Paeds Cases · clinical-assessment-and-reasoning
Home-ventilated child with night alarms — structured clinical encounter
Structured encounter testing CMC recognition, technology-dependent ABCDE, device-versus-disease reasoning, emergency care planning, polypharmacy reconciliation, caregiver partnership and safe disposition.
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Study tools
Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Aarav, 6 years, severe neurological impairment with tracheostomy, overnight home ventilation and gastrostomy, presents overnight with desaturation, ventilator alarms and maternal concern that he is not himself; no emergency care plan on file; regional hospital without on-site PICU.
Candidate instructions
You have 10 minutes at the bedside (simulated). Stabilise, reason aloud, and outline the next 24 hours and discharge-safety plan for this technology-dependent child with medical complexity. [1]
References8ShowHide
- [1]Kuo DZ, Houtrow AJ Recognition and Management of Medical Complexity. Pediatrics, 2016.PMID 27940731
- [2]Cohen E, Kuo DZ, Agrawal R, et al. Children with medical complexity: an emerging population for clinical and research initiatives. Pediatrics, 2011.PMID 21339266
- [3]Simon TD, Cawthon ML, Stanford S, et al. Pediatric medical complexity algorithm: a new method to stratify children by medical complexity. Pediatrics, 2014.PMID 24819580
- [13]Natesan A, Behar S Technology-Dependent Children. Emergency medicine clinics of North America, 2021.PMID 34215407
- [16]Starmer AJ, Spector ND, Srivastava R, et al. Changes in medical errors after implementation of a handoff program. The New England journal of medicine, 2014.PMID 25372088
- [17]Feinstein JA, Orth LE Making Polypharmacy Safer for Children with Medical Complexity. The Journal of pediatrics, 2023.PMID 36252865
- [19]Sobotka SA, Hall DE, Thurm C, et al. Home Health Care Utilization in Children With Medicaid. Pediatrics, 2022.PMID 35028664
- [20]Mauskar S, Ngo T, Haskell H, et al. In their own words: Safety and quality perspectives from families of hospitalized children with medical complexity. Journal of hospital medicine, 2023.PMID 37559415