Master Document
The RCEM curriculum, being outcome based, is structured around the things that a trained EM specialist needs to be able to do. Underpinning these actions is the clinical knowledge that informs them.
The breadth of that clinical knowledge is described below in the Clinical Syllabus. It defines the scope of presentations or clinical conditions that an EM clinician may encounter in the work place, and therefore need to know about. These lists are to be used to give a context to the Programme of Learning that supports the delivery of the curriculum. Trainees are expected to develop their knowledge base in each of these presentations or conditions. This might be done in formal teaching, self-directed learning and use of on-line resources.
They will be the context for the formal RCEM examinations and learners will be expected to know about relevant basic sciences as well as relevant epidemiology, differential diagnoses, investigation and management of these conditions.
Key: paediatric specific presentations and conditions
Clinical syllabus
| Clinical Presentations | Condition / Issues |
| RP1. Acute airway obstruction | RC1. Choking |
| RP2. Anaphylaxis/Anaphylactoid reaction | RC2. Stridor |
| RP3. Cardiorespiratory arrest | RC3. Organ donation |
| RP4. Major Trauma | RC4. BRUE |
| RP5. Respiratory failure | RC5. SUDIC Protocol |
| RP6. Sepsis | |
| RP7. Shock | |
| RP8. Unconsciousness |
| Clinical Presentations | Condition / Issues |
| AP1. Acute allergy |
AC1. Drug allergy / severe Adverse drug reactions
|
| AP2. Anaphylactoid reactions | |
| AP3. Angioedema | |
| AP4. Urticaria |
| Clinical Presentations | Condition / Issues |
| CP1. Chest pain | CC1. Acute Coronary Syndromes |
| CP2. Breathlessness | CC2. Myocardial infarction |
| CP3. Palpitations | CC3. Arrhythmias |
| CP4. Transient Loss of Consciousness | CC4. Cardiac failure |
| CC5. Cardiac tamponade | |
| CC6. Congenital heart disease | |
| CC7. Diseases of the arteries, including aortic dissection | |
| CC8. Diseases of myocardium | |
| CC9. Hypertensive emergencies | |
| CC10. Pacemaker function & failure | |
| CC11. Pericardial disease | |
| CC12. Sudden Cardiac Death | |
| CC13. Valvular heart disease |
| Clinical Presentations | Condition / Issues |
| DP1. Dermatological manifestations of systemic illness | DC1. Common childhood exanthems |
| DP2. Rashes | DC2. Cutaneous drug reactions |
| DC3. Eczema | |
| DC4. Erythroderma | |
| DC5. Infections of skin and soft tissues | |
| DC6. Necrotising Fasciitis | |
| DC7. Pressure ulcers | |
| DC8. Purpuric rash including Henoch Scholein Purpura | |
| DC9. Stevens-Johnson syndrome | |
| DC10. Toxic-epidermal necrolysis | |
| DC11. Urticaria |
| Clinical Presentations | Condition / Issues |
| EP1. ENT foreign bodies | EC1. Croup |
| EP2. ENT injuries | EC2. Epiglottitis |
| EP3. Epistaxis | EC3. Glandular Fever |
| EP4. Hearing loss | EC4. LMN facial nerve palsy |
| EP5. Painful ear | EC5. Meniere’s disease |
| EP6. Sore throat | EC6. Nasal fractures |
| EP7. Vertigo | EC7. Otitis externa |
| EC8. Otitis media | |
| EC9. Pharyngitis | |
| EC10. Post-tonsillectomy bleed | |
| EC11. Tonsillitis | |
| EC12. Tracheostomy emergencies | |
| EC13. Quinsy | |
|
EC14. Salivary gland disease |
|
| EC15. Vestibular neuritis |
| Clinical Presentations | Condition / Issues |
| ElP1. Delirium | ElC1. Comprehensive geriatric assessment |
| ElP2.Deterioration in mobility | ElC2.Acute confusion |
| ElP3. Falls | ElC3. Ceiling of care & End of life care |
| ElP4. Fragility fractures | ElC4. Dementia – cognitive impairment |
| ElP5. Frailty | ElC5. Fragility fractures |
| ElP6. Hypothermia | ElC6. Mobility |
| ElP7. Incontinence | ElC7. Osteoporosis |
| ElP8. Increasing care needs | ElC8. Pharmacology considerations in the older patient |
| ElP9. Memory loss | |
| ElP10. Unsteadiness / balance disturbance |
| Clinical Presentations | Condition / Issues |
| EnP1. Addisonian Crisis | EnC1. Adrenal disorders |
| EnP2. Hyperglycaemia | EnC2. Diabetic ketoacidosis |
| EnP3. Hypoglycaemia | EnC3. Diabetes mellitus & complications including diabetic foot |
| EnC4. Hyperosmolar hyperglycaemic state | |
| EnC5. Pituitary disorders | |
| EnC6. Thyroid emergencies |
| Clinical Presentations | Condition / Issues |
| EnvC1.Heat stroke and heat exhaustion | |
| EnvC2. Drug-related hyperthermias | |
| EnvC3. Hypothermia and frost bite | |
| EnvC4. Decompression sickness | |
| EnvC5. Near-drowning | |
| EnvC6. Radiation exposure and safety | |
| EnvC7. Industrial chemical incidents | |
| EnvC8. Bites and envenomations typical for the UK | |
| EnvC9. High altitude emergencies – cerebral and pulmonary oedema | |
| EnvC10. Acid attacks |
| Clinical Presentations | Condition / Issues |
| GP1. Abdominal and loin pain | GC1. Alcohol related liver disease including withdrawal |
| GP2. Abdominal swelling or mass | GC2. Decompensated cirrhosis |
| GP3. Ascites | GC3. Dehydration in children |
| GP4. Constipation | GC4. Functional bowel disorders |
| GP5. Diarrhoea | GC5. Gastrointestinal infections |
| GP6. Haematemesis and melaena | GC6. Hepatitis |
| GP7. Jaundice | GC7. Inflammatory bowel disease |
| GP8. Anal pain and rectal bleeding | GC8. Peptic ulcer disease |
| GP9. Nausea and vomiting | GC9. Pyloric stenosis |
| GP10. Dysphagia |
| Clinical Presentations | Condition / Issues |
| HP1. Anaemia | HC1. Anti-coagulant reversal |
| HP2. Bruising and spontaneous bleeding | HC2.DIC |
| HP3. Massive haemorrhage | HC3. Haemophilia |
| HC4. ITP | |
| HC5. Leukaemia | |
| HC6. Lymphoma | |
| HC7. Marrow failure | |
| HC8. Sickle cell disease/crisis | |
| HC9. Transfusion reactions |
| Clinical Presentations | Condition / Issues |
| IP1. Fever | IC1. Influenza |
| IP2. Pyrexia in travellers | IC2. Infection in immunocompromised patients |
| IP3. Sepsis | IC3. Infestations |
| IP4. Needlestick injury/exposure to blood borne viruses | IC4. Kawasaki Disease |
| IC5. Notifiable diseases | |
| IC6. Pyrexia of Unknown origin – different age groups | |
| IC7. Malaria | |
| IC6. HIV infection |
| Clinical Presentations | Condition / Issues |
| MaP1. Dental pain | MaC1. Dental abscess |
| MaP2. Facial swelling | MaC2. Facial wounds |
| MaP3. Avulsed or fractured teeth | MaC3. Post extraction complications |
| MaP4. Facial bone injury | MaC4. TMJ dislocation |
| Clinical Presentations | Condition / Issues |
| MHP1. Aggressive or disturbed behaviour | MHC1. Alcohol and substance misuse |
| MHP2. Anxiety/Panic | MHC2. Depression |
| MHP3. Physical symptoms unexplained by organic disease | MHC3. Eating disorders |
| MHP4. Self-harm | MHC4. Personality disorders |
| MHP5. Refusal of treatment | MHC5. Acute Psychosis including bipolar, schizophrenia |
| MHC6. Somatic symptom disorders | |
| MHC7. Stress disorders | |
| MHC8. Suicide |
| Clinical Presentations | Condition / Issues |
| MuP1. Acute back pain | MuC1. Cauda equina syndrome |
| MuP2. Limb pain and swelling | MuC2. Crystal related arthropathies |
| MuP3. Neck pain | MuC3. Septic arthritis |
| MuP4. Joint swelling | MuC4. Limb pain and swelling: bursitis & tendonitis in the upper and lower limb including ruptured biceps, Achilles tendonitis, plantar fasciitis, metatarsalgia, carpal tunnel and other entrapment neuropathies plus sinister causes bone tumour, stress fracture |
| MuP5. Acute hot swollen joint | MuC5. Spinal pain and radiculopathy |
| MuC6. Risks of rheumatological disease modifying drugs | |
| MuC7. Spinal infections | |
| MuC8. Torticollis | |
| MuC9. Limping child | |
| MuC10. Osteochondritis |
| Clinical Presentations | Condition / Issues |
| NeoC1. Delivery and resuscitation of the newborn | |
| NeoC2. Neonatal sepsis | |
| NeoC3. Cyanotic/ non- cyanotic congenital heart disease | |
| NeoC4. Jaundice | |
| NeoC5. Feeding patterns |
| Clinical Presentations | Condition / Issues |
| NepP1. Electrolyte disorders | NepC1. Acute kidney injury |
| NepP2. Oliguria | NepC2. Drugs and the kidney |
| NepC3. Electrolyte disorders | |
| NepC4. Fluid balance disorders | |
| NepC5. Renal replacement therapy |
| Clinical Presentations | Condition / Issues |
| NeuP1. Acute Confusion | NeuC1. Botulism |
| NeuP2. Headache | NeuC2. Cerebral venous sinus thrombosis |
| NeuP3. Seizures/status epilepticus | NeuC3. Febrile Convulsion |
| NeuP4. Speech disturbance | NeuC4. Functional illness |
| NeuP5. Hemiparesis/hemiplegia | NeuC5. Guillian-Barre |
| NeuP6. Gait abnormality | NeuC6. Meningitis and encephalitis |
| NeuP7. Visual disturbance | NeuC7. Multiple sclerosis |
| NeuP8. Weakness/paralysis | NeuC8. Myasthenia gravis |
| NeuP9. Dizziness and vertigo | NeuC9. Parkinson’s disease and other movement disorders |
| NeuC10. Peripheral neuropathy (acute) | |
| NeuC11. Subarachnoid haemorrhage | |
| NeuC12. Stroke & TIA | |
| NeuC13. Tetanus | |
| NeuC14. Tumours involving the brain and spinal cord | |
| NeuC15. VP Shunts | |
| NeuC16. Wernicke’s Encephalopathy |
| Clinical Presentations | Condition / Issues |
| ObP1. Pelvic pain | ObC1. Ante-partum haemorrhage |
| ObP2. Vaginal bleeding | ObC2. Bleeding in early pregnancy |
| ObP3. Pregnancy | ObC3. Exposure to infections during pregnancy eg chickenpox |
| ObP4. Genital injury/Assault | ObC4. Ectopic pregnancy |
| ObP5. Vaginal discharge | ObC5. Genital injury /Female Genital Mutilation |
| ObP6. Foreign bodies | ObC6. HELLP |
| ObP7. Patient in labour | ObC7. Heavy menstrual bleeding |
| ObC8. Hyperemesis Gravidaram | |
| ObC9. Maternal Collapse | |
| ObC10. Post-partum haemorrhage | |
| ObC11. Pre-eclampsia/eclampsia | |
| ObC12. Pelvic infection | |
| ObC13. Post menopausal bleeding | |
| ObC14. Prescribing in pregnancy | |
| ObC15. Rhesus D prophylaxis | |
| ObC16. Sepsis in and following pregnancy | |
| ObC17. Thrombosis during and following pregnancy | |
| ObC18. Trauma in pregnancy | |
| ObC19. OHSS |
| Clinical Presentations | Condition / Issues |
| OncP1. Acute presentations of undiagnosed cancer that may present to the ED (including weight loss, dysphagia, pain etc) | OncC1. Complications related to local tumour progression e.g. acute cord compression, upper airway obstruction, pericardial and pleural effusions, SVC compression syndrome, raised intracranial pressure |
| OncC2. Complications relating to cancer treatment including – neutropenic sepsis, anaemia and thrombocytopenia and immunotherapy | |
| OncC3. Biochemical complications of malignancy- hypercalcaemia, SIADH, adrenocortical insufficiency |
| Clinical Presentations | Condition / Issues |
| OptP1. Diplopia | OptC1. Acute glaucoma |
| OptP2. Eye trauma including foreign bodies | OptC2. Cranial nerve palsy |
| OptP3. Painful eye |
OptC3. Orbital & per-orbital preseptal or peri-orbital
cellulitis |
| OptP4. Red eye | OptC4. Opthalmia neonatorum |
| OptP5. Sudden visual loss | OptC5. Inflammatory eye disease |
| OptC6. Temporal arteritis |
| Clinical Presentations | Condition / Issues |
| PC1. Analgesics | |
| PC2. Non-pharmacological methods of pain management | |
| PC3. Pain assessment | |
| PC4. Sedation |
| Clinical Presentations | Condition / Issues |
| PalP1. Advanced malignancy and end stage chronic disease | PalC1. Advanced care planning |
| PalC2. Anticipatory medications | |
| PalC3. End stage organ failure | |
| PalC4. Pain management | |
| PalC5. Physical symptoms other than pain | |
| PalC6. Psychosocial concerns including spiritual care and care of the family | |
| PalC7. The dying patient |
| Clinical Presentations | Condition / Issues |
| PhP1. Medication side effects/interactions | PhC1. Overdose of prescription and non-prescription medications including legal and non-legal drugs |
| PhP2. Overdose | PhC2. Poisoning – carbon monoxide, cyanide, organo-phosphate |
| PhP3. Accidental Poisoning | PhC3. Toxidromes |
| PhC4. Use of antidotes | |
| PhC5. Batteries, household chemicals, poisonous plants |
| Clinical Presentations | Condition / Issues |
| RP1. Chest pain | RC1. Asthma |
| RP2. Breathlessness | RC2. Bronchiolitis |
| RP3. Haemoptysis | RC3. COPD |
| RP4. Cough | RC4. Foreign body inhalation |
| RC5. Pertussis | |
| RC6. Pleural effusion | |
| RC7. Pneumonia | |
| RC8. Pneumothorax | |
| RC9. Pulmonary Aspiration | |
| RC10. Pulmonary embolus | |
| RC11. Viral induced wheeze in children |
| Clinical Presentations | Condition / Issues |
| SeP1. Genital discharge | |
| SeP2. Genital lesions | SeC2. Sexual assault |
| SeP3. Emergency contraception | SeC3. Sexually transmitted infections |
| SeP4. Post-exposure prophylaxis |
| Clinical Presentations | Condition / Issues |
| SuP1. Abdominal pain | SuC1. Ano-rectal abscesses |
| SuP2. Abdominal swelling/mass | SuC2. Appendicitis |
| SuP3. Constipation | SuC3. Bilary colic |
| SuP4. Diarrhoea | SuC4. Bowel obstruction |
| SuP5. GI bleeding | SuC5. Breast abscess |
| SuP6. Anal/rectal pain | SuC6. Cholangitis |
| SuP7. Nausea/vomiting | SuC7. Cholecystitis |
| SuC8. Diverticular disease | |
| SuC9. Haemorrhoid disease | |
| SuC10. Hernias | |
| SuC11. Intussusception | |
| SuC12. Ischaemic Bowel | |
| SuC13. Lower gastrointestinal and rectal bleeding | |
| SuC14. Pancreatitis | |
| SuC15. Viscus perforation | |
| SuC16. Volvulus |
| Clinical Presentations | Condition / Issues |
| TP1. Head injury | TC1. Compartment syndrome |
| TP2. Spinal injury | TC2. Limb and joint injury including bony, musculo-tendinous and complications |
| TP3. Chest and lung injury | TC3. Electrical burns |
| TP4. Major vascular injury | TC4. Salter- Harris classification |
| TP5. Abdominal injury | TC5. Infection – paronychia, pulp space, flexor sheath nail bed, amputations etc. |
| TP6. Pelvic injury | TC6. Animal bites including human |
| TP7. Limb and joint injury | TC7. Injury to bladder, urethra, testes or penis |
| TP8. Burns | |
| TP9. Inhalational injury | |
| TP10. Wounds |
| Clinical Presentations | Condition / Issues |
| UP1. Dysuria | UC1. Epididymo-orchitis |
| UP2. Injury to bladder, urethra, testes or penis | UC2. Renal stone disease |
| UP3. Urinary retention | UC3. Phimosis/Paraphimosis |
| UP4. Testicular pain/swelling | UC4. Priapism |
| UP5. Loin pain | UC5. Testicular torsion |
| UP6. Haematuria | UC6. Prosatatis |
| UC7. UTI/Pyelonephritis |
| Clinical Presentations | Condition / Issues |
| VC1. Acute limb ischaemia | |
| VC2. Aortic aneurysmal disease | |
| VC3. DVT |
| Clinical Presentations | Condition / Issues |
| XC1. Major Incident Management | |
| XC2. PHEM | |
| XC3. Safeguarding in adults | |
| XC4. Domestic Abuse |
| Clinical Presentations | Condition / Issues |
| SaP1. Self-harm in children and adolescents | SaC1. Conditions presenting as a symptom of NAI or psychological distress, e.g. deliberate self harm, aggression or risk-taking behaviour, recurrent abdominal pain, headaches or faints, recurrent attendances in young children. |
| SaP2. Concerning presentation | SaC2. Roles of other systems in protecting children, e.g. Social Services, the Child Protection Plan, Police Child Protection and Domestic Violence Units, SureStart, Childline, Health Visitors, School Nurses |
| SaC3. Mental illness in childhood including depression, anxiety, OCD, bipolar and schizophrenia | |
| SaC4. Sexual abuse |
