paces revision: paediatrics
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DESCRIPTIONPACES Revision: Paediatrics. Kathryn Wright & Sarah Hewett. Kindly sponsored by:. Schedule . 9: 00 - 10:00 Paediatrics PACES Talk + Questions 10 :00 - 10:15 Practical demonstration of a station 10:30 - 11:00 short break station 1 - 11.00 - 11.35 station 2 - 11.40 - 12.15 - PowerPoint PPT Presentation
Kindly sponsored by:Kathryn Wright & Sarah Hewett1Schedule 9:00 - 10:00 Paediatrics PACES Talk + Questions10:00 - 10:15 Practical demonstration of a station10:30 - 11:00 short break station 1 - 11.00 - 11.35station 2 - 11.40 - 12.15station 3 - 12.20 - 12.55station 4 - 13.00 - 13.352The ObjectiveKnow what to expect from a stationKnow how to take the perfect historyUse your history to demonstrate your breadth of knowledgeBe familiar with key topicsKnow where to look for further resourcesFeel more confident and less daunted by Paediatrics!3The planIntroduction to PACES and paediatric stationsThe handbookThe historyThe examinationHydration status and fluid managementRashesPaediatric emergenciesNon-accidental injuriesPaediatric ethicsThe MDTHandy hints and resourcesPractice station4The planIntroduction to PACES and paediatric stationsThe handbookThe historyThe examinationHydration status and fluid managementRashesPaediatric emergenciesNon-accidental injuriesPaediatric ethicsThe MDTHandy hints and resourcesPractice station5PACESPractical Assessment of Clinical Examination SkillsThis will assess your history, examination and communication skills in six 15 minute stationsCant fail on one stationExpect overlap between specialties Teen - depression/substance abuse/self harm/poor complianceTeen - contraception: competence/confidentialityGP - Rash/vaccinations/development COMMUNICATION skills
Dont expect to get a straight forward paeds case, there may be elements of other specalties in there too, for example an previous case was a a poorly controlled T1 diabetic who refusing to do his injections and suffering with depression. They can be complex. The trick is to go in with an open mind, dont assume you know their angle from the blub on the door. Take a really good history and show them your communication skills! 6
Quickly run over the mark scheme, highlight where the marks are etc. 7The Paediatric stationMay or may not have a patient inHistoryExamination/explain how you would examine/examination findingsInvestigations/management/questions around a topicDiscussion with family answer questions, explain, reassure, ICESAFETY NET!!More likely to have to take a history from a parent and explain how you would examine/what you would be looking for. Could have a teenager or an adult playing a teenager. Dont assume either way!
Frequently asked to go back to the family to explain findings, answer their questions. Use ICE, always ask if they have concerns and if they would like to ask you naything. This is your comm skills point!
Always safety net your management plan must always include senior review, bringing them back, referring them on some level of safetry netting is essential! You will gain points for knowing your limitations and seeking senior support. 8The planIntroduction to PACES and paediatric stationsThe handbookThe historyThe examinationHydration status and fluid managementRashesPaediatric emergenciesNon-accidental injuriesPaediatric ethicsThe MDTHandy hints and resourcesPractice station9The HandbookHistoryExaminationKey topicsEmergency algorithmsTop tips and handy hints
Good resource for shaping your revision. Very brief, not comprehensive but a guide. 10The planIntroduction to PACES and paediatric stationsThe handbookThe historyThe examinationHydration status and fluid managementRashesPaediatric emergenciesNon-accidental injuriesPaediatric ethicsThe MDTHandy hints and resourcesPractice station11The historyBy taking a history you aim to show the examiner your thought process:Consider all differentialsNarrow the diagnosis downPlace the child in contextShow your communication skills
Knowledge is clearly essential but all the knowledge in the world will not b enough if you are not able to demonstrate it! Clinical medicine is about more than just regurgitating the facts.
We aim to show you that a good history is the key to passing PACES it will give you an opportunity to show your breadth of knowledge to the examiner.
We will show you how to start with broad open questions to give you an overview of the problem.
You will then need to narrow your questions down to show that you are excluding certain diagnosis and exploring others.
We will show you how to structure your history to ensure that you dont miss any key points even if you are not sure what the problem is or how to get to the answer.
We will show you how to put the child into context socio/ecconomic etc and how this can help as well
Finally we will drill into you the importance of using your comm skills, ICE and safety netting!! 12History OverviewIntroductionPresenting complaintSystems reviewPast medical historyDevelopmentalFamilySocial Adolescent QuestionsConclusionsIntroductionIntroduce yourself and state your roleName and age of the child and clarify who is present (parents, family, carers)Presenting complaint and history or presenting complaintOpen-ended to closed questionsSystems reviewGeneral fever, skin colour, sleep, weight lossCardio sweating, cyanosis, pallor, SOB, faintsResp coryza, sore throat, earache, cough, wheeze, SOB, snoringGastro infant feeding, appetite, diet, vomiting, abdo pain, distention, bowel habitUrological passing urine, enuresis, dysuriaNeuro headache, fits, hearing, visionMusc limp, joint or limb pain, swollen joint, gaitDerm lumps or bumps, rashesPast medical historyBirth pregnancy complications, timing of delivery, mode of delivery, birth weight, complications at birth and their management, neonatal problemsFeeding (breast, bottle, food)Previous admissionsCommon conditions age-appropriate eg. asthma, eczema, diabetes, epilepsyDrug history including OTC/alternative/complementary, inhalers, creams, patchesAllergies medications, allergens, hayfeverVaccinations up to date?Developmental history
Gross Motor, fine motor and vision, hearing, speech and language, social, emotional and behaviouralHeight and weight ask for the red book
Relevant conditionsHealth of siblingsConsanguinityFamily tree
Who lives at home?School/day careAnyone else unwell?Smokers, pets at home, if relevant
Adolescent Questions - HEADSHome relationships/problemsEducation/Employment problemsAlcoholDrugs smoking, illicit, tried/regular useSex orientation, active, partner, contraception, STIs, menstrual historyConclusionWould you like to tell me anything else that may be worrying you?
13IntroductionsWho are you youWho is the patientWho is with themWhat are you there for
Name, role and grade.
Should you be addressing the child or the parent. You would be surprised how much information a child can give you. Start by talking to them before the parents, it gains their trust and makes you seem less intimidating.
Explain why you are there if you need to are you doing the fulll assessment, are you just taking a history, is someone else going to review the child etc14Presenting ComplaintOpen ended questionsThe main cause for concernAssociated symptomsTime frame + duration Why have they come to youStart broad open questions
What are the symptoms and any associated symptoms and the timing of these.
For example: You are in A&E with a child who has presented with abdominal pain. What do you want to know?
Are you the GP, A&E etc? What have they come to you does this give you any clues as to the severity or their level of concern?15Our patientLucy, 3 years oldPC: Does not seem herself, C/O abdominal painLast couple of daysSome diarrhoea, 1 episode of vomitingNot wanting to E+D muchPU reduced volumeLow grade fevers16Systems reviewGeneral fever, skin colour, sleep, weight lossCardio sweating, cyanosis, pallor, SOB, faintsResp coryza, sore throat, earache, cough, wheeze, SOB, snoringGastro infant feeding, appetite, diet, vomiting, abdo pain, distention, bowel habitUrological passing urine, enuresis, dysuriaNeuro headache, fits, hearing, visionMusc limp, joint or limb pain, swollen joint, gaitDerm lumps or bumps, rashes
Good point for group interaction: Can you give me some causes of
The problem with children is that they cant always explain what the problem is. The present with very general symptoms sometimes that do not lead youto a diagnosis the way they would in an adult. You need to consider all avenues to understand what you are dealing with.
General: can you give me some causes of wt loss?-Are they their normal selves? -Fever doesnt narrow it down but good indicator for childs state: help to tailor thoughts down lines of infection. -Skin: are they mottled, flushed etc, -Weight loss; acute or chronic? FFT, Malignancy, Dehydration, DKA, Anoxexia
Cardio: -known congenital problems?
Resp:-coryzal: seems insignificant but can be the the case of abdominal pain mesenteric adenitis, viral rash, renal problems (e.g HSP)
Gastro:- Bo, vomiting: Use this to gauge level of dehydration is pertinent to hx. Feeding: are they too SOB to feed, are they so unwell that theyhave lost appetite, do they have a sore through so dont want to swallow?Are they constipated, could this be overflow diarrhoeaChildren vomit with everything! Dont let that hone you in to a gastro problem!
Urological:PU: very quick way of guaging how unwell or dehydrated a child is.
Neuro:Fits: febrile, behavioural, first presentation of epilepsy, infection, malignant
Musculoskeletal:Limp could be a reactive synovitis/arthritis in relation to infection elsewhere,
Derm:Never forget this!!!! Rash is something never to miss, however well a child looks, always ask and always check. Sometimes a diagnosis be put together from a rash ( e.g erythema marginatum: rheumatic fever) 17Our patientLucy, 3 years oldPC: not hers