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