Pediatric emergency medicine trisk 4636 4636
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CHAPTER 135 ■ TECHNOLOGY-ASSISTED
CHILDREN
ELLEN G. SZYDLOWSKI, KATHLEEN M. CRONAN, JOEL A. FEIN, JILL C. POSNER
INTRODUCTION
Nearly one-fourth of the visits to a pediatric emergency department (ED) are for
complaints associated with chronic illness. Many children with chronic illness
have indwelling medical devices, such as tracheostomy tubes, cerebrospinal fluid
(CSF) shunts, venous catheters, and gastrostomy tubes (G-tubes). Medical
technology has enabled these children, who in the past would have required
specialized inpatient or intensive care, to thrive at home. Emergency physicians
must be able to diagnose and treat the common problems associated with these
devices and recognize when it is appropriate to consult other specialists.
Devices most commonly found in the pediatric population include CSF shunts,
tracheostomy tubes, venous catheters, and percutaneous gastrointestinal (GI) and
urologic catheters. This chapter familiarizes the emergency clinician with the
equipment and with the clinical manifestations and management of the common
problems related to these devices.
APPROACH TO THE CARE OF THE TECHNOLOGYASSISTED CHILD
The evaluation of the technology-assisted child who visits the ED may, at times,
seem overwhelming. First, these children are often assisted by several pieces of
equipment. Second, the history can be difficult to obtain because of its inherent
complexity or a lack of consistent caretakers related to care at a long-term facility
or care by home healthcare nurses who work in shifts. Finally, a thorough
physical examination may be impeded by the technology. When a common illness
is superimposed on a chronic condition, the illness may appear more complex,
misleading the examiner. In addition, the ED visit may have been prompted by
multiple reasons.
When a technology-assisted child arrives in the ED, early contact with the
primary care provider may be helpful. The primary care provider may be able to
offer suggestions about the management of the child, potentially avoiding
unnecessary tests and admission. In many situations, a home health nurse may
accompany the patient to the ED and can be a valuable source of information.
