Paediatrics & Child Health: Emergency Medicine

Acute illness

Presentations

• Brief resolved unexplained events (BRUE)
• Cyanosis
• Eye abnormalities
• Febrile convulsions
• Fever
• Irritable infant
• Poor growth
• Recurrent unexplained presentation
• Testicular pain, acute
• Vomiting

Conditions

• Orbital and periorbital cellulitis

Acute injury

Presentations

• Cervical spine injury
• Foreign bodies, inhaled, ingested, or inserted
• Fracture
• Head injury or concussion
• Laceration
• Injury that may have been inflicted by another person
• Ocular trauma or foreign body
• Pulled elbow

Behavioural and psychiatric

Presentations

• Agitation
• Aggression
• Overdose
• Suicidal and self-harming behaviour

Conditions

• Acute psychosis
• Eating disorders

Cardiovascular

Presentations

• Chest pain

Conditions

• Arrhythmias and rhythm disorders

Endocrinological

Conditions

• Adrenal crisis
• Diabetic ketoacidosis (DKA)
• Hypoglycaemia

Gastrointestinal 

Presentations

• Abdominal pain
• Abdominal trauma
• Constipation
• Diarrhoea
• Vomiting

Conditions

• Appendicitis
• Gastroenteritis
• Hernias
• Intussusception
• Meckel diverticulum
• Peritonitis
• Pyloric stenosis
• Volvulus

Infectious diseases

Presentations

• Fever without a focus

Conditions

• Cellulitis
• Infections, such as Group A streptococci and Staphylococcus aureus
• Meningitis and encephalitis
• Viral rashes

Musculoskeletal

Presentations

• Irritable hip
• Limp

Conditions

• Osteomyelitis
• Perthes disease
• Septic arthritis
• Slipped capital femoral epiphysis

Neurologic

Presentations

• Collapse and altered conscious state
• Paraplegia or weakness, acute

Conditions

• Seizure
• Spinal cord lesions
• Status epilepticus

Renal and urologic

Presentations

• Dysuria
• Enuresis
• Urinary retention

Conditions

• Acid–base disturbances
• Electrolyte disorders
• Urinary tract infection

Respiratory

Presentations

• Cough
• Shortness of breath
• Stridor
• Upper airway obstruction
• Wheeze

Conditions

• Asthma
• Bronchiolitis
• Croup
• Pneumonia
• Upper respiratory infection

Resuscitation and critical care

Presentations

• SIDS or SUDI
• Death of a child

Conditions

• Anaphylaxis
• Cardiorespiratory arrest
• Coma
• Shock

Toxic injury

Conditions

• Adverse drug reactions:
  
  • serum sickness
  • severe cutaneous reactions
• Poisonings and overdoses due to:
  
  • alcohol
  • opioids
  • paracetamol

For each presentation and condition, Basic 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 investigations
• consider the impact of illness and disease on patients¹ and their quality of life

Manage

• provide evidence-based management
  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

Presentations

• Envenomation
• Hyperthermia
• Oncological emergency:
  
  • febrile neutropenia
  • sickle cell crisis

Conditions

• Oncological emergency:
  
  • tumour lysis syndrome (TLS)
• Pituitary crisis
• Poisonings and overdoses, such as those due to:
  
  • amphetamines
  • antidepressants
  • antipsychotic drugs
  • benzodiazepines
  • carbon monoxide
  • iron
  • lead
• Thyroid crisis
• Toxic syndromes:
  
  • anticholinergic syndrome
  • neuroleptic malignant syndrome
  • serotonergic syndrome

For each presentation and condition, Basic 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 investigations
• consider the impact of illness and disease on patients¹ and their quality of life

Manage

• provide evidence-based management
  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

• Pathophysiology of cardiovascular failure
• Pathophysiology of coma
• Pathophysiology of respiratory failure
• Pathophysiology of shock
• Physiology of acid–base and electrolyte disturbances

Investigations

• Evidence-based appropriate investigations, such as biochemistry, haematology, microbiology, and medical imaging
• Eye examination:
  
  • extraocular movements
  • fundoscopy
  • slit lamp examination
  • visual acuity
  • visual field testing

Procedures

• Airway management and basic and advanced life support
• Intravenous cannulation
• Intraosseous needle insertion
• Lumbar puncture
• Microbiological specimens, such as urine, blood, and cerebrospinal fluid (CSF)
• Oxygen therapy
• Removal of foreign bodies from ears and nose
• Sterile urine collection
• Undisplaced, closed fracture management
• Wound management

Clinical assessment tools

• Trauma:
  
  • stabilisation for transfer
  • triage and medical assessment

• Broader context of the trajectory of patient illness and quality of life, including areas of uncertainty
• Contribution of psychological factors, mental illness, or personality disorders to clinical presentations
• Drug elimination times for urine toxicology
• Importance of planning patient review and follow-up with family or carers