RCGP Joint Statement:
Faculty of Accident and Emergency's Curriculum
Accident and Emergency Medicine features a large volume of patients with a wide
breadth of presenting complaints requiring rapid assessment, management or
referral. The specialty is at the interface between the hospital and community
medicine. The correct management of the patient depends on good communication
skills as well as medical knowledge and technical skills.
A
local induction course is essential and should include an introduction to the
working practice in the Department, orientation with equipment and include a
lecture on the overall management of the A&E patient.
This Curriculum outlines the subjects that should be covered during a six month
Senior House Officer post. Only a minority of doctors will get practical
experience in all the topics covered.
If available, an audit of the departmental computer should record the number and
variety of procedures undertaken. The Senior House Officer will be expected to
present one audit topic during his or her tenure.
The following curriculum is comprehensive. The intention is that SHOs should
have a depth of knowledge/experience of each section appropriate to their
workload and future career.
Overview of Management of the A&E Patient
a)
Role of the Paramedic
b)
Triage in A&E
c)
History Taking
d)
Clinical examination
e)
Teamwork
f)
Appropriate Tests and
Investigations
g)
Documentation
h)
The Decision to Admit, Refer,
Follow Up or Discharge
i)
Communication with General
Practitioners
Knowledge Base
1)
Poisoning
a)
Substance Abuse
b)
Carbon Monoxide Poisoning
c)
Drug Overdose (Management of
common overdoses and specific therapy)
d)
Use of Poison's Centre
2)
Cardiovascular
a)
Advanced Cardiac Life Support
b)
Acute Cardiac Failure
c)
Collapse Cause Recognition and
treatment of Arrhythmias.
d)
(e)
e)
Chest Pain Evaluation and
Management of Myocardial Infarction
f)
Hypertensive Emergencies
3)
Neurology
a)
Epilepsy including management of
Status Epilepticus
b)
Headache, differential diagnosis
including Subarachnoid Haemorrhage.
c)
Assessment and Management of the
Unconscious Patient
d)
Cord Compression
4)
Respiratory
a)
Dyspnoea (differential diagnosis)
b)
Acute Asthma in Adults
c)
Acute Hyperventilation
d)
Pneumothorax
e)
Acute Respiratory Failure
f)
Pulmonary Embolus
g)
Pneumonia
h)
Chronic Obstructive Airways
Disease
5)
Shock
a)
Definition and Clinical Findings
b)
Types: hypovolaemic, septic,
anaphylactic, cardiogenic, neurogenic
c)
Principles of fluid resuscitation
d)
Treatment of Anaphylaxis
6)
Severe Infections
a)
Bone and Joint Infection
b)
Septicaemia
c)
Recognition and treatment of
Meningitis
d)
HIV associated illness
7)
Metabolic Emergencies
a)
Diabetic Emergencies:
Hypoglycaemia, Hyperosmolar coma and Ketoacidosis
b)
Electrolyte abnormalities
c)
Acid base abnormalities
8)
The Elderly
a)
Collapse in the Elderly
b)
Social Problems of the Elderly
c)
Causes of Being "Off Legs"
d)
Hypothermia in the Elderly
e)
Organic Confusion
f)
Dementia
9)
Paediatric - General
a)
Principles of Paediatric Life
Support
b)
Recognition of the seriously ill
child including septicaemia / meningitis
c)
Airway Obstruction in Children
d)
Acute Respiratory Illness in
Children including asthma / bronchiolitis / pneumonia
e)
Sudden Infant Death Syndrome and
Near Misses
f)
Status Epilepticus
g)
Febrile Convulsions
h)
Poisoning in Children
i)
Diarrhoea and Vomiting
j)
Child Abuse
10)
Paediatric - Trauma
a)
Paediatric Trauma - Fractures
b)
The Limping child
c)
Paediatric Abdominal and Chest
Trauma
d)
Paediatric Head Injury
e)
Burns and Scalds in Children
11)
ATLS System
a)
Primary Survey and Resuscitation
b)
Secondary Survey
c)
Definitive Care
12)
Surgical Emergencies - Trauma
a)
Trauma in Pregnancy
b)
Gunshot Wounds
c)
Management of Stabbings in A&E
d)
Bomb Blast
e)
The Major Incident
13)
Soft Tissue Injury and Infection
a)
Strains and ligamentous injuries
b)
Musculotendinous injury
c)
Haematomas
d)
Bites
e)
Needle Stick Injury
f)
Indications for Physiotherapy
g)
Peripheral Nerve Injury
h)
Cellulitis
i)
Abscess
j)
Compartment Syndrome
14)
Wound Management
a)
Wound Management and closure
b)
Wound Dressings
c)
Tetanus Prophylaxis
d)
Antibiotic Usage in A&E
e)
Splints and Bandages
f)
Foreign Bodies in Wounds
15)
The Hand
a)
Examination of the Hand
b)
Soft Tissue Injuries of the Hand
c)
Tendon and Nerve Injuries
d)
Fractures of the Hand
e)
Hand Infections
16)
Orthopaedic. Upper limb and Neck
a)
Neck Sprain including Wry Neck
b)
Acute Shoulder Injuries
c)
Elbow Injuries
d)
Wrist Injuries
e)
Fracture and Dislocation reduction
f)
Non-traumatic orthopaedic problems
17)
Orthopaedic - Lower limb and Back
a)
Back Pain
b)
Pelvis and Hip injuries
c)
Knee Injury
d)
Ankle and Foot Injury
e)
Fracture and Dislocation reduction
f)
Differential Diagnosis of Painful
Swollen Leg
18)
Craniofacial Problems
a)
Maxillo-Facial Injuries
b)
Dental Emergencies
19)
Regional Injury
a)
Head Injuries
b)
The Spine and Spinal Cord
c)
Chest Trauma
d)
Abdominal Trauma
e)
Genito-urinary Trauma
20)
Surgical Emergencies - Non-Trauma
a)
Vascular Emergencies (including
peripheral vascular disease and aortic aneurysm)
b)
Acute Abdomen
c)
Ingested foreign bodies
d)
G.I. Bleed
21)
Gynaecological and Genito-Urinary
Emergencies
a)
Vaginal Bleeding
b)
Sexually transmitted disease and
Pelvic Inflammatory disease
c)
Scrotal emergencies
d)
Renal Colic
e)
Urinary Tract Infection
f)
Obstetric Emergencies
22)
Environmental
a)
Major burns
b)
Minor burns
c)
Inhalation injury
d)
Electrical injury
e)
Near drowning
f)
Heat Stroke and Hypothermia
g)
Casualty decontamination
23)
ENT Problems
a)
Epistaxis, Septal haematoma and
Nasal Fractures
b)
ENT Infections
c)
Foreign body in Throat and Ear
d)
Upper Airways obstruction
e)
Painful ear
24)
Ophthalmological problems
a)
The Red eye
b)
Eye trauma
c)
Sudden visual loss
d)
Orbital cellulitis
25)
Anaesthetic Techniques
a)
Airway Management and intubation
b)
Entonox and Sedation
c)
Local Anaesthetic procedures
d)
Regional Intravenous anaesthesia
e)
Peripheral Nerve blocks
26)
Pain Control (Trauma)
a)
Drugs and modes of administration
b)
Use of splints and
non-pharmacological methods for pain control
c)
Paediatric pain relief
27)
Radiographic investigation
a)
Indications for plain radiography,
ultrasound and CT scan.
b)
General Rules of X-ray
Interpretation
c)
Implications of "Misses" on
X-rays, common errors.
28)
Psychiatric and behavioural
problems in A&E
a)
Deliberate Self Harm - physical &
drugs
b)
Drug and Alcohol abuse -
management
c)
The violent patient
d)
management of drunk patients
e)
Mental Health Act 1983 -
Sectioning in A&E
f)
Acute psychosis
g)
Depression - risk factors for
suicide
h)
Munchausen patients
29)
A&E and the Law - Police and
Courts
a)
Documentation
b)
Patient confidentiality
c)
Police Statements
d)
The Court Appearance
e)
Consent
f)
Sudden Death and the Coroner
g)
Alcohol and Accidents
30)
Ethics
a)
Religious practices and conflicts
b)
Self discharge against medical
advice
c)
Common Law and Restraint
d)
Organ donation
Skills
1)
Clinical Skills
Areas to be covered include theory, practical and patient experience
a)
Basic Life Support
b)
Oral and Nasopharyngeal Airways
c)
Mask Ventilation
d)
Intubation
e)
Needle cricothyroidotomy
f)
Heimlich Manoeuvre
g)
Defibrillation
h)
CVP
i)
Gaining peripheral intravenous
access in adults and children
j)
Insertion of intraosseous needle
k)
Reduction of fractures and
dislocations
l)
Needle aspiration of pneumothorax
m)
Insertion of a chest drain
n)
Bladder catheterisation
o)
Plastering techniques
p)
Log rolling and spinal
immobilisation
q)
Limb splinting
r)
Surgical skills appropriate to the
A & E Department
s)
Suturing and other wound closure
techniques
t)
Wound management - dressings
u)
Local anaesthetic techniques
v)
Acute subcutaneous abscess -
drainage/incision
w)
Joint examination
x)
Joint aspiration and injection
y)
Nasal packing
z)
A single day spent with a
paramedic crew 'in the field' is valuable, though this may need to be in the
Senior House Officers' own time.
2)
Communication Skills
a)
Communication Skills in A&E
b)
Multi-Disciplinary Team Working
c)
Talking to Bereaved and Distressed
Relatives
d)
Dealing with Difficult Patients
and Relatives
e)
Complaints
f)
Accident Prevention and Health
Promotion
3)
Managerial Skills
a)
Audit - performance & presentation
b)
Administration
Attitudes
c)
Reliability
d)
Teamwork
e)
Self-motivation
f)
Relationship with:
·
colleagues
·
patients
·
other staff
Learning experience in the subject
Emergency Care
