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