Emergency medicine clinics of North America
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Emergency providers are likely to encounter sickle cell disease-related emergencies. The pathophysiology of emergent complaints are usually related to either an acute anemia or a vasoocclusive crisis. ⋯ Vasoocclusive crises must be appropriately treated with aggressive pain management, gentle hydration, and other appropriate adjuncts. Early recognition and treatment are key in providing excellent emergency care to those with sickle cell disease.
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Emerg. Med. Clin. North Am. · Aug 2018
ReviewRapid Fire: Infectious Disease Emergencies in Patients with Cancer.
Patients with cancer can be immunocompromised because of their underlying malignancy as well as the medical therapies with which they are treated. Infections frequently present atypically and can be challenging to diagnose. The spectrum of infectious diseases encountered in patients receiving chemotherapy, hematopoietic stem cell transplant, and immunotherapy is broad depending on the depth of immunosuppression. Early recognition of infectious processes followed by appropriate diagnostic testing, imaging, and empiric antibiotic therapy in the emergency department are critical to providing optimal care and improving survival in this complex patient population.
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Hypercalcemia is commonly encountered in the clinical setting and requires identification by the clinician to avoid disastrous patient outcomes. The 2 most common causes are malignancy and hyperparathyroidism. The underlying cause for hypercalcemia may be readily known at presentation or may require further investigation. ⋯ In the emergency setting, intravenous hydration with isotonic fluids is the treatment mainstay. Other commonly used medications to further decrease calcium include bisphosphates, calcitonin, steroids, and (rarely) furosemide. In life-threatening circumstances, dialysis can be implemented.
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Emerg. Med. Clin. North Am. · Aug 2018
Review Case ReportsRapid Fire: Pericardial Effusion and Tamponade.
One of the most common causes of pericardial effusion in the Western world is malignancy. Emergency physicians must maintain vigilance in suspecting pericardial effusion and tamponade in patients with known or suspected malignancy who present with tachycardia, dyspnea, and hypotension. Diagnosis can be expedited by key physical examination, electrocardiogram, and sonographic findings. Unstable or crashing patients with tamponade must undergo emergent pericardiocentesis for removal of fluid and pressure to restore cardiac output.
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Emerg. Med. Clin. North Am. · Aug 2018
Review Case ReportsRapid Fire: Acute Blast Crisis/Hyperviscosity Syndrome.
Emergency providers are likely to encounter patients with acute and chronic leukemias. In some cases, the first presentation to the emergency department may be for symptoms related to blast crisis and leukostasis. Making a timely diagnosis and consulting a hematologist can be life saving. ⋯ Presentations may include fatigue (anemia), bleeding (thrombocytopenia), shortness of breath, and/or neurologic symptoms owing to hyperleukocytosis and subsequent leukostasis. Treatment of symptomatic cases involves induction chemotherapy and/or leukapheresis. Asymptomatic hyperleukocytosis can be treated with hydroxyurea.