Download History Taking and Examination Skills for Paediatrics

History Taking and Examination
Skills for Paediatrics
D. Hilton
[email protected]
Welcome to
the
Department
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GEH / Warwick / UHCW
Exams at UHCW
Ward Work
Clinics (inc teaching
clinics)
Emergency Dept / PAU
Educational meetings
Handovers
Bedside Teaching
Portfolios
End of block assessment
Written Paper
– Common Paediatric conditions (Bronchiolitis, meningitis, neonatal
jaundice, asthma)
- Development
Observed consultation
- 20 minutes history and examination
- Thorough paediatric history, systems based examination
- 20 minutes thinking time
- 20 minutes presentation, investigations, management
Marked according to Leicester Assessment Package
Compared to skills required of newly qualified F1
Leicester Assessment Package
• Interviewing/history taking
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Introduces self to patients
Puts patients at ease
Allows patients to elaborate presenting problem fully
Listens attentively
Seeks clarification of words used by patients as appropriate
Phrases questions simply and clearly
Uses silence appropriately
Recognises patients' verbal and non-verbal cues
Identifies patients reasons for consultation
Elicits relevant and specific information from patient and/or their
records to help distinguish between working diagnoses
– Considers physical, social and psychological factors as appropriate
– Exhibits well organised approach to information-gathering
History Taking
• Organised approach – start with open questions
and clarify appropriately
• Remember to include ALL subheadings from
history
• Try and assess medical significance of what
parents tell you (vomiting, fever, diarrhoea)
• Show what you know about paediatrics
(development, immunisations etc)
• ICE
• Response to cues from parents and child
Leicester Assessment Package
• Physical examination
– Performs examination and elicits physical signs correctly
and sensitively
– Uses the instruments commonly used in family practice in
a selective, competent and sensitive manner
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Generally systems based
Some general baby examinations
OBSERVE!!!!
Resp rate, Heart rate, machines, hydration status,
interaction, development, feeding
– Top to toe, organised wherever possible
Leicester Assessment Package
• Problem solving
– Generates appropriate working diagnoses or identifies
problem(s) depending on circumstances
– Seeks relevant and discriminating physical signs to help
confirm or refute working diagnoses
– Correctly interprets and applies information obtained from
patient records, history, physical examination and
investigations
– Is capable of applying knowledge of basic, behavioural and
clinical sciences to the identification, management and
solution of patients' problems
– Is capable of recognising the limits of personal
competence and acting accordingly
Problem Solving
• PLEASE relate to the history and examination
that you have performed
• Consider in relation to age of child
• What treatment has the child has so far?
• What investigations are you likely to need to
help you differentiate between them
• Pathophysiology of the conditions and
response to treatment
Patient Management
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General Principles
Fluids
Analgesia
Team working & senior support
Potential complications
• Emergency Management (A, B, C, D, E)
Interaction with
Patient
- Involve child as much as
possible
- INSPECTION &
OBSERVATION
- Examiner will be aware of
efforts made to placate
child
- Leave with parent if
required
- Use parents / toys /
disctractions
- Expose with respect and
considering child’s mood
- Get on your knees!
- If you arent sure you
should proceed, mention
to examiners
• Presenting complaint
Paediatric
• History of presenting
History Taking
complaint (Clarification)
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(Previous Episodes)
Past Medical History
Birth History
Medications
Allergies
Developmental History
Immunisations
Social History
Family History
Presenting Complaint
• Use your medical knowledge to interpret what
you are being told by parents
• Associated symptoms
• Clarify what parents mean – wheeze etc
• Duration of symptoms
• Systems review & overall impression of the
child
Past Medical History
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Birth (if relevant)
Preterm / Term
SCBU & Resuscitation
Previous illnesses & treatments
Associated illnesses (Atopy etc)
Other medical conditions
Other professionals involved (Physio, OT, SALT)
Development
• Know milestones for ages
• Consider school in older
children
• Don’t rely solely on
parental reports
Social History & Family History
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Siblings
Parents / Step-parents
Smoking / Pets
Social Services
Health Visiting
Education
Physio / OT / SALT
Relevant illnesses in others
ICE
Examination
• Generally systems based
• General baby examination
Examination
• Look around room
• Look at the child
• Hydration, Demeanour, Development, Pain,
DIB, Growth
• Interact with child before examination
• Inspect before approach
Respiratory Examination
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Observe – RR, DIB, Recession, Medical Adjuncts
Hands
Eyes & Mouth
Airway, Lymphadenopathy
Palpation – chest expansion
Percussion
Auscultation
TVF
Sats, PEFR, Growth
Cardiovascular Examination
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Observe – HR, RR, DIB, Recession, Medical Adjuncts
Hands
Pulses
JVP
Eyes & Mouth
Palpation – heaves, thrills, apex
Auscultation (front & Back)
Liver edge
Oedema
BP, sats, growth
Abdominal Examination
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Observe – HR, RR, Medical Adjuncts, Hydration
Hands
Face
Inspection
Palpation- masses, tenderness, organomegaly
Percussion
Auscultation
Urine, Stool, Feeding charts, growth
Neurological Examination
• Observe – Medical Adjuncts, Hydration,
dysmorphism, development, posture,
neurocutaneous lesions
• Cranial
• Peripheral – tone, power, reflexes, coordination
• Gait
• Co-ordination
Baby
Examination
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Not newborn check (but should be
aware how to do)
Observe – medical adjuncts,
hydration, posture, DIB,
demeanour, interaction,
dysmorphism
Often need to be opportunistic
Auscultation lungs & Heart sounds
Palpation abdomen – masses &
organomegaly
Genitalia & femorals
Growth
Common problems
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Inadequate inspection & observation
“Pouncing on the child”
Failure to respond to childs cues
Forgetting the details
Obvious inexperience
Advice
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Get experience
Practice being watched, presenting cases
Ask questions
Always make sure someone sees patients
with you