Care of children with medical complexity and technology dependence — formative SAQs

SAQ 1 — Night ED: technology-dependent deterioration (20 marks, ~15 minutes)

A 6-year-old with severe neurological impairment, tracheostomy, overnight home ventilation and gastrostomy presents at 02:00 with desaturation, thick secretions and parental concern that “he is not himself.” There is no printed emergency care plan in the notes. Usual baseline SpO2 is 93–95% on his home settings. [1]

Questions

1. Define children with medical complexity using Cohen’s domains and state how technology dependence alters acute risk. (4 marks) [1]
2. Outline your first 5 minutes of bedside assessment and management, including device checks. (6 marks) [13]
3. List essential contents of an emergency care plan you will create before discharge. (5 marks) [1]
4. Name two system failures that may have contributed to this presentation and one handoff improvement. (5 marks) [1]

Model answer

1. Definition and technology (4) [1] CMC: chronic conditions (often multi-system), functional limitations, high health-care use, family-identified service needs. [2]
Technology dependence: device supports a vital function; interruption can cause rapid harm — acute differential always includes device failure as well as disease. [13]

2. First 5 minutes (6) [1] Call for help; ABCDE with technology. Airway/tracheostomy patency, suction, oxygen, circuit/ventilator check, spare tube readiness. Compare SpO2 and interaction to personal baseline; treat obstruction/disconnect immediately; do not wait for labs. Use parent expertise on usual settings while you lead. [1]

3. Emergency care plan (5) [1] Diagnoses that matter in crisis; baseline vitals/interaction; devices and settings; allergies; preferred hospital/contacts; resuscitation/goals discussions if relevant; who to call 24/7; spare equipment list. [1]

4. System failures and handoff (5) [1] Missing emergency plan; possible supply/training/home-nursing gaps; fragmented notes. Structured handoff (I-PASS principles) reduces medical errors across teams — document baseline, devices, changes and outstanding actions. [1]