTERL association
Ear, nose, and throat
- Nasal polyps
- Obstructive sleep apnoea
Endocrine
- Addison disease
- Adrenal crisis
- Congenital adrenal hyperplasia
- Diabetes insipidus
- Goitre
- Hyperpigmentation
- Hypothalamus disorders
- Parathyroid disorders
- Pituitary:
- crisis
- gland disorders
- Precocious puberty
- Rickets
- Thyroid crisis
- Thyrotoxicosis
Gastrointestinal
- Abdominal mass / organomegaly
- Short gut
General
- Sudden unexplained death
Haematological and oncological
- Haemoglobinopathies
- Transfusion reactions
- Tumour lysis syndrome
Immunological
- Angioedema
- Immune deficiency-related infections
Infectious
- Fever in the returned traveller
- Immunisation and complications of immunisation
- Infections in immunocompromised children
Metabolic
- Amino acid metabolism
- Carbohydrate metabolism
- Inborn errors of metabolism
- Lipids metabolism
Musculoskeletal and rheumatological
- Inflammatory joint conditions:
- juvenile idiopathic arthritis
- Neoplasms
- Overuse syndromes
- Skeletal dysplasia
Neurological
- Acute disseminated encephalomyelitis
- Ataxia
- Autonomic neuropathies
- Guillain–Barré disease
- Haemorrhagic and ischaemic strokes
- Neurodegenerative disorders
- Neuromuscular disorders
- Spinal cord disorders
- Toxic neuropathies
- Transverse myelitis
- Vascular disorders
- Venous sinus thrombosis
Obstetric and gynaecological
- Non-pregnancy-related emergencies, including:
- dysfunctional uterine bleeding
- menorrhagia
- heavy per vaginum (PV) bleeding
- pelvic inflammatory disease
- sexually transmitted infections
- vaginal trauma
- Pregnancy-related emergencies, including:
- bleeding in:
- early pregnancy
- late pregnancy
- ectopic pregnancy
- pre-eclampsia / eclampsia Renal
- bleeding in:
Renal
- Kidney vein thrombosis
- Neurogenic bladder
- Polycystic kidney disease
- Renal artery stenosis
- Renal stones
- Urinary tract obstructions
- Vesicoureteral reflux
Respiratory
- Chronic respiratory disease, such as:
- congenital abnormalities, such as:
- congenital diaphragmatic hernia
- cystic fibrosis
- primary ciliary dyskinesia
- congenital abnormalities, such as:
- Pneumomediastinum
- Pulmonary:
- embolism
- sequestration
- Subglottic stenosis
- Tuberculosis
- Vascular ring
- Vocal cord dysfunction
Toxicological
- Anticholinergic syndrome
- Beta blocker overdose
- Calcium channel blocker overdose
- Carbon monoxide poisoning
- Cholinergic syndrome
- Drugs of abuse – use and withdrawal
- Hydrocarbon toxicity
- Neuroleptic malignant syndrome
- Non-steroidal anti-inflammatory drug (NSAID) overdose
- Opiate overdose
- Organophosphate toxicity
- Serotonin syndrome
- Sodium channel blocker overdose
- Sympathomimetic syndrome
- Toxic alcohol overdose
Urological
- Paraphimosis
- Penile discharge
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
- Normal dental development
Prescribing and treatment
- Basic toxicology
- Clinical pharmacology
- Infections that require medication prescription:
- antifungal
- antiparasitic
- antiviral
- Pathophysiology of:
- acid-base and electrolyte disturbances
- cardiovascular failure
- coma
- respiratory failure shock
Clinical assessment tools
- Airway, Breathing, Circulation, Disability, Exposure (ABCDE) assessment of critically unwell children
- Development assessment
- Home, Education / Employment, Eating / Exercise, Activities, Drugs and alcohol, Sexuality, and Suicide and depression, Safety (HEEADSSS) assessment
- Mental state
- Percentile growth chart
- Primary, secondary, and tertiary survey
Investigations and procedures
Cardiovascular
- Antiarrhythmic therapy
- Blood:
- arterial and venous blood sampling and analysis
- blood, platelet, and clotting factor transfusion
- Ductus arteriosus therapy
- Intravenous catheter insertion:
- central
- peripheral
- Use of defibrillator for resuscitation or for cardioversion
Dental
- Assessment of dental injuries
- Temporary fixation of injured secondary teeth
Developmental abnormalities and syndromes
- Developmental screening
Ear, nose, and throat
- Ear wick insertion
- Epistaxis management with nasal packing
- Nasal packing
- Post-tonsillectomy haemorrhage management
Endocrinological
- Blood glucose check
- Ketone check
- Venous blood gas, and interpretation of results
Gastrointestinal
- External rectal examination
- Gastrostomy tube replacement
- Hernia reduction
- Nasogastric tube insertion
- Orogastric tube insertion
Haemtological and oncological
- Central line access
Immunological
- Coombs test
- Immunisation
Infection disease
- Abscess drain
- Cultures from:
- cerebrospinal fluid
- mucosa
- secretions
- skin
- stool
- urine
- Lumbar puncture (LP)
- Malarial films
- Perinasal swab
- Serology
- Suprapubic aspirate
- Swab for:
- enzyme immunoassay
- immunofluorescence
- polymerase chain reaction (PCR)
- Urethral catheterisation
Metabolic
- Take and interpret glucose and ammonia levels
Musculoskeletal
- Knee joint aspiration
Neurological
- Consciousness levels using:
- Glasgow Coma Scale
- Paediatric Glasgow Coma Scale
- Fundoscopy
- Interpretation of CT scan
- Measurement of opening pressure on LPs
- Performing an LP for cell count, glucose, and protein, and interpretation of results
Obstetric and gynaecologic
- External genital examination for injuries
- Forensic examination of sexual assault victims
- Pregnancy test
- Vaginal speculum examination for pregnant patients experiencing significant miscarriage or cervical shock
Opthalmology
- Bacterial and viral swabs of the eye
- Use of slit lamp with fluoresceine
Respiratory
- Ability to set up ventilators for acute medical conditions, such as a patient intubated for seizure control or severe asthma
- Arterial and venous blood gas
- Basic CT chest scan interpretation
- Bubble continuous positive airway pressure (CPAP)
- Chest x-ray interpretation
- High-flow oxygen therapy
- Lateral airway radiography
- Non-invasive ventilation
- Pulse oximetry
- Spirometry and measures of gas exchange
Urological
- Acute treatment of phimosis with urinary retention
- Reduction of paraphimosis
- Suprapubic aspirate of urine
- Urethral catheter insertion
- Urine dipstick
- Awareness of ‘one pill can kill’ medications, such as:
- calcium channel blockers
- carbamazepine
- clozapine
- opioids
- propranolol
- sodium channel blockers
- sulfonylureas
- tricyclic antidepressants
- venlafaxine
- Awareness of ‘one sip can kill’ medications, such as:
- camphor
- corrosives
- hydrocarbons
- naphthalene
- organophosphates
- paraquat
- Expected clinical course and outcome of illnesses
- High-risk clinical features of illnesses and comorbidities
- Impact of long-term illness on development
- Infection control:
- communicable disease reporting
- immunisation
- isolation
- Management of infection in travellers
- Management process following needlestick injury
- Medical and support agencies for pregnancy referral
- Methods of:
- behaviour modifications
- physical restraint
- Paediatric resuscitation
- Potential risks to patients’ safety
- Safety issues for patients and staff:
- personal protective equipment
- universal precautions
- Sexual assault counselling agencies
- Signs of severity and patterns of decompensation
- Techniques, utility, and limitations of focused ultrasound in guiding paediatric procedures
- The need for medical clearance
Treatment therapies
- Treatment of haematological and oncologic conditions:
- chemotherapy
- radiation therapy