I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.
You can find more things on the FRCEM on this site here
I used to see a lot of kids but that was before the NICE 2013 guidance on fever in under 5 in children appeared and to my shame this is my first read through it.
- avoid oral or rectal in <5
- electronic in the axilla for <4 weeks
- 4 weeks-5 years
- electronic in the axilla
- dot in the axilla
- tympanic
- the report of fever by parents is valid
http://emergencymedicineireland.com/wp-content/uploads/2017/07/NICE-traffic-light.pdf
This contains a lot of information but it’s genuinely really useful and should be readily available in your ED and readily available in your head for exams
- think in fever >5 days AND 4 of the 5 below
- conjunctivits
- the cracked lips or strawberry tongue
- limb oedema or desquamation
- polymorphous rash
- cervical nodes
- <3 months
- FBC
- blood culture
- CRP
- urine
- CXR only if resp signs
- stool only if diarrhoeah
- LP and IV antibiotics (should be cefotaxime/ceftriaxone AND ampicillin/amoxicillin)
- <1 month
- 1-3 months who are unwell
- 1-3 months with WCC <5 or > 15
- >3 months if 1 or more “red” features and no source
- FBC
- CRP
- Blood cultures
- urine
- “consider”
- LP
- CXR
- electrolytes and VBG
- 1 or more “amber” features and no source (there is an additional get out here that these can be omitted if an “experienced paediatrician” says so)
- blood culture, FBC, CRP
- urine
- consider LP if <1
- CXR if T>39 and WCC>20
- (a little non exam reflection here: of note it’s pretty easy to get into this group and this suggests a lot of testing (more than i might do in real life). That being said – this is for “fever without source” kids and if you’re confident it’s a bad case of the sniffles then maybe you don’t need to go down this pathway.)
- all green features but no clinical source apparent
- test the wee wee
- >3 months with fever without source
- observation with or without testing is reasonable
(largely common sense so i’ve written my own interpretation to make it easy to remember…)
- under 3 months and sick all get antibiotics
- under 1 month and fever
- 1-3 months and looks unwell
- 1-3 months WCC<5 and >15
- in general IV antibiotics for all ages if
- shocked
- unrousable
- signs of meningococcal
- but remember aciclovir if encephalitis a possibility
- 20ml/kg the bolus of choice with saline as the choice
- don’t do it to stop seizures
- don’t rely on it coming down to exclude serious illness
- tepid sponging is physical method of choice