Pediatric emergency medicine trisk 4638 4638
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reassuring. Thus, the practitioner should consider altering the usual criteria for
admission in this specific population. On the other hand, technology-dependent
children may show more subtle signs of illness and can deteriorate rapidly.
Having a technology-assisted child in the home creates a stressful situation for
family members and other caregivers. A visit to the ED for an acute problem
exacerbates this level of stress. These families may be more likely to question the
diagnostic tests and therapies offered during the evaluation of their child because
of their level of medical knowledge, as well as the constant illness-related anxiety
that intrudes upon their lives. The ED visit is more effective if the practitioner
recognizes the psychosocial issues associated with this population of patients.
TABLE 135.1
APPROACH TO THE TECHNOLOGY-DEPENDENT CHILD IN THE
EMERGENCY DEPARTMENT
Common pediatric illnesses can afflict chronically ill children
Presence of foreign bodies or hardware predisposes the patient to infection
Families are the experts in their children’s problems—rely on them for
important information
Consider altering the usual criteria for admission
Latex allergy is common among technology-dependent children
TRACHEOSTOMY CARE
Background
Advances in neonatology and pediatric critical care medicine have enabled
children to survive the complications of premature birth, congenital anomalies,
and severe life-threatening illnesses. As home care has become more widely
recognized as an alternative to prolonged and costly hospitalization, the number
of children managed at home with tracheostomies and mechanical ventilation has
increased dramatically. Consequently, the number of such children seeking care in
the ED has also increased. To approach these situations calmly and
systematically, the emergency physician should (1) appreciate the physiologic
differences in a patient with chronic respiratory insufficiency (CRI), (2) be
familiar with the equipment used in the care, and (3) understand the commonly
encountered complications and their management.
Pathophysiology
