What you must demonstrate
- Observe before touching
- Age-specific vital-sign interpretation
- Hydration and work-of-breathing assessment
- Communicate with child and caregiver
- Weight-based safe planning
11-minute performance map
1. Opening and immediate safety
Introduce yourself, confirm identity, explain the task, obtain consent and identify instability before routine questioning.
2. Focused assessment
Clarify onset, progression, severity, associated features, discriminating positives/negatives and the most relevant background risks.
3. Targeted examination
Perform only the examination maneuvers needed to assess severity, confirm localization and discriminate the leading diagnoses.
4. Synthesize
Give a one-sentence summary, leading diagnosis and two to four prioritized alternatives including the dangerous diagnosis you cannot miss.
5. Investigations
Choose tests that answer a specific diagnostic or safety question; state urgent tests first.
6. Immediate management
Treat instability, begin syndrome-specific care, consult early when needed and define disposition.
7. Communication and safety net
Explain the plan, check understanding, address concerns and state exact deterioration/return criteria.
Focused history prompts
Define the presentation
- Onset, chronology, triggers and progression.
- Severity and effect on function.
- Associated symptoms that support the leading diagnosis.
- Relevant negatives that reduce dangerous alternatives.
Risk context
- Relevant past medical/surgical/obstetric/psychiatric history.
- Medications, allergies and adherence.
- Family, social, substance, travel/exposure or safeguarding factors as applicable.
- Patient ideas, concerns, expectations and goals.
Dangerous alternatives to prioritize
- Toxic appearance
- Non-blanching rash
- Apnea or cyanosis
- Poor perfusion
- Altered consciousness
- Safeguarding concern
Targeted investigations
Age-specific vital signs, weight and hydration/respiratory assessment
Bedside glucose when altered/unwell
Targeted blood/urine/microbiology testing based on age and syndrome
Imaging only when indicated, minimizing unnecessary radiation
Immediate management and disposition
- Treat airway, breathing, circulation, hypoglycemia and dehydration promptly.
- Use weight-based medication/fluid planning and age-specific thresholds.
- Involve caregivers while preserving adolescent confidentiality where applicable.
- Choose discharge only when the child is clinically safe and caregivers understand return precautions.
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