Paediatric Presentations

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ME 3.21.1.1

Comparative anatomy and physiology of the newborn, 2 year old, 5 year old, and adolescent.

ME 3.21.1.2

Pathophysiology of non-critical illness and injury in children, as compared to adults.

ME 3.21.1.3

Approach to the assessment of a paediatric patient, with consideration of age and development of the child, use of age appropriate communication and assessment tools e.g., HEADSSS assessment.

ME 3.21.1.4

Paediatric considerations of fundamental pharmacological principles, including pharmacokinetics, drug metabolism and weight-based prescribing.

ME 3.21.1.5

Conduct a brief initial assessment of a child to determine the requirement for resuscitation.

ME 3.21.1.6

Indications, contraindications, complications and basic medical science principles underpinning the procedures to be performed independently by the end of TS1.

ME 3.21.1.7

Understand the concept that children live within the context of families, society, schools and extended families.

ME 3.21.1.8

Public health as pertains to paediatric emergency medicine.

ME 3.21.1.9

The special needs of vulnerable children, including those in temporary care, looked after children, children with chronic illness, children at risk of harm and those that live in situations of domestic violence and poverty.

ME 3.21.1.10

Understand the importance of public health promotion in paediatrics including promotion of breast feeding, accident prevention, immunisations, water safety, creating safe homes.

ME 3.21.1.11

Recognise the severely ill or deteriorating child and recruit help when treating, as required.

ME 3.21.1.12

Demonstrate suitable approaches to vulnerable children

ME 3.21.1.13

Perform basic life support in the arrested child, including the relevant algorithms.

ME 3.21.1.14

Provide standard first line treatment in advanced paediatric life support algorithms for the critically ill or injured child.

ME 3.21.1.15(a)

Independently perform the following airway and breathing procedures: Basic airway manoeuvres

ME 3.21.1.15(b)

Independently perform the following airway and breathing procedures: Insertion of oropharangeal or nasopharyngeal airway

ME 3.21.1.15(c)

Independently perform the following airway and breathing procedures: Use of self-inflating bag for ventilation

ME 3.21.1.16(a)

Independently perform the following circulation procedures: External chest compressions

ME 3.21.1.16(b)

Independently perform the following circulation procedures: Defibrillation (manual and AED)

ME 3.21.1.16(c)

Independently perform the following circulation procedures: Venipuncture

ME 3.21.1.16(d)

Independently perform the following circulation procedures: Arterial puncture for blood sampling

ME 3.21.1.17(a)

Independently perform the following neurological and orthopaedic procedures: In-line cervical spine immobilisation

ME 3.21.1.17(b)

Independently perform the following neurological and orthopaedic procedures: Full spinal immobilisation, log roll, transfer

ME 3.21.1.17(c)

Independently perform the following neurological and orthopaedic procedures: Backslab application

ME 3.21.1.17(d)

Independently perform the following neurological and orthopaedic procedures: Application of sling/collar and cuff

ME 3.21.1.18

Assess pain in a paediatric patient and prescribe analgesia, including suitable adjuncts.

ME 3.21.1.19(a)

Independently perform the following sedation and anaesthesia procedures: Topical anaesthesia

ME 3.21.1.19(b)

Independently perform the following sedation and anaesthesia procedures: Direct infiltration of local anaesthetic

ME 3.21.1.19(c)

Independently perform the following sedation and anaesthesia procedures: Digital nerve block

ME 3.21.1.20

Perform basic skin suturing techniques and alternate skin closure, such as tissue adhesive, staples.

ME 3.21.1.21

Analyse and interpret investigations performed in paediatric patients, including blood tests and plain radiology images.

ME 3.21.1.22

Independently perform direct ophthalmoscopy.

ME 3.21.1.23

Independently perform the removal of superficial foreign bodies from nose and ear.

ME 3.21.2.1(a)

Patterns in presentation of non-critical illness and injury in children of various age groups (under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Fever

ME 3.21.2.1(b)

Patterns in presentation of non-critical illness and injury in children of various age groups (under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Dehydration

ME 3.21.2.1(c)

Patterns in presentation of non-critical illness and injury in children of various age groups (under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Vomiting

ME 3.21.2.1(d)

Patterns in presentation of non-critical illness and injury in children of various age groups (under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Crying infant

ME 3.21.2.1(e)

Patterns in presentation of non-critical illness and injury in children of various age groups (under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Abdominal pain

ME 3.21.2.1(f)

Patterns in presentation of non-critical illness and injury in children of various age groups (under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Rash

ME 3.21.2.1(g)

Patterns in presentation of non-critical illness and injury in children of various age groups (under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Feeding problems

ME 3.21.2.1(h)

Patterns in presentation of non-critical illness and injury in children of various age groups (under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Head injury

ME 3.21.2.1(i)

Patterns in presentation of non-critical illness and injury in children of various age groups (under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Congenital syndromes (e.g., Trisomy 21)

ME 3.21.2.1(j)

Patterns in presentation of non-critical illness and injury in children of various age groups (under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Gastroesophageal reflux

ME 3.21.2.1(k)

Patterns in presentation of non-critical illness and injury in children of various age groups (under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Ovarian and testicular torsion

ME 3.21.2.1(l)

Patterns in presentation of non-critical illness and injury in children of various age groups (under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Bronchiolitis, viral induced wheeze

ME 3.21.2.1(m)

Patterns in presentation of non-critical illness and injury in children of various age groups (under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Asthma

ME 3.21.2.1(n)

Patterns in presentation of non-critical illness and injury in children of various age groups (under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Respiratory tract infection

ME 3.21.2.1(o)

Patterns in presentation of non-critical illness and injury in children of various age groups (under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Anaphylaxis

ME 3.21.2.1(p)

Patterns in presentation of non-critical illness and injury in children of various age groups (under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Haematological presentations (as per John)

ME 3.21.2.1(q)

Patterns in presentation of non-critical illness and injury in children of various age groups (under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Soft tissue and bony injuries (as per John)

ME 3.21.2.1(r)

Patterns in presentation of non-critical illness and injury in children of various age groups (under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Non accidental, inflicted injuries and neglect

ME 3.21.2.2

Pathophysiology of critical illness and injury in children and how this differs to adults.

ME 3.21.2.3(a)

Patterns in presentations of critical illness and injury, including toxicological, trauma, and sepsis in children of various age groups (newborn, under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: The collapsed neonate

ME 3.21.2.3(b)

Patterns in presentations of critical illness and injury, including toxicological, trauma, and sepsis in children of various age groups (newborn, under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Congenital heart disease

ME 3.21.2.3(c)

Patterns in presentations of critical illness and injury, including toxicological, trauma, and sepsis in children of various age groups (newborn, under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Arrhythmia

ME 3.21.2.3(d)

Patterns in presentations of critical illness and injury, including toxicological, trauma, and sepsis in children of various age groups (newborn, under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Metabolic disease

ME 3.21.2.3(e)

Patterns in presentations of critical illness and injury, including toxicological, trauma, and sepsis in children of various age groups (newborn, under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Respiratory distress

ME 3.21.2.3(f)

Patterns in presentations of critical illness and injury, including toxicological, trauma, and sepsis in children of various age groups (newborn, under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Seizures, altered mental state

ME 3.21.2.3(g)

Patterns in presentations of critical illness and injury, including toxicological, trauma, and sepsis in children of various age groups (newborn, under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Infections/sepsis, including occult bacteraemia

ME 3.21.2.3(h)

Patterns in presentations of critical illness and injury, including toxicological, trauma, and sepsis in children of various age groups (newborn, under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Acute behavioural disturbance

ME 3.21.2.3(i)

Patterns in presentations of critical illness and injury, including toxicological, trauma, and sepsis in children of various age groups (newborn, under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12 years, adolescent), including: Sudden Unexplained Death in an Infant

ME 3.21.2.4

Physiological changes occurring in the newborn at birth.

ME 3.21.2.5

Common presentations in the newborn within four hours of birth.

ME 3.21.2.6

Approaches to functional complaints in children.

ME 3.21.2.7

Apply evidence-based care to a broad range of paediatric presentations.

ME 3.21.2.8

Undertake a focused history and physical examination for a patient less than 3 months, less than 24 months, a preschool-aged child, and an older child with non-critical presentations.

ME 3.21.2.9

Take into consideration the impact of illness and injury on families and siblings when treating children.

ME 3.21.2.10

Create an appropriate investigation plan for a complex paediatric presentation.

ME 3.21.2.11

Generate an appropriate provisional and differential diagnosis relevant to the age of the patient for non-critical care presentations of low and medium complexity.

ME 3.21.2.12

Organise and initiate an appropriate treatment plan for children with common non-critical diagnoses.

ME 3.21.2.13

Formulate a management plan for psychiatric acute crises in paediatric patients.

ME 3.21.2.14

Utilise observational medicine appropriately when managing paediatric patients.

ME 3.21.2.15

Recognise a critically ill, injured or deteriorating child and activate appropriate systems, including calling for help.

ME 3.21.2.16

Tailor an initial treatment plan to the patient based on the problems presented and the provisional diagnosis, as applicable.

ME 3.21.2.17

Create initial treatment plans for the specific diagnoses found in non- critically ill or injured children.

ME 3.21.2.18

Modify the initial treatment plan in response to newly discovered information to create a definitive treatment and discharge plan.

ME 3.21.2.19

Transfer discharge plans to the responsible parent/carer, GP services, and other health agencies.

ME 3.21.2.20

Summarise salient points when presenting patient at handover or when referring to inpatient services.

ME 3.21.2.21(a)

Independently perform the following airway and breathing procedures: Insertion of a laryngeal mask airway

ME 3.21.2.21(b)

Independently perform the following airway and breathing procedures: Nasogastric and orogastric tube insertion

ME 3.21.2.22(a)

Independently perform the following circulation procedures: Paediatric peripheral intravenous access

ME 3.21.2.22(b)

Independently perform the following circulation procedures: Intraosseous access

ME 3.21.2.22(c)

Independently perform the following circulation procedures: Preparation and operation of transport monitoring equipment

ME 3.21.2.23(a)

Independently perform the following fluids procedures: Non-invasive urine collection

ME 3.21.2.23(b)

Independently perform the following fluids procedures: Insertion of an infant urinary catheter (male & female)

ME 3.21.2.23(c)

Independently perform the following fluids procedures: Suprapubic aspiration of urine in an infant, with and without ultrasound guidance

ME 3.21.2.23(d)

Independently perform the following fluids procedures: Lumbar puncture and measurement of CSF opening pressure

ME 3.21.2.24(a)

Independently perform the following orthopaedic procedures: Pelvic binding device, traction splinting

ME 3.21.2.24(b)

Independently perform the following orthopaedic procedures: Emergency reduction of fracture or major joint dislocation.

ME 3.21.2.25

Manage behavioural disturbance in paediatric patients.

ME 3.21.2.26(a)

Independently perform the following ENT and eye procedures: Removal of corneal foreign bodies

ME 3.21.2.26(b)

Independently perform the following ENT and eye procedures: Use of slit lamp in the eye examination

ME 3.21.3.1

Medications and other substances that, if a single adult dose is ingested by a child, is potentially lethal.

ME 3.21.3.2

Principles of first line treatment in newborn resuscitation, including the use of the infant resuscitaire.

ME 3.21.3.3

Adolescent presentations and their multidisciplinary management

ME 3.21.3.4(a)

Modifications to assessment and management of illness and injury in children with the following co-morbidities: Acute behavioural disturbance

ME 3.21.3.4(b)

Modifications to assessment and management of illness and injury in children with the following co-morbidities: Functional disorders

ME 3.21.3.4(c)

Modifications to assessment and management of illness and injury in children with the following co-morbidities: Behavioural disorders such as autistic spectrum and ADHD

ME 3.21.3.5

Principles of chronic disease management in paediatric patients.

ME 3.21.3.6

Indications, contraindications, complications and basic medical science principles underpinning the procedures to be performed independently by the end of TS3.

ME 3.21.3.7

Initiate appropriate time critical interventions for a child, such as bag valve mask ventilation.

ME 3.21.3.8

Generate an appropriate provisional and differential diagnosis relevant to age for high complexity patients, including post- resuscitation patients.

ME 3.21.3.9

Appropriately use critical care monitoring equipment.

ME 3.21.3.10(a)

Independently perform the following airway and breathing procedures: Use of non-self-inflating bag (T-piece) for ventilation/neopuff

ME 3.21.3.10(b)

Independently perform the following airway and breathing procedures: Use of paediatric non-invasive ventilation device (high flow nasal cannula therapy, if available, mask CPAP/BiPAP and bubble CPAP)

ME 3.21.3.10(c)

Independently perform the following airway and breathing procedures: Direct laryngoscopy, insertion of oral ETT, use of RSI technique

ME 3.21.3.10(d)

Independently perform the following airway and breathing procedures: Securing and caring for ETT, including during transport

ME 3.21.3.10(e)

Independently perform the following airway and breathing procedures: Emergency replacement of blocked or dislodged tracheostomy tube

ME 3.21.3.10(f)

Independently perform the following airway and breathing procedures: Set up a transport ventilator

ME 3.21.3.10(g)

Independently perform the following airway and breathing procedures: Decompression needle/finger thoracostomy

ME 3.21.3.10(h)

Independently perform the following airway and breathing procedures: Tube thoracostomy

ME 3.21.3.11(a)

Independently perform the following circulation procedures: DC cardioversion

ME 3.21.3.11(b)

Independently perform the following circulation procedures: External pacing

ME 3.21.3.12(a)

Independently perform the following fluids procedures: Emergency replacement of a dislodged gastrostomy tube

ME 3.21.3.13(a)

Independently administer: Procedural sedation

ME 3.21.3.13(b)

Independently administer: Femoral nerve block

ME 3.21.3.13(c)

Independently administer: Fascia iliaca block

ME 3.21.4.1

Principles of troubleshooting resuscitation when a patient does not respond to first line therapy and/or standard resuscitation methods.

ME 3.21.4.2

Principles of managing patient flow and communication with teams to best service paediatric patients.

ME 3.21.4.3

Clinical governance and safety of paediatric patients attending emergency departments.

ME 3.21.4.4

Perform standard first line treatment in neonatal resuscitation.

ME 3.21.4.5

Resuscitate a child who does not respond to first line therapy or standard paediatric resuscitation algorithms.

ME 3.21.4.6

Demonstrate a safe approach to the ongoing management of a critically ill or injured child prior to transfer to a definitive paediatric critical care unit.

ME 3.21.4.7

Prepare a stabilised critically ill/injured child for transport to a definitive paediatric critical care unit or for retrieval to another hospital.

ME 3.21.4.8

Independently administer peripheral nerve blocks other than femoral nerve or fascia iliaca block.