The Paediatric Emergency Physician recognises, assesses and manages the full range of paediatric emergency conditions

Key Capabilities

• Manages the critically ill neonate, child and young person? ESLE, CBD or Mini-CEX (via In Situ Simulation or Shop Floor Teaching)
• Assesses and manages the patient in respiratory failure? ESLE, CBD or Mini-CEX (via In Situ Simulation or Shop Floor Teaching)
• Assesses and effectively manages the septic or shocked patient? ESLE, CBD or Mini-CEX (via In Situ Simulation or Shop Floor Teaching)
• Assesses and manages the patient with a cardiac disorder? ESLE, CBD or Mini-CEX (via In Situ Simulation or Shop Floor Teaching)
• Assesses and manages the patient presenting with a reduced level of consciousness? ESLE, CBD or Mini-CEX (via In Situ Simulation or Shop Floor Teaching)
• Assesses, diagnoses and manages the patient presenting to the PED with major or minor trauma? ESLE, CBD or Mini-CEX (via In Situ Simulation or Shop Floor Teaching)
• Identifies and manages acute mental health conditions in the PED? ESLE, CBD or Mini-CEX (via In Situ Simulation or Shop Floor Teaching)
• Assesses and manages presentations that suggest physical or psychological abuse? ESLE or CBD
• Manages the processes following an unexpected death in the PED? ESLE or CBD

Illustrations

Demonstrates knowledge of the PED management of:

1. Upper airway obstruction (PMP2)
2. Allergic conditions and anaphylaxis (PMP1)
3. Respiratory failure, in particular related to acute asthma, pneumonia and bronchiolitis (PMP3, PAP5)
4. Sepsis, the systemic inflammatory response, and shock (PMP5, PAP9)
5. Hypotension and heart failure (PMP3, PMP5, PAP5)
6. Congenital heart disease (PMP5, PMP3, PAP10)
7. Cardiac arrhythmias (PMP3)
8. Myocarditis (PMP5, PMP3)
9. Hypertension
10. Syncope
11. Acute neurological emergencies, including status epilepticus (PMP6, PAP10)
12. Febrile and non-febrile seizures (PMP6)
13. Raised intracranial pressure and reduced level of consciousness. (PMP6)
14. Headaches (PAP12)
15. The neurosurgical patient (PMP6, PAP10)
16. Diabetic ketoacidosis (PMP6)
17. Hypoglycaemia (PMP6)
18. Metabolic disease
19. Endocrine abnormalities
20. Common childhood illnesses (PAP1, PAP5, PAP7, PAP8, PAP9, PAP10, PAP11, PAP12, PAP18, PAP19)
21. Minor and severe infections (PMP2, PMP5, PMP6, PAP5, PAP7, PAP9, PAP10, PAP12, PAP13, PAP18, PAP19)
22. Upper respiratory tract infection (URTI) and lower respiratory tract infection (LRTI) (PAP5, PAP9, PAP19)
23. Gastroenteritis (PAP1, PAP7, PAP11)
24. Non-blanching rash (PAP18, PAP9, HAP28)
25. Kawasaki disease (PAP9)
26. Upper and lower urinary tract infections (PAP1, PAP9)
27. Common and emergency nephro-urological presentations (PAP1)
28. Abdominal pain including surgical and non-surgical causes, and functional abdominal pain (PAP1)
29. Scrotal pain (PAP1)
30. Bilious vomiting (PAP7)
31. Gastrointestinal bleeding (PAP11)
32. Inflammatory bowel disease (PAP1, PAP7, PAP11)
33. Common and emergency gynaecological presentations (PAP1)
34. Sexually transmitted diseases (HAP31)
35. Patients seeking emergency contraception (HAP30, HAP31)
36. Life-threatening ENT emergencies, e.g. quinsy and post-tonsillectomy bleeding (PMP2, PAP8)
37. Common ear, nose and throat (ENT) disorders, e.g. otitis media, nasal injuries, epistaxis and removal of foreign bodies (PMP2, PAP8)
38. Common oral and dental injuries and emergencies (PAP8, HAP9)
39. Common and emergency ophthalmological presentations (PAP14)
40. Common and emergency dermatological conditions (PAP18)
41. Bites and infestations (PAP18)
42. The limping child (PAP16, PAP17)
43. Rheumatological and non-traumatic musculoskeletal presentations (PAP16, PAP17)
44. Acute and chronic pain (PAP15)
45. Oncological conditions, including making an initial assessment and diagnosis, and managing complications related to the disease process or its treatment (HAP21)
46. Haematological disorders, e.g. sickle cell disease (PAP4, HAP7, HAP21)
47. Immunodeficient states
48. Delirium and psychosis (PAP2, PAP6)
49. Self-harm (PAP2, PAP6)
50. Poisoning, accidental drug ingestion and overdose (PAP2)
51. Hypothermia and hyperthermia (PMP3, PAP13, HAP11)
52. Electrolyte abnormalities (PMP6, PAP7)
53. Needlestick injuries (C3AP7)

Management of the injured child: (PMP4, PAP17)

1. Anticipates injury patterns in common trauma presentations in each age group
2. Demonstrates knowledge of the PED management of:
• The child with polytrauma and potential major trauma
• Bleeding disorders in trauma, and is able to recognise and manage massive haemorrhage
• Chest trauma, and is able to perform and facilitate key chest procedures, e.g. chest drain insertion
• Abdominal and pelvic trauma, including the application of pelvic binders
• Acute head and spinal injury, including spinal cord injury
• Acute drowning and immersion injury
• Acute burn injuries (including electrical burns), and subsequent complications
• All limb-threatening injuries, including open fractures, and is able to reduce injuries compromising nerve or vascular supply
• All fractures and ligamentous injuries
• A dislocated joint, and is able to reduce the joint and manage the onward referral
• All lacerations and open wounds
• Rhabdomyolysis and compartment syndrome

Safeguarding within the PED:

1. Demonstrates an understanding of presentation patterns which suggest physical or psychological abuse, is able to stratify risk, and engages with allied professionals in accordance with national and local policies and guidance.
2. Demonstrates an understanding of how societal issues, such as sex trafficking, involvement with gang culture and female genital mutilation (FGM) may impact on children presenting to the PED.
3. Manages children sensitively where sexual assault and child sexual abuse is suspected.

Mental health:

1. Performs a mental health assessment relevant to PED care.
2. Risk-stratifies children attending the PED with acute mental health issues to identify those who require admission or urgent intervention.

The Paediatric Emergency Physician assumes the role of paediatric emergency team leader and takes responsibility for this domain of service

Key Capabilities

• Leads a multispecialty trauma team? ESLE or Mini-CEX (via In Situ Simulation or Shop Floor Teaching)

Illustrations

1. Leads a resuscitation team.
2. Assembles and effectively prepares a multispecialty team prior to the arrival of a critically unwell or injured child.
3. Understands the prognostic factors in resuscitation episodes, including situations when extracorporeal life support may be appropriate.
4. Organises and leads a team to support an unexpected birth in the PED to ensure the safety of the mother and baby.
5. Takes decisions in circumstances which present ethical issues and knows when to cease resuscitation.
6. Provides or signposts staff to psychological support in response to acute events or system pressures.
7. Signposts families to sources of psychological support after traumatic events which may have precipitated the ED visit, and demonstrates ability to follow the principles of psychological first aid.

The Paediatric Emergency Physician performs high-level clinical and technical skills and procedures in the paediatric emergency setting

Key Capabilities

• Demonstrates the clinical knowledge necessary to manage the range of problems seen in the PED? ESLE, CBD or Mini-CEX (via In Situ Simulation or Shop Floor Teaching)
• Employs the technical skills required to manage patients in the PED? ESLE, Mini-CEX or DOPS (via In Situ Simulation or Shop Floor Teaching)

Illustrations

1. Uses a range of techniques, including simulation, to guide and support learning within the PED. (CC23)
2. Performs a primary and secondary survey in a patient with an acute life-threatening medical illness. (PMP5, PMP6)
3. Appropriately uses and interprets invasive and non-invasive physiological monitoring.
4. Interprets the significance of changes in physiological parameters in the critically unwell patient, and intervenes accordingly.
5. Obtains vascular access and manages the complications.
6. Interprets results of acid-base physiology in the clinical context, and provides interventions where necessary.
7. Provides adequate analgesia using different agents and administration routes.
8. Demonstrates an understanding of distraction techniques and their use in facilitating examination and the performance of procedures.
9. Delivers local anaesthesia at discrete sites e.g. for wound repair and for nerve blocks using a range of agents.
10. Delivers safe, appropriate procedural sedation to the child of any age in the PED for a range of procedures, and by using a variety of sedation agents.
11. Demonstrates an understanding of appropriate pharmacological agents for use in the induction of anaesthesia.
12. Demonstrates an understanding of the management, including sedation, of the child intubated in the PED.
13. Follows age-appropriate algorithms for obstructed or difficult airways, including the indications and techniques for performing a surgical airway.
14. Initiates and uses non-invasive respiratory support, and applies appropriate ventilatory strategies.
15. Manages traumatic and spontaneous pneumothoraces, and understands the indications and techniques for drainage, including needle aspiration and chest drain placement.
16. Applies appropriate techniques to maintaining adequate cerebral perfusion.
17. Uses vasoactive drugs appropriately and is aware of their potential complications.
18. Utilises neuroimaging appropriately in the PED environment.
19. Selects and interprets the appropriate imaging modality and body area for patients following trauma.
20. Uses point-of-care ultrasound as a diagnostic aid in the ED for specified conditions, e.g. pneumothorax, cardiac standstill and foreign body detection.
21. Uses point-of-care ultrasound for ultrasound-assisted and ultrasound-guided procedures, e.g. femoral nerve block or vascular access.

The Paediatric Emergency Physician liaises effectively with pre-hospital, hospital and community specialist teams

Key Capabilities

• Manages a PEM department and its interactions with the hospital and community? ESLE, CBD or Mini-CEX (via In Situ Simulation or Shop Floor Teaching)

Illustrations

1. Interfaces effectively with all affiliated services including paramedic and pre-hospital, general paediatric, and inpatient specialty teams. (CC8, CC12, CC15)
2. Safely transports the acutely unwell child within the hospital, and facilitates transport between hospitals where necessary. (CC15)
3. Interfaces effectively with general practice and community care. (CC8, CC12, CC15)
4. Provides both written and verbal safety-netting advice to families for all conditions amenable to discharge from the ED. (CC8, CC12, CC15)
5. Understands the roles of other professionals, agencies and the voluntary sector in the management of a child’s or young person’s mental health. (CC8, CC12, CC15, CC18, CC19)
6. Understands how young people transition from paediatric to adult services and how this may impact on acute presentations to the PED. (CC8, CC12, CC15, CC18, CC19)
7. Understands the legal process if faced with objections from patients or carers to the use of blood products. (CC8, CC12, CC15, CC19)
8. Facilitates organ donation as a part of end-of-life care, including the referral to donation services. (CC18, CC19)
9. Manages the processes that take place after an unexpected death, including investigations, involvement of other healthcare professionals, and engagement with other agencies, e.g. the coronial officer, police, and child death overview panel. (CC8, CC12, CC15, CC18, CC19)

The Paediatric Emergency Physician effectively manages and coordinates patient flow, staffing, safety and quality in a PED

Key Capabilities

• Recognises ED crowding, and implements effective strategies to relieve it as quickly as possible while maintaining safety and quality of care? ESLE, CBD or Mini-CEX (via In Situ Simulation or Shop Floor Teaching)

Illustrations

1. Demonstrates an understanding of acuity scoring and triage systems. (CC7, CC8)
2. Recognises and responds to potential or real threats to patient safety in the PED. (CC6, CC7, CC8)
3. Manages conflict with staff and families. (CC12, CC15)
4. Understands the importance and impact of human factors on the care of the acutely unwell child in the PED. (CC7, CC8, CC9, CC15)
5. Recognises the importance of, and has an understanding of the techniques involved with quality improvement and audit in the ED setting to effectively improve care. (CC19, CC21, CC22, CC23, CC25)
6. Recognises the potential impact of existing and emerging online technology for engagement and communication, including social media, and employs professional boundaries for its use. (CC24, CC25)

The Paediatric Emergency Physician demonstrates the ability to make pragmatic and rapid decisions across a broad range of paediatric emergencies

Key Capabilities

• Leads and manages a paediatric emergency? ESLE, CBD or Mini-CEX (via In Situ Simulation or Shop Floor Teaching)

Illustrations

1. Provides leadership in hot or cold debrief episodes and supports the PED team after a significant event, Major Incident or resuscitation. (CC7, CC8, CC13, CC23)
2. Uses national policy and targets for quality and safety of care in PEM. (CC9, CC21, CC25)
3. Undertakes appropriate roles within a Major Incident response as laid out in local and national policies. (HAP20)
4. Demonstrates understanding of the management of all forms of Major Incidents, including chemical, biological, radiological and nuclear (CBRN) and those with mass casualties. (HAP20)