Case 1 - Linda

• You are a clinician working in an emergency department in Queensland.
• You are about see a 14 year old female called Linda. She comes in with her mother Riley. Linda presents with suicidal thoughts and feeling unsafe at home.
• Observations: RR: 15   O2: 100%   T: 36.5   HR: 80
• Linda has a history of depression on fluoxetine. She is known to a private psychologist whom she has seen twice. There were no other relevant or concerning findings on perinatal history, developmental history, medical history, medications, allergies, vaccinations, family history, and social history.
• You have done a thorough examination.

Questions to discuss about Linda’s case

• What are some healthcare considerations given your patient is an adolescent?
• What are some additional considerations when you come to perform your examination?
• What is the approach to confidentiality in adolescents? Do parents need to provide consent?
• What is the HEEADSSS psychosocial interview?
• What are the components of a mental state examination?
• When should you consider referring to a mental health clinician?

Normal range for vital signs by age

Case 2 - Martha

• You are a clinician working in an emergency department in Queensland.
• You are about see a 14 year old female called Martha. She was brought in by the Queensland Police Service (QPS) on an Emergency Examination Order (EEA).
• Martha had an altercation with her mother, Juliana, about her recent school attendance and behaviour. The argument escalated and Martha threatened to kill Juliana. Juliana called the police.
• Martha’s background history is not known at this stage.
• You have been asked by the team leader to see Martha now as her behaviour has escalated and is becoming more erratic. She is shouting obscenities at the staff and other families in the department and stating 'I’m leaving now'.

Questions to discuss about Martha’s case

• What are some causes of acute behavioural disturbance?
• What is your approach to management in acute behavioural disturbance, such as Martha?
  • Consider legal considerations, de-escalation strategies, medication options, sedation assessment tool (SAT), adverse effects of these medications, role of physical restraint, documentation.
• What strategies could you use in managing a child with autism spectrum disorder presenting with acute behavioural disturbance?
• What is an EEA?
  • Can it be extended?

Case 3 - Campbell

• You are a clinician working in an emergency department in Queensland.
• You are about see a 4 year old male called Campbell who was brought in by his father Lincoln. Lincoln separated from Campbell’s mother Patricia 4 months prior. Lincoln reports that he has concerns that Patricia’s new partner Christian has been physically hurting Campbell. The current custody arrangement is that Campbell spends time with each parent for one week at a time. He picked up Campbell this morning from his mother’s house and noticed a number of unusual bruises. Lincoln immediately presented to the emergency department.
• Observations: RR: 20   O2: 100%   T: 37.0   HR: 100
• There were no other relevant or concerning findings on perinatal history, developmental history, medical history, medications, allergies, vaccinations, family history, and social history.
• You take a detailed history and examination. You note a number of bruises including bruises on the torso, ears, and neck. One of the bruises appears consistent with a hand print. You speak to your senior and all of the bruises are documented carefully. The cardiovascular, respiratory, and abdominal, and neurological examinations are all normal.

Questions to discuss about Campbell’s case

• What history and examination is important to take?
  • Discuss how clinical photos are taken in your department.
• Are you concerned about Campbell’s bruising? What would you do next?
  • What location and patterns of bruising is concerning?
  • Consider QLD child safety reporting as well as your local processes.
• What fractures should raise suspicion for possible NAI?
• What burns should raise suspicion for possible NAI?
• What investigations may you consider for a suspicious fracture or bruising (in discussion with an expert in child protection)?

Normal range for vital signs by age