Consultation skills

Introduction
Mr Smith?
Hello. I am Dr Roy. Pleasure to meet you.
I am the doctor on duty today
Before we begin, can I check your DOB? And your address
please.
PC

So, what can I do for you? (Let them speak for 1min). Oh I am
really sorry to hear that
So, its the headaches and tiredness. Anything else?
Tell me more about your headaches

HPI

DODFCP AAABT
BBWFS
PFAM
SAP

Obs

CRT
Temp, PR, RR, O2 sats, BP

General Examination
Peripheral Pulses etc.
Neck thyroid, LA, JVP
Mouth moist mucous membranes
Bloods
ECG
Drugs
XR
What do you know about XXX (diabetes)?
Pediatric vital signs
Neonate (upto 1m), Infant (upto 12m)
HR <160
Toddler (upto 3yr)
HR <130
Preschooler (upto 5yr)
HR <110
Schoolage (upto 12yr)
Like Adult
Adolescent / Teenage (>13yr)
Like Adult
Viral-induced wheeze / Bronchiolitis
Pre-school children
Viral URTI

D/D
o Asthma
o Inhaled foreign body
Choking
Related to eating or playing
Unexplained recurrent pneumonia
O/E Asymmetrical chest expansion, tracheal
deviation
Referral to Pediatrics
o Pneumonia
Abrupt temp
Focal consolidation
Referral to Pediatrics
T/t
o No response to trial therapy

Asthma
H/O
o Smokers in the house?
o Pets in the house?
o Precipitating factors?
Viral infections
Exercises
Pets, pollen, house dust
Teddy bear
Smoke, chemical irritants
Cold air
o Inhaler technique?
o Peak flow diary? in >6years
o Compliance?
o Symptoms during day? Night? Activities?
Child H/O
o CBIGLAD
Sick child assessment
o A eg speaking only few words
o B eg breathless
o C eg well perfused
o D eg alert
Interval symptoms
Atopy eczema / rhinitis
FH atopy
o Both parents 2/3 chance
o 1 parent 1/3 chance
Minimum age to label = 2
Commonly school-age children
T/t

o Upto 10 puffs via MDI + spacer + mask

o Monitor for 30min to ensure wheeze subsides
o FU in 2 days
Sicker child T/t
o Upto 10 puffs via MDI + spacer + mask Or
o Nebulisation 2.5mg Salbutamol / 5mg terbutaline +
0.25mg ipratropium not exceeding 4 hourly
o Consider soluble 20mg-40mg Prednisolone can
continue upto 3-5 days or IV hydrocortisone 50-100mg
o 5mg Salbutamol with nebulizer driven by O2
o 40mg Prednisolone
4 week trial of t/t with inhaled corticosteroid (clenil) via spacer
2 puffs BD
Salbutamol 2 puffs 4 hourly and then when symptomatic
Symptom diary
Peak flow diary : age 6 and above
Rv every 3 months stepwise reduction in steroid 50% if
control is achieved

Symptoms
Dyspnoea
Coughing
Wheezing
Relievers (Blue)
Preventers (Brown or Orange) Morning & Evening
Medicine delivery devices (dependent on age)
Children <3yr spacer with mask
3-5yr smaller spacer with mask
Schoolage
o Accuhaler
Thumb put in little dip, pulled down to bottom,
clicks
Child blow out, Deep breathe in, and breath held
for 10seconds
Close the device
Dose counter from 60
o Dry powder inhaler
Base twisted one way and then back the other,
clicks
Child blow out, Deep breathe in, and breath held
for 10seconds
Older children (8-9 yr)
o Autohaler
Device shaken, Lever lifted ready to use

Child blow out, Deep breathe in, and breath held

for 10seconds
o Autohaler2
Shake the inhaler, open the lid
Child blow out, Deep breathe in, and breath held
for 10seconds

Age 5 12 years

Age < 5 years