Almost regarded as odds and ends in medical training, the key skill is distinguish between the serious and the benign

PAP18 – Rashes

PAP14– Opthalmology

PAP12– Headache

EM Curriculum: (click to view)

Background

Rashes and ophthalmology can almost be regarded as "odds and ends", they are often taught very minimally at an undergraduate level. However at a post graduate level you are expected to manage them without further exposure to the specialities.

The key skill is to be able to distinguish between the serious pathology and the benign conditions. This is also the key step in the management of headaches.

Another difficulty may be parental anxiety surrounding these topics, parents may worry the rash is meningitis, the eye problem may blind their child or if the headache a tumour? It is the non-technical skills, backed up by sound clinical knowledge that are needed for these problems.


LEARNING OUTCOMES FROM COMPLETING THE TASKS

  • Recognise common childhood rashes.

  • Be able to describe and document a rash accurately.

  • Recall the common organisms causing infections of the eye.

  • Distinguish between orbital and periorbital cellulitis.

  • List the different causes of headaches in children and recall the concerning features to look out for.

LEARNING OUTCOMES FROM FACE-TO-FACE TEACHING

  • Recognise that meningitis is a differential for headache and recall the different bacterial and viral aetiologies.

  • Recognise the features of and be able to start treatment for raised ICP.

  • Consider infestation as a cause of rash in children and discuss the different parasites involved.

  • Be able to identify the typical features of eczema and know how to manage both eczema and it's complications.

  • Compare Snellen charts suitable for different age groups and how to assess a child's eyes.


TASKS

Complete the following before the face-to-face session:

TASK 1: Common Childhood EXANTHEMs

Duration: 60 mins

A good summary of rashes in childhood, including how to describe/ document rashes with pictures as examples. This module also covers the immunisation schedule in the UK and those conditions which are notifiable. It is hosted on the new RCEM Learning website which replaces enlightenMe, if you are new to the website take a minute or two to look around as there is lots of good content and its all free! (although as an RCEM member you can login and generate a certificate)

Task 2: Eye infections and Eye trauma

Duration: 50 mins

Video summaries of the two topics by an american opthalmologist, some of it is more relevant to our opthalmology colleagues and the antibiotic therapies he reccomends differ from our practice. However the section on orbital vs pre-orbital cellulitis is useful and relevant to the CT3 curriculum, as are the anatomy and clinical features of the other conditions.

Task 3: A Swollen Eye

Duration: 15 mins

A case report from the EMJ in 2004 highlighting orbital cellulitis and its diagnosis, but also how it can be mis-diagnosed. It then follows up the management of the patient.

Task 4: Paediatric Headache

Duration: 50 mins

Two podcasts looking at paediatric headaches and their investigation.

The first includes specific discussion around the international classification of headache and the features of different types of headache. They also reflect on some cases where serious pathology was missed. There is some focus on the clinical examination of a child with headache and they use a pneumonic: "P.A.W.E.R" to screen for significant pathology and touch upon the evidence base behind this.

The second reviews the literature around the investigation of paediatric headaches, and the attempt to answer the question of how to discriminate the serious from the "benign".

Paeds Headache Podcast

Paeds Headache Podcast

Investigation of Headache Podcast

Investigation of Headache Podcast

Task 5: Be Brain Tumour Aware

Duration: 45 mins

Each week in the UK, around ten children or teenagers are diagnosed with a brain tumour in the UK. The time taken from a child’s first symptoms to diagnosis of a brain tumour for half of the children to be diagnosed is currently 12-13 weeks (median) in the UK, the other half take longer, sometimes up to a year or two. In comparison, similar figures in other countries show that half the cases are diagnosed in as little as 5 weeks.

The aim of the HeadSmart campaign is to reduce the time it takes to diagnose children and young people with brain tumours in the UK by educating healthcare professionals and the public about the symptoms of brain tumours in children and young people.


#EM3 Content

Lightning Learning:

Simblog:


CASE DISCUSSION

We have written a series of interactive cases (wikis) with short answer questions to be answered by trainees prior to the face to face teaching sessions. Currently this is only available to East Midlands Trainees.

Answer one or two questions before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. We will also provide tutor comments. If you find good resources that answer a question why not include links in your comment.

Part of the face-to-face teaching will be spent discussing the case(s) below:

A 7 year old is brought to your department late at night with a swollen eye.
A rather anxious father has brought his 11 year old daughter to the emergency department after midnight. She has been having headaches for over 3 months now.
A young mum brings her 6 day old girl to your ED, both the child’s eyes were stuck shut this morning with greenish discharge.

ADDITIONAL RESOURCES

Here are some extra resources to review if you want more information:

Headaches

PEMBlog: Headache A Clinical Update Live Tweet.

An update on paediatric headaches, highlighting red flags and tactics for eliciting history from children. Also discusses treatment and its effectiveness. All in 140 character morsels! You don't need to have a Twitter account to access this.

Uptodate®:

The UpToDate® article on paediatric headaches.

Sketchy Medicine:

Signs of meningitis and organisms involved.

HeadSmart:

HeadSmart is a project that aims to enhance the awareness of symptoms of brain tumours in children and young people.

HeadSmart – Education Package:

Work through the cases to test your learning.

Eyes

Emergency Eye Manual

This document from NSW health board is a fantastic resource containing pretty much all you'll ever need to know about ophthalmology emergencies including anatomy, assessment techniques, diagnoses and management as well as practical tips on how to protect an injured eye. You can also download it for free as an App – very handy for the middle of the night in minors!

Don't Forget the Bubbles:

An article comparing orbital and peri-orbital cellulitis with a case example.

Bromley Case of the Week no. 55

Sudden visual loss in an adult.

Eye anatomy videos

These three videos available from RCEM FOAMed network give a detailed overview of eye anatomy to get you through MRCEM & FRCEM.

Rashes

Sketchy Medicine:

A cartoon illustrating common childhood rashes and their distribution, good for visual learners.

Emergency Medcine Ireland: Tasty Morsels of EM 035

Erythema Multiforme, a quick guide + picture.

Bromley Case of the Week no. 12:

Lip lesions in a 2 year old.

BMJ Learning (Free to BMA Members)

  1. Eczema: a guide to management


COURSE FEEDBACK

Once you have worked through the exercises, discussed the example cases and attended the face-to-face teaching, please complete the following form: