Pediatric emergency medicine trisk 4637 4637
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The American College of Emergency Physicians and the American Academy
of Pediatrics released a policy statement advocating the use of an Emergency
Information Form (EIF) for children with special healthcare needs. The EIF is a
medical summary that describes the patient’s medical conditions, medications,
and special healthcare needs. This can help improve the accuracy of the history
and improve the quality of care administered. Currently there is not a central
standardized electronic repository of EIFs; however, individual groups have
demonstrated feasibility on a smaller scale, suggesting that a central repository
may be possible with the appropriate advocacy and oversight.
When caring for the technology-assisted child, several important principles
emerge that should be used in the acute care setting ( Table 135.1 ).
First, common things are common; common pediatric illnesses may afflict
children with medical devices. This point is always important to remember when
evaluating a seemingly complicated child who presents with the routine signs and
symptoms characteristic of typical childhood diseases. For example, a child with
a CSF shunt may have vomiting caused by gastroenteritis.
Second, the presence of indwelling devices predisposes the patient to infection.
When a child presents with symptoms associated with a specific piece of
equipment, the clinician must be suspicious of infection of that equipment. For
example, if a child with a tracheostomy presents with fever, cough, and increasing
secretions, it is crucial to evaluate for the possibility of tracheitis. At the same
time, the equipment has a tendency to become colonized with commensal
organisms. Therefore, all bacterial growth does not indicate acute infection and
other sources of infection should be considered.
Above all, families should be relied on for important information because they
often have become knowledgeable of specific illnesses and equipment. Parents
are sensitive to subtle changes in their children. Families are experts and should
play an integral role in the evaluation, management, and ultimate disposition of
their child in the ED setting.
Children with chronic illnesses have a higher likelihood of being admitted to
the hospital, resulting in longer lengths of stay in the ED. The practitioner should
realize that the families of technology-assisted children often have sufficient
equipment and trained personnel available in the home setting to care for an
exacerbation of a chronic problem or an unrelated acute problem. For example,
family members whose child has a chronic respiratory illness often have
supplemental oxygen in the home and are facile with its use. Knowing that
families of technology-assisted children are compliant and likely to return to the
ED if their child’s degree of illness exceeds the capabilities of the home care is
